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Diabetes Tx > Oral Hypoglycemics & DM tx > Flashcards

Oral Hypoglycemics & DM tx Flashcards

1
Q

DM meds that cause hypoglycemia

A
  1. Insulin >
  2. Sulfonylureas < (glipizide)
  3. GLP-1 RA (when used in combo)
  4. DPP-4 (when used in combo)
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2
Q

Oral Hypoglycemics that cause weight gain

A
  1. Sulfonylureas
  2. Thiazolidinedones
  3. Insulin
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3
Q

Oral Hypoglycemics that cause weight loss?

A
  1. SGTL2 inhibitors
  2. GLP-1 agonists
  3. Metformin (or neutral) - biguanides
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4
Q

Oral Hypoglycemics that are weight neutral?

A
  1. DDP-4 inhibitors
  2. Metformin (or loss) - biguanides
  3. Alpha-glucosidase inhibitors
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5
Q

Oral Hypoglycemics with GI SFx?

A
  1. Metformin - biguanides
  2. GLP-1 receptor agonists (nausea/vomiting from decreased gastric emptying)
  3. Alpha-glucosidase inhibitors - (acrabose and miglitol)
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6
Q

Oral Hypoglycemics with SFx of lactic acidosis?

A
  1. Metformin
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7
Q

Oral Hypoglycemics with SFx of edema?

A

Thiazolidinediones

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8
Q

Oral Hypoglycemics with risk of heart failure?

A

Thiazolidinediones

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9
Q

Oral Hypoglycemics with risk of fractures?

A
  1. Thiazolidinediones

2. SGLT2 inhibitors

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10
Q

Oral Hypoglycemics with GU SFx?

A

SGLT2 inhibitors

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11
Q

Oral Hypoglycemics with SFx of dehydration?

A

SGLT2 inhibitors

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12
Q

Oral Hypoglycemics with potential risk for increasing risk of MI?

A

Thiazolidinediones

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13
Q

Name a Biguanide

A

metformin

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14
Q

What medication affects B12?

A

Metformin - check B12 regularly

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15
Q

What class is Metformin?

A

Part of Biguanide class

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16
Q

Mechanism of action of Metformin

A
  1. Decreases gluconeogenesis (glucose production in liver) ** does this most
  2. Increases insulin sensitivity
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17
Q

What oral medication can improve cardiovascular outcomes in overweight and newly diagnosed type 2 DM?

A

Metformin

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18
Q

What oral medication can decrease mortality in DM?

A

Metformin

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19
Q

What 2 medications can be used in children with DM?

A
  1. Metformin

2. Insulin

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20
Q

What class is Metformin in Pregancy? What can it help decrease risk of?

A
  1. Class B in Pregnancy

2. Can decrease risk of pre-eclampsia

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21
Q

What medication is also used in PCOS?

A

Metformin

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22
Q

In which 3 patient classes should you use Metformin with caution?

A
  1. Elderly > 65
  2. Renal disease (don’t use in cr > 1.5 in men or > 1.4 in women)
  3. Hepatic disease
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23
Q

When is it not safe to use Metformin in patients with renal disease?

A
  1. Men w/ Cr > 1.5
  2. Women w/ Cr > 1.4
  3. GFR < 30
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24
Q

Mechanism of Action of Thiazolidinediones?

A
  1. Increases insulin sensitivity ** does this most

2. Decreases gluconeogenesis in liver

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25
Q

What class is Pioglitazone? What is brand name?

A
  1. Thiazolindinediones

2. Actos

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26
Q

Name 2 Thiazolidinediones? plus brand names? Which is more frequently used?

A
  1. Pioglitazone = Actos

2. !Rosiglitazone = Avandia = used less frequently due to sfxs

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27
Q

What class is metformin?

A

Biguanide

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28
Q

Two functions of Metformin

A
  1. Decreases gluconeogenesis (MAIN)

2. insulin sensitizer

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29
Q

What 2 medications can be used in children and adolescents?

A
  1. Insulin

2. Metformin

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30
Q

What pregnancy class is metformin?

A

B - B>R

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31
Q

Metformin is contraindicated in what level of renal dysfunction?

A
  1. Cr. > 1.5 (men) or 1.4 (women)

2. GFR <30

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32
Q

What vitamin deficiency can metformin cause?

