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NMT200 midterm (wk1-6) > pharm wk 4 > Flashcards

pharm wk 4 Flashcards

1
Q

what drugs can cause dysglycemia

A

Beta-blockers (drugs ending in –olol)

Corticosteroids (prednisone)

HMG-CoA Reductase Inhibitors (drugs ending in statin)

Thiazide or loop diuretics (hydrochlorothiazide, furosemide)

Protease antiviral medications

Second-generation antipsychotics (olanzapine, quetiapine)

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2
Q

goals of T2D treatment

A

Establish and maintain glycemic control while avoiding hypoglycemia

Prevent or minimize the risk of acute and chronic complications

Achieve optimal control of associated risk factors such as hypertension, obesity, and dyslipidemia

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3
Q

where does insulin drugs come from

A

Most available are human insulin and insulin analogues since they cause less antibody generation and adverse effects

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4
Q

rapid onset insulin vs long-acting insulin- when are they useful?

A

Rapid onset insulin preparation are useful for postprandial insulin injections or use with an insulin pump (continuous infusion)

Long-acting insulin preparations are useful for basal insulin infusion

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5
Q

adverse effects of insulin preparations

A

Hypoglycemia is the most common and is usually the result of a missed meal or an increase in exercise

Localized fat hypertrophy

Allergic reactions

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6
Q

what type of drug is metformin

A

biguanides

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7
Q

examples of biguanides

A

metformin

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8
Q

what is the first choice drug for patients with new and uncomplicated T2D

A

metformin

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9
Q

what does metformin do

A

Decreases hepatic glucose production

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10
Q

how much does metformin lower HbA1c by

A

1-1.5%

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11
Q

what is metformin not associated with

A

weight gain

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12
Q

adverse effects of metformin

A

Nausea, diarrhea, abdominal discomfort, anorexia, metallic taste

May cause lactic acidosis in patients with existing hepatic or renal disease - contraindicated

Vitamin B12 deficiency with long-term use

Risk of hypoglycemia is low when used as monotherapy

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13
Q

vitamin deficiency in metformin

A

Vitamin B12 deficiency with long-term use

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14
Q

who is metformin contraindicated for

A

May cause lactic acidosis in patients with existing hepatic or renal disease - contraindicated

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15
Q

what is acarbose drug class

A

alpha-glucosidase inhibitors

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16
Q

what is an example of alpha-glucosidase inhibitors

A

acarbose

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17
Q

what does acarbose do

A

Inhibits intestinal alpha-glucosidases resulting in delayed digestion of starches and disaccharides which reduces postprandial glucose levels

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18
Q

what type of carb does acarbose work on

A

starches and disaccharides

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19
Q

what does acarbose not significantly inhibit

A

Does not significantly inhibit intestinal lactase

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20
Q

when must you take acarbose

A

only effective if taken with a meal

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21
Q

dosing on acarbose

A

TID

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22
Q

acarbose effect on HbA1c

A

lowers is by 1% or less

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23
Q

what should hypoglycemic patients taking acarbose be treated with

A

Hypoglycemic patients taking acarbose should be treated with glucose rather than sucrose

this is because they cant break down complex carbs

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24
Q

what does acarbose not cause

A

weight gain

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25
Q

adverse effects of acarbose

A

Flatulence, diarrhea, abdominal pain, cramps, nausea.

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26
Q

contradindications for acarbose

A

Contraindicated in irritable bowel syndrome, inflammatory bowel disease

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27
Q

what does acarbose reduce bioavailabitly of

A

metformin

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28
Q

sitagliptin is a …

A

DIPEPTIDYL PEPTIDASE-4 INHIBITOR

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29
Q

DIPEPTIDYL PEPTIDASE-4 INHIBITOR example

A

sitagliptin

Generic naming: -gliptin

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30
Q

what does sitagliptin

A

Inhibit the enzyme (DPP4) responsible for the degradation of GLP-1 and other active peptides involved in glucose homeostasis

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31
Q

what does sitagliptin indirectly act as

A

incretin mimetic

32
Q

how much do DPP4 inhibitors/ sitagliptin lower HbA1c

A

1% or less

33
Q

effect of sitagliptin on weight

A

Do not cause weight gain (considered weight neutral)

34
Q

effect of sitagliptin on CVD risk

A

none

35
Q

adverse effets of sitalgiptin

A

Nasopharyngitis, hypersensitivity reactions

Rare events of pancreatitis and severe joint pain

Sitagliptin does not inhibit cytochrome P450 isozymes resulting in a low potential for drug interactions

Low risk of hypoglycemia

36
Q

2 examples of GLP-1 agonists

A

semaglutide and liraglutide

37
Q

semaglutide and liraglutide action…

A

Direct incretin mimetics by acting on GLP-1 receptors

Increases insulin secretion, suppresses postprandial glucagon secretion, slows gastric emptying, increases satiety

38
Q

how is semiglutide and liraglutide usually given

A

Usually given by subcutaneous injection although there is an oral formulation of semaglutide

39
Q

semaglutide and liraglutide lower HbA1c by

A

1-1.5%

40
Q

effect of semiglutide and liraglutide on weight and CVD

A

Do not cause weight gain (cause weight loss)

Evidence suggesting prevention of cardiovascular events in both primary and secondary prevention patients

41
Q

adverse effects of semiglutide and liraglutide (GLP1 agonist)

A

GI adverse effects are common and nausea upon initiation is a common experience

May also cause injection site reactions

Rarely causes acute pancreatitis

Caution in patients with heart rhythm disturbances and severe renal impairment

Contraindicated in pregnancy and those with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2

42
Q

contraindications for GLP1 agonist

A

pregnancy

some cancer historys

43
Q

example of sulfonylureas

A

glyburideg

Generic names often begin with gly or gli

44
Q

glyburide is a

A

sulfonylurea

45
Q

what does glyburide (a sulfonylurea) do?

