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AmCare Exam 2 > Non-Insulin Therapies Part 1 > Flashcards

Non-Insulin Therapies Part 1 Flashcards

1
Q

A1c Less than 7%

A

At goal

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2
Q

A1c less than 7.5%

A

Mildly elevated

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3
Q

A1c between 7.6-9.0%

A

Moderately elevated

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4
Q

A1c greater than 9.0%

A

Significantly elevated

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5
Q

Metformin MOA

A

Reduces hepatic gluconeogenesis

Insulin sensitizer

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6
Q

Metformin Benefits

A 
	Good A1c reduction
	Inexpensive
	Well tolerated
	Some weight loss
	Some lipid
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7
Q

Metformin Risk/Issues

A

 GI: cramping, diarrhea, N/V
 Severe but rare: lactic acidosis
 B12 deficiency

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8
Q

Metformin CI

A

 Renal function: eGFR

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9
Q

Sulfonylureas MOA

A

Stimulation of insulin secretion through pancreatic beta-cells

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10
Q

Sulfonylureas Drugs

A

 Glyburide
 Glipizide
 Glimepiride

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11
Q

Sulfonylureas Benefits

A

 Both fasting and post-prandial glucose
 Inexpensive
 Good A1c decrease

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12
Q

Sulfonylureas Risks/Issues

A

 AE: Weight gain, Hypoglycemia, Rash, GI complaints, SIADH (rare)
 Beta-cell function loss
 Differing renal doses

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13
Q

Sulfonylureas Good Candidate

A

 A1c moderately elevated
 Indigent patient (cheap)
 Short duration or DM diagnosis

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14
Q

Sulfonylureas Bad Candidate

A

 H/o hypoglycemia
 Increased weight not wanted
 Long duration of DM

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15
Q

Meglitinides MOA

A

Glucose-dependent activty via pancreatic beta cells

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16
Q

Meglitinides Drugs

A

 Repaglinide

 Nateglinide

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17
Q

Meglitinides Benefits

A

 Post-prandial BG
 Activity is glucose-dependent (less hypoglycemia)
 Can use if renal impairment exist

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18
Q

Meglitinides Risks/Issues

A

 Weight gain
 Hypoglycemia
 Cost!!!
 Mealtime dosing (TID)

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19
Q

Meglitinides Good Candidate

A

 Significant post-prandial BG issues

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20
Q

Meglitinides Bad Candidate

A 
	Already taking a SU 
	H/O hypoglycemia
	Increased weight not wanted
	Compliance issues (TID)
	Cost!!
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21
Q

Thiazolidinediones MOA

A

Improve insulin sensitivity in many places especially the muscles

22
Q

Thiazolidinediones Drugs

A

Pioglitazones

Rosiglitazone

23
Q

Thiazolidinediones Benefits

A 
	Good A1c reduction
	Fasting and Post-prandial 
	Improved insulin sensitivity
	Cheap
	Beta cell function
24
Q

Thiazolidinediones Risk/Issues

A

 Weight gain
 Edema
 Exacerbate CHF
 Proximal bone fracture risk

25
Q

Thiazolidinediones Good Candidate

A

 Moderate elevated A1c
 Indigent (cheap)
 Significant insulin resistance

26
Q

***Thiazolidinediones Bad Candidate

A 
	HF
	H/O osteopenia/osteoporosis
	Weight gain
	H/O bladder cancer
	Existing edema (esp if on insulin too)
27
Q

DPP-4 Inhibitors MOA

A

Increase pancreatic insulin secretion in the GI tract

28
Q

DPP-4 Inhibitors Drugs

A

 Sitagliptin
 Aloglipitin
 Linagliptin
 Saxagliptin

29
Q

DPP-4 Inhibitors Benefits

A

 Post-prandial
 Once daily
 Well tolerated
 Weight neutral

30
Q

DPP-4 Inhibitors Risks/Issues

A 
	Modest reduction in A1c
	Expensive
	No titration
	Pancreatitis
	Renal dose adjustment
31
Q

DPP-4 Inhibitors Good Candidate

A

 Mildly elevated A1c
 Compliance issues
 Weight gain is an issue

32
Q

DPP-4 Inhibitors Bad Candidate

A

 Indigent

 Moderately elevated A1c

33
Q

SGLT-2 Inhibitors MOA

A

Increase urinary glucose excretion by blocking reabsorption via the kidneys

34
Q

SGLT-2 Inhibitors Drugs

A

 Dapagliflozin
 Canagliflozin
 Empagliflozin

35
Q

SGLT-2 Inhibitors Benefits

A 
	Oral, once daily
	Moderate A1c reduction
	Fasting and Post-prandial
	Weight REDUCTION
	Minimal hypoglycemia
	Mild effects on BP
36
Q

SGLT-2 Inhibitors Risk/Issues

A

 Renal dose adjustments
 Expensive
 Urinary and genital infections
 Diuresis/polyuria

37
Q

SGLT-2 Inhibitors Good Candidate

A

 Moderately elevated A1c
 Compliance issue
 Weight loss wanted/needed

38
Q

SGLT-2 Inhibitors Bad Candidate

A

 Indigent (expensive)
 H/O frequent genital yeast infections
 Difficulty urinating
 Renal dysfunction

39
Q

SGLT-2 Inhibitors CI

A

 Renal impairment
• Increase hyperkalemia risk
 H/O Genital mycotic infections
 H/O Bladder CA

40
Q

GLP-1 Agonists MOA

A

glucose-dependent insulin secretion, reduction in glucagon secretion, reduced gastric emptying

41
Q

GLP-1 Agonists Drugs

A

 Exenatide
 Liraglutide
 Dulaglutide
 Albigultide

42
Q

GLP-1 Agonists Benefits

A 
	Good A1c reduction
	Low hypoglycemia
	Some effect on lipid/BP
	Weight reduction
	Preserves beta-cell function
	Once weekly agents: fasting and post-prandial
	QD/BID agents: post-prandial
43
Q

GLP-1 Agonists Risk/Issues

A

 Injectable
 Expensive
 Lots of N/V
 Pancreatic risk
 Renal impairment differs between agents
 Hypoglycemia risk if added to SU or insulin
 Thyroid carcinoma (only in animals)

44
Q

GLP-1 Agonists Good Candidate

A

 Moderately elevated A1c
 Weight loss
 Compliance issue
 Post-prandial BG issue

45
Q

GLP-1 Agonists Bad Candidate

A 
	H/O pancreatitis
	Can’t handle injections
	Poor renal function
	H/O gastroparesis
	Indigent (expensive)
46
Q

GLP-1 Agonists Once Weekly Options

A

Exenatide, dulaglutide, albigulutide

Can be given any time of the day

47
Q

Exenatide BID Dosing

A

60 minutes before meals
Avoid if CrCl less than 30
Can NOT be mixed

48
Q

Lireglutide Dosing

A

Without regards to meals
No CrCl cut off
Can NOT be mixed

49
Q

CI to Weekly GLP-1 Agonists

A

Renal impairment

50
Q

GLP-1 Agonists Missed Dose

A

 Next dose at least 3 days away  give right away

 Next dose within 1-2 days  skip and resume normal schedule

51
Q

GLP-1 Agonists Changing Day of Week

A

 Last dose within 3 days  hold

 Last dose was at least 3 days ago  change to desired day

AmCare Exam 2 (5 decks)

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