Pharm

Question 1

What is the first line therapy in patients with CHF and reduced LV function?

Answer 1

ACE inhibitors (or ARBs if ACEi not tolerated) -> decrease preload, afterload and increase CO, inhibits renin-angiotensin system

Question 2

Rapid acting insulin

Answer 2

lispro or aspart, onset=15min, duration 3-5hr

Question 3

Short acting insulin

Answer 3

regular insulin, onset=30-60min, duration of action 5-8hr

Question 4

intermediate acting insulin

Answer 4

NPH insulin, onset 13hr, duration 18-24hr

Question 5

long acting insulin

Answer 5

glargine insulin, insulin detemir

onset 1hr, duration 24hr

Question 6

management of DM type 1

Answer 6

combo therapy with short acting insulin before meals and intermediate/long acting basal insulin + frequent monitoring of blood glucose and adjustment

Question 7

management of DM type 2

Answer 7

1. diet & exercise

2. oral hypoglycemics, Metformin 1st line +/- insulin and/or sulfonylurea

Question 8

Biguanides

Answer 8

Metformin,
mechanism: decrease glucose output from liver during gluconeogenesis
HbA1c decrease: 1-2%
Advantages: decrease in CV events, no hypoglycemia, potential weight loss, decreased TG and LDL
safe in pregnancy and breastfeeding
Disadvantages: GI, *contraindicated in renal insufficiency (Cr >1.5) -> lactic acidosis

Question 9

Sulfonylureas

Answer 9

Glyburide, Glipizide, Glimepiride
mechanism: stimulate beta cells to release insulin
HbA1c decrease: 1-2%
Advantages: rapidly effective
Disadvantages: weight gain, poor response in many patients, hypoglycemia, contraindicated w/ sulfa allergy

Question 10

TZDs

Answer 10

Pioglitazone (Actos), rosiglitazone (Avandia)
mechanism: TF regulation of PPARy -> improves periph insulin sensitivity
HbA1c decrease: 0.5-1.4%
Advantages: improves lipid profile and potential decrease in MI (pioglitazone)
Disadvantages: fluid retention, CHF DO NOT USE IN NYHA CLASS 3 or 4, weight gain, bone fractures, expensive

Question 11

GLP-1 agonist

Answer 11

Exenatide (Byetta), Liraglutide (Victoza)
mechanism: activates GLP1 receptor-> activates beta cells to release insulin, inhibits glucagon, slows gastric emptying/ promotes satiety
HbA1c decrease: 1%
Advantages: weight loss
Disadvantages: GI, hypoglycemia, acute pancreatitis (Exenatide), contraindicated in Fx of medullary thyroid CA (Liraglutide)

Question 12

alpha Glucosidase inhibitor

Answer 12

Acarbose (Precose), Miglitol (Glyset)
mechanism: delay carb absorption -> decrease post-prandial hyperglycemia
HbA1c decrease: 0.5%
Advantages: weight neutral
Disadvantages: GI side effects, TID dosing, expensive

Question 13

Glinide

Answer 13

Repaglinide (Prandin), Nataglinide (Starlix)
mechanism: increases insulin response to meals
HbA1c decrease:
Advantages: Rapidly effective, can be used in renal disease
Disadvantages: TID dosing, hypoglycemia, Expensive

Question 14

pramlintide

Answer 14

Amylin analog
mechanism: decreases post-prandial glucose excursions, decreases glucagon, slows gastric emptying
HbA1c decrease: 0.5-1%
Advantages: weight loss
Disadvantages: GI side effects, 3 injections qD

Question 15

DPP-4 inhibitors

Answer 15

Sitagliptin (Januvia)
mechanism: prevents breakdown of GLP-1
HbA1c decrease: 0.5-0.8%
Advantages: weight neutral, no hypoglycemia
Disadvantages: expensive, URIs, anaphylaxis, SJS, pancreatitis

Question 16

Fluoroquinolones have a black box warning for what?

Answer 16

increased risk of tendinopathy and tendon rupture