Oral Medications

Question 0

Caution with metformin

Answer 0

Not for those that drink 2 Or more drinks per day, concurrent heart failure, dehydration, acidosis, NPO, or iodine radio contrast

Question 1

Metformin is contraindicated at what values due to decreased renal function?

Answer 1

GFR less than 30 or serum creatinine of 1.5 for men or 1.4 for women

Question 2

Side effects of sulfonylureas

Answer 2

Hypoglycemia, weight gain, sun sensitivity, headache, or nausea

Question 3

Extra risk for hypoglycemia on sulfonylureas

Answer 3

Decreased liver or kidney function
Elderly
Adrenal or pituitary functions

Question 4

True or false: people with severe sulfa allergies should not take sulfonylureas

Answer 4

True

Question 5

Metformin MOA

Answer 5

Decrease glucose dumping from liver

Question 6

Sulfonylurea MOA

Answer 6

Stimulate pancreas to produce insulin (need some beta cell function)

Question 7

Metformin dose range

Answer 7

500-2550 mg

Question 8

TZD MOA

Answer 8

Increase insulin sensitivity of liver and skeletal tissues and suppress glucose production by liver

Question 9

TZD risks

Answer 9

Weight gain, edema, fractures in women, and upper respiratory symptoms

Question 10

Black box with TZDs

Answer 10

Cause or exacerbate CHF. Contraindicated in stage III or IV HF.

Question 11

Rosiglitazone risk with ______ medications

Answer 11

Nitrate or insulin, because can cause heart problems

Question 12

Which class doesn’t cause hypoglycemia alone, but will with insulin or Sulfonylurea

Answer 12

TZDs, AGIs

Question 13

TZDs can be associate with what rare side effect?

Answer 13

Idiosyncratic hepatocellular damage, so no use in hepatic dysfunction (and monitor serum transaminase every 2 months for 1st year and then periodically)

Question 14

_____ may cause ovulation in premenopausal women

Answer 14

TZDs

Question 15

DPP-4 examples

Answer 15

Sitagliptin (Januvia)

Saxagliptin (Onglyza)

Question 16

DPP-4 inhibitors MOA

Answer 16

Prolong incretin levels by preventing DPP-4 enzyme from breaking it down.

Question 17

What are incretins?

Answer 17

Digestive hormones released in small intestine after a meal due to blood glucose spike. They stimulate insulin release and decrease glucagon production in pancreas.

Question 18

AE of DPP-4’s

Answer 18

URTI, UTI, and headache. Follow dosage for renal impairment

Question 19

Alpha glucosidase inhibitor examples

Answer 19

Acarbose (precose) and miglitol (glyset)

Question 20

AGI MOA

Answer 20

Reduce rate of starch digestion and slow absorption in small intestine (lower post meal glucose)

Question 21

AE of AGIs

Answer 21

Abdominal pain, flatulance, and diarrhea. Start low and go slow

Question 22

Which sugars are used for hypoglycemia treatment if a patient is using an AGI?

Answer 22

Glucose and lactose, because AGIs block absorption of complex sugars

Question 23

AGI contraindications

Answer 23

IBD, cirrhosis, malabsorption, pregnancy, and lactation. Also not to be used with serum creatinine greater than 2 (or creatinine clearance less than 25 ml/min

Question 24

Meglitinide examples

Answer 24

Repaglinide (Prandin) and nateglininde (Starlix)

Question 25

Meglitinide MOA

Answer 25

Stimulate pancreas to release insulin in glucose-dependent fashion with shorter duration of action than sulfonylureas

Question 26

Meglitinide dosing with meals

Answer 26

0-30 minutes, so good if erratic eating habits

Question 27

Caution for meglitinide

Answer 27

Hepatic impairment or patients at risk for hypoglycemia (elderly, impaired renal, adrenal, or pituitary function)

Question 28

AE with meglitinides

Answer 28

Hypoglycemia (less than Sulfonylurea). Other uncommon are GI complaints, upper respiratory symptoms, back pain, and arthralgia

Question 29

Example incretin mimetics

Answer 29

Exanatide (Byetta and Bydureon)
Liraglutide (Victoza)
Albiglutide (Tanzeum)

Question 30

Incretin mimetic MOA

Answer 30

Mimic inctretin hormones GLP-1 (glucagon like peptide) and gastric inhibitory polypeptide (GIP), causing insulin release from pancreas

Question 31

Exanatide dosing

Answer 31

30-60 minutes prior to AM and PM meals

Question 32

Caution for Exanatide

Answer 32

Not for use with insulin and CI in Type 1. Pancreatitis.

Question 33

AE of incretin mimetics

Answer 33

Nausea, vomiting, and diarrhea. Hypoglycemia if used with sulfonylureas

Question 34

Black box warning with Liraglutide

Answer 34

Thyroid tumors

Question 35

True or false: Liraglutide is not approved as monotherapy

Answer 35

True

Question 36

Incretin mimetic dosing frequency

Answer 36

Byetta twice daily
Bydureon weekly
Victoza daily
Tanzeum weekly

Question 37

How to minimize nausea with incretin mimetics

Answer 37

Inject closer to meal, and it usually subsides with continued use

Question 38

_______ and _____ should be taken 1 hour away from incretin mimetics

Answer 38

Oral Antibiotics and contraceptives

Question 39

Symptoms of pancreatitis are ________ and should be monitored with ______ medications

Answer 39

Prolonged abdominal pain or vomiting; incretin mimetics

Question 40

What meds are contraindicated at ALT 2.5 times normal?

Answer 40

Metformin

TZDs

Question 41

What are the signs of glucose toxicity and what med should be started?

Answer 41

Prolonged hyperglycemia, A1C > 9, possible ketones

Start insulin instead of oral meds

Question 42

When renal function is decreased, the risk of hypoglycemia is ____________ with use of insulin secretagogues.

Answer 42

Greater

Question 43

If ALT is elevated >2.5 times normal, which meds are contraindicated?

Answer 43

metformin and TZDs

Question 44

What are symptoms of glucose toxicity, which require insulin instead of oral meds?

Answer 44

prolonged hyperglycemia, A1C >9%, and possibly ketones.