A

B12

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33
Q

Name 2 Thiazolidinediones

A
  1. Pioglitazone (Actos) –> used more frequently

2. Rosiglitazone (Avandia) –> NOT usually used

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34
Q

Two functions of Thiazolidinediones

A
  1. Insulin sensitizer (MAIN)

2. decreases gluconeogenesis

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35
Q

What oral DM medications can cause fluid overload?

A

Thiazolidinediones ( Pioglitazone - Actos)

36
Q

What oral DM med has a black box warning for use in CHF class III and IV? Why?

A

Thiazolidinediones ( Pioglitazone - Actos) –> causes fluid overload

37
Q

Which oral hypoglycemics require freqent liver function monitoring and should not be used in patients w/ significant liver disease?

A
  1. Thiazolinediones (pioglitazone=actos)

2. alpha-glucoseidase inhibitors (acarbose and miglitol)

38
Q

What oral DM med can increase ovulation?

A

Thiazolidinediones ( Pioglitazone - Actos)

39
Q

What pregnancy class are Thiazolidinediones?

A

C - caused growth retardation in animal studies

40
Q

What oral DM medication has an increased risk of pancreatic, prostate, & bladder cancer?

A

Thiazolidinediones ( Pioglitazone - Actos)

41
Q

Name 3 Sulfonylureas

A
  1. Glipizide (glucotrol)
  2. Glyburide
  3. Glimepiride (Amaryl)
42
Q

Which class is okay to use in mild renal dysfunction? ONly 2/3 can be used, which one can’t?

A
  • sulfonylureas (glipizide & glimepiride)

- CANT use glyburide

43
Q

MoA of Sulfonylureas

A

-stimulate insulin production in pancrease

44
Q

2 common sfx of Sulfonylureas?

A
  1. hypoglycemia - be careful!! (rapid acting)

2. weight gain

45
Q

Name 2 Meglitinides

A
  1. Repaglinide (Prandin)

2. Nateglinidie (Starlix)

46
Q

MoA of Meglitinides

A
  • insulin secretagogues
  • rapid acting
  • only work when taken with food
47
Q

Sfx of Meglitinides

A

-hypoglycemia - instruct pt to take only w/ meals

48
Q

What 2 classes are okay to use in patients who are elderly, have renal failure, and/or cardiopulmonary diseases?

A
  1. Sulfonylureas (except glyburide)

2. Meglitinides

49
Q

name 2 Alpha-glucosidase Inhibitors

A
  1. Acarbose (Precose)

2. Militol (Glyset)

50
Q

MoA of Alpha-glucosidase inhibitors

A
  • delay carbohydrate absorption in the gut
  • decreases peak glucose levels
  • WONT cause hypoglycemia
51
Q

What oral hypoglycemics do not cause hypoglycemia?

A
  1. Metformin

2. Alpha-glucosidase Inhibitors

52
Q

Which oral hypoglycemics are good for patients w/ erratic eating schedules

A
  1. Meglitinides (repaglinide or nateglinide)

2. Alpha-glucose inhibitors (acarbose and miglitol)

53
Q

What DM medscannot be use with renal dysfunction? (~Cr >1.5)?

A
  1. metformin
  2. alpha-glucoseidase inhibitors (acarbose and miglitol)
  3. GLP-1 Agonists
54
Q

Which oral hypoglycemic medication do you have to use glucose specifically to treat hypoglycemia?

A
  • alpha-glucoseidase inhibitors (acarbose and miglitol)

- drinking juice, etc wont work!

55
Q

What pregnancy category are alpha-glucose inhibitors?

A

Class B

56
Q

What class of oral hypoglycemic medications can reduce risk of cardiovasacular events?

A

alpha-glucoseidase inhibitors (acarbose and miglitol)

57
Q

Name 4 GLP-1 Receptor Agonists

A
  1. Exenatide (Byetta)
  2. Liraglutide (Victoza)
  3. Albiglutide (Tanzeum)
  4. Dulaglutide (Trulicity)
58
Q

MoA of GLP-1 Receptor Antagonisits

A
  1. secreted w insulin to increase effect
  2. suppresses postprandial glucagon secretion
  3. slows gastric emptying
  4. increase satiety
59
Q

Sfx of GLP-1 Agonists

A
  1. GI sfx due to decreased gastric emptying
  2. weight loss
  3. pancreatitis
  4. Hypoglycemia (if used in combo)
  5. Thyroid C-cell tumor risk
60
Q

What DM medications can cause pancreatitis?