A

Considered an insulin secretagogue which stimulates both basal and meal-stimulated insulin release

46
Q

what can you add glyburide to as a therapy

A

Generally considered add-on therapies to metformin rather than used as monotherapy

47
Q

how much does glyburide lower HbA1c by

A

1-1.5%

48
Q

differences in sulfonyleureas

A

Significant differences exist between the available drugs in this class in terms of effectiveness, risk of hypoglycemia, and weight gain

49
Q

glyburide effect on weight

A

Glyburide is associated with a higher risk of hypoglycemia and more weight gain

50
Q

adverse effects of glyburide

A

Weight gain; prolonged hypoglycemia.

Risk of hypoglycemia may be greater compared with gliclazide and glimepiride, especially in elderly or patients with renal impairment

beta-blockers may mask hypoglycemic symptoms

51
Q

what is repaglinide an example of

A

meglitinides

52
Q

example of meglitinides

A

repaglinide

53
Q

what is repaglinide

A

A different class of insulin secretagogues

54
Q

meglitinides (ie.. repaglinide) is a different class of insulin secretagogue . what else is a insulin secretagogue?

A

sulfonylureas (i.e. glyburide)

55
Q

what is the similarity and differences between meglitinides (ie.. repaglinide) and sulfonylureas (i.e. glyburide)

A

Stimulate insulin release but the activity is much shorter

Effect and adverse effects are similar to those with sulfonylureas

56
Q

what is the pro and con of meglitinides (ie.. repaglinide) vs sulfonylureas (i.e. glyburide)

A

meglitinides:
Lower risk of hypoglycemia in the context of skipped meals

More extensive metabolic drug interactions

57
Q

what is an example of a SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGC2I)

A

canagliflozin

58
Q

canagliflozin is an example of

A

SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGC2I)

59
Q

what does canagliflozin work on

A

Work by preventing glucose reabsorption in the kidneys which leads to enhanced glucose excretion

60
Q

pneumonic for canagliflozin

A

“glifozin” = glucose flow

Work by preventing glucose reabsorption in the kidneys which leads to enhanced glucose excretion

61
Q

effect of canagliflozin on weight

A

weight loss

62
Q

effect of cangliflozin on HbA1c

A

1% or less

63
Q

what effects do SGC2I / canaglifozin have

A

Shown to reduce the risk of cardiovascular mortality, major adverse cardiovascular events, and hospitalization due to heart failure

Cause a small decrease in blood pressure

Shown to slow the progression of nephropathy

64
Q

what organ function is important for canagliflozin / SGC2I

A

Require sufficient kidney function to work; as kidney function declines so does the antihyperglycemic effect

Shown to slow the progression of nephropathy

65
Q

adverse effects of canagliflozin / SGC2I

A

Increased risk of genitourinary infections

Reduced intravascular volume resulting in hypotension

Hyperkalemia,

Risk of diabetic ketoacidosis

Use with loop diuretics increase risk of hypotension

66
Q

example of THIAZOLIDINEDIONES

A

pioglitazone

67
Q

pioglitazone is a

A

THIAZOLIDINEDIONES

68
Q

what is the mechanism of THIAZOLIDINEDIONES (pioglitazone)

A

act on PPARG receptors –> up regulate GLUT4 transporters –> reabsorb glucose

This class acts as agonists at peroxisome proliferator-activated receptor gamma (PPARG) receptors located on the cell nucleus (particularly in adipose tissue)

This influences gene expression including upregulation of GLUT4 transporters and lipoprotein lipase

This enhances glucose reabsorption and hydrolysis of circulating triglycerides, respectively

Precise mechanism is still unclear

69
Q

what do thiazolidinediones (pioglitazone) do

A

Increased peripheral glucose uptake

Enhanced fat cell sensitivity to insulin

Decreased hepatic glucose output

70
Q

thiazolidinediones (pioglitazone) effect on HbA1c

A

reduce by 1-1.5%

71
Q

thiazolidinediones (pioglitazone) effect on weight

A

weight gain

72
Q

adverse effects of thiazolidinediones (pioglitazone)

A

Increased incidence of heart failure likely because of their ability to cause increased fluid retention and edema

Increase the risk of fractures (hip and wrist)

Worsen macular edema

73
Q

what needs to be done every time thiazolidinediones (pioglitazone) is prescribed

A

written consent

To ensure that the risks and benefits of this medication have been clearly communicated, Health Canada requires that physicians counsel patients and obtain their written consent for all new and renewed rosiglitazone prescriptions

74
Q

Which of the following medications is generally considered first-line therapy for most patients with type 2 diabetes?
A. Glyburide
B. Metformin
C. Canagliflozin
D. Semaglutide

A

B. Metformin

75
Q
A

NMT200 midterm (wk1-6) (22 decks)

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