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Pharm II- Exam 2 > Oral DM Meds > Flashcards

Oral DM Meds Flashcards

1
Q

when would you check a premeal blood sugar?

A

To help calculate bolus dose of insulin or agents given to improve insulin secretion

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2
Q

Purpose of fasting blood sugar?

A

Measures the effectiveness of basal insulin or agents which decrease hepatic gluconeogenesis overnight (“leaky liver”)

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3
Q

when do we measure Postmeal blood sugar—2 hour post prandial?

A

Measures the effectiveness of bolus insulin or agents given to increase levels of insulin (pancreas “poop out”)

Helps determine needed food intake changes

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4
Q

what is the most important measurement for a type 2 DM?

A

Post-meal blood sugar—2 hour post prandial

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5
Q

What BG lab values are classified as hypoglycemic?

A

<70mg/dL = alert level
<54 mg/dL = clinically signf.
no specific value = severe hypoglycemic

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6
Q

what is the diagnostic lab criteria for DM?

A

FPG >126 or
2hr-PG >200mg during OGTT or
A1c >6.5% or
classic sxs w/random PG >200mg/dL

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7
Q

What A1c range is concerned pre-diabetic?

A

5.7-6.4

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8
Q

microvascular comps assoc. with DM?

A

retinopathy

neuropathy

nephropathy

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9
Q

macrovascular comps assoc. with DM?

A

coronary heart disease

HTN

PVD

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10
Q

What are the 5 things you should do to decrease complications and reduce mortality in diabetic patients?

A

smoking cessation

BP control

Metformin therapy

Lipid reduction

glycemic control

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11
Q

What should you tell your pt to do if hypoglycemia occurs?

A

consume 15g of simple carbohydrate and then retest BG 15 minutes later

if BS still <70, repeat rule of 15 until norm.

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12
Q

What can cause blood glucose to rise quickly?

A

infections and corticosteroids

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13
Q

Which DM meds decrease glucose absorption?

A

alpha glucosidase inhibitors

amylin mimetics

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14
Q

Which DM meds decrease glucose production?

A

Biguanides (Metformin)

insulin

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15
Q

Which DM meds increase insulin secretion?

A

Sulfonylureas

Meglinitides

GLP-1 activators

DPP-4 inhibitors

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16
Q

Which DM meds increase glucose excretion?

A

SGLT2 inhibitors

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17
Q

Which DM meds increase glucose utilization?

A

thiazolidinediones

Insulin

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18
Q

What major concerns should you consider when selecting a DM med?

A

hypoglycemia

weight change

CV effects

renal adjustments

FDA warnings

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19
Q

Metformin is contraindicated in pts….

A

with GFR <30

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20
Q

ADEs of Metformin?

A

GI upset

potential B12 deficiency

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21
Q

CV effect of SGLT2 inhibitors?

A

Benefit!

Canagliflozin

Empagliflozin

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22
Q

Black box warning for SGLT2 inhibitors? other ADEs?

A

Amputation (canagliflozin)

UTIs, risk of bone fx, vulvovaginal candidiasis

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23
Q

Black box warning for GLP-1? other ADEs?

A

risk of thyroid c-cell tumors

GI upset, injection site rxn, acute pancreatitis

24
Q

ADEs of DPP-4s?

A

potential risk of acute pancreatitis

joint pain

25
Q

Which DM meds may cause weight gain?

A

TZDs

Sulfonylureas

Insulin

26
Q

Which DM med is assoc. with an increased risk of HF?

A

Thiazolidinediones

also increased risk of bone fx and bladder CA

27
Q

Which DM meds are administered SQ?

A

Insulin

GLP-1

28
Q

MOA of Metformin?

A

Activates AMP kinase

enhances insulin sensitivity of hepatic and peripheral tissues

29
Q

MOA of sulfonylureas?

A

Close K-ATPase channels on B cell plasma membranes

30
Q

MOA of Meglinitides?

A

Close K-ATPase channels on B cell plasma membranes

31
Q

MOA of TZDs?

A

Activates the nuclear transcription factor PPAR-gamma >

improves insulin sensitivity

32
Q

MOA of alpha-glucosidase inhibitors?

A

inhibits intestinal alpha-glucosidase

Breakdown of sucrose and complex carbohydrates in the small intestine, prolonging carbohydrate absorption

33
Q

Name 2 sulfonylureas

A

Glyburide

Glipizide

34
Q

Name 2 Meglitinides

A

Repaglinide

Nateglinide

35
Q

Name 2 TZDs

A

Pioglitazone

Rosigitazone

36
Q

Name 2 alpha-glucosidase inhibitors

A

Acarbose

Miglitol

37
Q

Name 2 DPP-4 inhibitors

A

Sitagliptin

Saxagliptin

38
Q

Name 2 SGLT2 inhibitors

A

Canagliflozin

Dapagliflozin

39
Q

Name 2 GLP-1 receptor agonists

A

Exenatide

Liraglutide

Dulaglutide

40
Q

Name a bile acid sequestrant. MOA?

A

Colesevelam

binds bile acids in intestinal tract, increasing hepatic bile acid production

41
Q

Name a dopamine -2 agonist, effect?

A

Bromocriptine

increases insulin sensitivity

42
Q

Why are Suulfonylureas and Metaglinides freq. prescribed, even though they are considered first line agents?

A

bc they are often what a pt can afford

43
Q

Urticaria/facial edema and rare cases of SJS may be seen with what DM medication?

A

DPP-4 inhibits “Gliptins”

44
Q

Use of a SGLT2 inhibitor and a diuretic may cause….

A

orthostatic hypotension and electrolyte abnormalities

45
Q

ADEs of alpha-glucosidase inhibitors?

A

Flatulence, bloating, abdominal discomfort, and diarrhea

46
Q

Effect of bile acid sequestrants on LDL?

A

may decrease by 12-16%

47
Q

Admin of Dopamine agonists?

A

take daily dose within 2 hours of waking from sleep

-skip is morning window is missed!

48
Q

Basal insulins are ____, while Mealtime insulins are____.

A

intermediate-acting, longing acting analogs

rapid acting, short

49
Q

Insulin is an ___ hormone

A

anabolic

50
Q

AACE goal BP for DM pts?

A

130/80 mmHg

51
Q

Starting dose for basal insulin?

A

10 units

or 0.1-.02U/kg/day

52
Q

How frequently should you adjust basal insulin dose?

A

every 2-3 days until glycemic goal is met

53
Q

What can you add if pt is not well controlled on basal insulin?

A

prandial insulin

-begin before largest meal, if not at goal progress to injections before 2 or 3 meals

54
Q

What DM meds can cause weight loss?

A

Metformin

GLP-!

SGLT2

PRAML

55
Q

Who is effected by the dawn phenomenon?

A

Everyone!

whether they have DM or not

56
Q

What is the dawn phenomenon?

A

surge of hormones that the body produces daily in the early morning hours before waking

-ppl with DM don’t have normal insulin responses to adjust for this and may see fasting BS go up

57
Q

What is the somogyi effect? Tx?

A

Increased morning blood sugar levels after nighttime hypoglycemia

-tx lower PM insulin dose, night time snack

Pharm II- Exam 2 (4 decks)

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