A
  • GLP-1 RAs

- DPP-4 inhibitors

61
Q

What DM medication can cause thyroid C-cell tumors?

A

-GLP-1 RAs

62
Q

What pregnancy category is GLP-1 RAs

A

Category C

63
Q

Name 4 DPP-4 Inhibitors

A
  1. Sitaliptin (Januvia)
  2. Sacagliptin (Onglyza)
  3. Alogliptin (Nesina)
  4. Linagliptin (Tradjenta)
64
Q

MoA of DPP-4 Inhibitors

A

-blocks DPP-4 which is an enzyme that breaks down GLP-1, so this means by inhibiting this enzyme there is more GLP-1 around

65
Q

What DM medications are injected subcutaneously?

A
  1. insulin

2. GLP-1 RAs (ex. Exenatide, liraglutide, albiglutide, dulagluttide)

66
Q

What GLP-1 Inhibitor is okay to use in elderly and/or renal disease?

A

Liraglutide (victoza)

** NOT renally excreted

67
Q

Which work better DPP-4 inhibitors or GLP-1 Agonists?

A

GLP-1 > DPP-4

68
Q

What DPP-4 Inhibitor is okay to use in elderly and/or renal disease?

A

Linagliptin (Tradjenta)

** NOT renally excreted

69
Q

Sfx of DPP-4 Inhibitors?

A
  1. URI sx
  2. Sore throat
  3. Diarrhea
  4. pancreatitis
70
Q

Name 3 SGLT2 Inhibitors

A
  1. Canagliflozin (Invokana)
  2. Dapagliflozin (Farxiga)
  3. Empagliflozin (Jardiance)
71
Q

MoA of SGLT2 Inhibitors

A

-block reabsorption of glucose in kidney –> increased urinary excretion of glucose

72
Q

Which oral DM medications can predispose a pt to DKA?

A

-SGLT2 inhibitors (Canagliflozin - Invokana, etc)

73
Q

Effects of SGLT2’s on BP and Cholesterol?

A
  • decrease BP

- increase HDL

74
Q

Average Dose of insulin?

A

-0.6-0.8 u/kg/day

75
Q

Effects of insulin on progression of renal disease?

A
  • no difference in Type 2 to eventual progression to dialysis
  • decrease progression in Type I
76
Q

Name 4 Long Acting Insulins

A
  1. NPH –> has to be used BID
  2. Glargine (Lantus)
  3. Detemir (Levemir) - less weight gain?
  4. Deglidec (Tresbia)
77
Q

Name 3 Short acting Insulins

A
  1. Lispro (Humalog)
  2. Aspart (Novolog)
  3. Glulisine (Apidra)
    * * All act the same, can be used interchangeably!
78
Q

What is the usual time of onset, peak, and duration of the short acting insulin?

A
  • onset = 15 min
  • peak = 1-3hrs
  • duration = 2-5hrs
  • *Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
79
Q

Name of inhaled insulin?

A

Afrezza

80
Q

Inhaled Insulin are contraindicated in which patients?

A
  1. Chronic Lung Disease

2. Smokers

81
Q

What 2 DM medications can be used in Children with DM?

A
  1. Metformin

2. Insulin

82
Q

Things to screen kids for with Type 1 DM and when?

A
  1. microalbumin - yearly starting at age 10 or 5 yrs after onset
  2. Retinopathy at age 15 or 5 yrs after onset
  3. celiacs disease @ dx
  4. hypothyroidism @ dx
  5. HTN @dx
83
Q

In which pediatric diabetic patients should lisinopril be used?

A
  1. HTN

2. Microalbuminuria

84
Q

Lipid screening in kids w/ DM

A

-ONLY screen in patients who have a family Hx of HLD, NOT screening everyone just bc they have DM

85
Q

What age can you start using a statin in a kid with HLD?

A

> 10 yrs

Diabetes Tx (1 decks)

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