Pharm Exam 3 (DM Medication)

Question 1

Biguanides (Metformin) — Insulin Sensitizers

ADR —

CI —

DI —

Monitoring —

Answer 1

ADR — GI (Upset stomach, Diarrhea)
CI — SCr >1.4 (F), SCr >1.5 (M)
DI — Cimetidine (INC Metformin lvs)
Monitoring — CHF, Severe lung disease, Liver disease

Question 2

Sulfonyluease (SU) — Insulin Secretagogues
Stimulation of Insulin Secretion

Caution —
Monitor —
ADR —
DI —

Answer 2

Caution — Hepatic and Renal Dysfunction
Monitor —. Reduced Efficacy over time
ADR — Allergic rxn w/ Sulfa, Hypoglycemia, Weight gain
DI — Avoid Chlopropamide in pts w/ Renal Dysfunction or the Elderly

Question 3

Meglitinides

Similar to SU, Require glucose
2nd or 3rd for T2DM
Taken w/ meals or up to 30 min prior to each meal; Sip doses if meals are skipped or if low in Carb

AD —

Answer 3

Upper respiratory infection, Flu-like syndrome

Question 4

TZDs — Insulin Sensitizers
Binds the PPAR-y —> Enhance insulin sensitivity at muscle, liver, and fat cell

ADR
Monitoring

Answer 4

ADR — Increased fracture rate

Monitoring — HbA1c, Liver, CV

Question 5

DPP-4 Inhibitors
Prevents the degradation of endogenous incretins (GLP-1 and GIP)
No effect on Gastric Emptying and Satiety (T2DM)

ADR

DI

Answer 5

ADR — Pancreatitis, INC risk of UTI, URI, Worsen HF, Reduction in absolute lymphocyte counts

DI — DEC the dose of SU by 50% if used in combo

Question 6

GLP-1
Secreted from the L-cells in response to MEALS

Characteristics (3)

INC production of insulin secretion in response to ______

ADR, CI, DI

Answer 6

Glucose dependent (Glucose count > 90)
Slows gastric emptying
Increasing Satiety

High BG levels

ADR — Diarrhea and Constipation, Pancreatitis
CI — pts w/ a history of Medullary Thyroid Cancer
DI — Delay the absorption of drugs due to delaying gastric emptying

Question 7

Synthetic Amylin Analogue

Characteristic

CLIN —
ADR -
Do NOT use in pts w/ _______ or pts taking _________

Answer 7

INC satiety —> weight loss, slows gastric emptying
CLIN — Adjunct to mealtime insulin therapy in T1DM and T2DM
ADR — Severe Hypoglycemia
Gastroparesis & GI Motility Agents

Question 8

A-glucosidase inhibitors

ADR —

CI —

Answer 8

ADR — GI (Gas, Bloating, Diarrhea)

CI — pts w/ short-bowel syndrome or IBD or Cirrhosis

Question 9

SGLT2

CLIN —
ADR —

Answer 9

Clin — Reducing CV risk (MI, Stroke, CV death) — Empagliflozin & Canagliflozin
ADR — Genital Fungal Infection, UTI

Question 10

Sulfonylureas (2nd)

Answer 10

Glipizide
Glyburide — Highest 2nd generation rates of HYPOglycemia
Glimepiride — Safer in Renal Dysfunction

Question 11

DPP-4 (4)

Answer 11

(-gliptin)

Sitagliptin
Saxagliptin — CYP3A4 substrate
Linagliptin — Dose adjustment NOT required for renal or hepatic impairment, CYP3A4 substrate (most selective)
Alogliptin

Question 12

GLP-1 (5)

Answer 12

Exenatide - Dose (Prior to AM & PM meals), NOT recommended if CrCl < 30, weight loss (1-2kg)
Exenatide ER — NOT recommended for Severe renal impairment or end stage Renal Disease (Cirrhosis)
Liraglutide (!!!!) — Indicated for weight management; FDA approved for reducing CV risk (MI, Stroke, CV Death)
Dulaglutide — NO dosage changes necessary in pts w/ Renal Impairment

Question 13

Sings of AAA

Answer 13

> 65, History of smoking, M, First degree relative w/ history of AAA, >5 (Rupture)

Question 14

Prolonged gurgles of hyperperistalsis

Answer 14

Borborygmi

Question 15

Increased/hyperactive bowel sound

Answer 15

Diarrhea, hunder of early obstruction

Question 16

Rushes of high pitched sounds w/ CRAMP

Answer 16

Obstruction

Question 17

Decreased bowel sound

Answer 17

Ileus and peritonitis