Pharmacotherapy of diabetes

Question 1

Microvascular DM complications

Answer 1

neuropathy, diabetic retinopathy, diabetic kidney disease or dephorpathy

Question 2

T2DM is _____ (pathophysiology)

Answer 2

insulin resistance

decreased insulin production from β cells

Question 3

What are the CV risk factors from DM

Answer 3

HTN, dyslipidemia, CKD, obesity, smoking, FH of premature CD

Question 4

Glycemic goal (A1C) for patients is less than

Answer 4

7%

Question 5

preprandial glucose goal? post prandial glucose goal?

Answer 5

80-130mg/dL

<180mg

Question 6

First line therapy for T2DM are

Answer 6

metformin and lifestyle (weight management and physical activity)

Question 7

If after first line for t2dm (and no ASCVD, HF or CKD), A1c is still not at target what is the first thought? What to do with that ?

Answer 7

Is there a hypoglycemia risk.

Add DPP-4q, GLP-1 RA, SGLT2, TZD

Question 8

If after first line for T2dm, weight is still a problem and a1c is not at goal, add

Answer 8

GLP1 and or SGLT2 i

Question 9

If after first line for T2dm, cost is a problem and a1c is not at goal, add

Answer 9

Sulfonureas, TZD

Question 10

T2DM + HF should be on

Answer 10

metformin and SGLT2 inhibitor regardless of A1C

Question 11

T2DM + ASCVD should be on

Answer 11

metformin with GLP1 and/or SGLT2i

Question 12

T2Dm and CKD should be on

Answer 12

metformin and SGLT2i. GLP1 if SGLT2i is not tolerated well

Question 13

If you need to add on insulin for T2DM, initate at

Answer 13

10IU/day or .1-.2IU/KG a day

longtime basal insulin

Question 14

What are the nonpharmagologic treatments for T2DM

Answer 14

nutrition therapy, physical activity, smoking cessation, psychosocial issues

Question 15

Metformin is a ____ (class)

Answer 15

biguanides

Question 16

MOA of biguanides

Answer 16

decrease hepatic glucose production, decrease intestinal absorption of glucose, improve insulin sensitivity

Question 17

eGFR needs to be ___ to use biguanides.

Answer 17

> 45
if 30-45, don’t start but if continued, reduce dose by 50%
<30-> contraindicated

Question 18

The metformin AEs are

Answer 18

predominantly GI, metallic taste, B12 deficiency, lactic acidosis

Question 19

What are the sulfonylreas used?

Answer 19

glimepiride, glipizide, glyburide

Question 20

MOA of sulfonylureas

Answer 20

stimulate insulin release from β cells, reduce glucose output from liver, increase insulin sensitivity at peripheral target sights

Question 21

What are safety concerns with SUs

Answer 21

may be associated with increased CV mortality

can’t use with sulfonamide allergy

Question 22

What are adverse effects of SUs

Answer 22

hypoglycemia (glyburide not recommended)
increased risk of C
weight gain

Question 23

What are the thiazolidinediones used

Answer 23

pioglitazone

rosiglitazone is discontinued

Question 24

Thiazolidinedione MOA

Answer 24

peroxisome proliferator-activated receptor γ agonist-> influences production of things involved in glucose/lipid metabolism

Question 25

TZDs are not recommended in individuals with

Answer 25

renal impairment from fluid retention. Heart failure

bladder cancer, increased LDL cholesterol, bone fractures

Question 26

What are the Dipeptidyl Peptidase-IV

Answer 26

alogliptin, linagliptin, saxagliptin, sitagliptin

Question 27

What is the renal constrictions with sitagliptin

Answer 27

CrCl<50-> only 50mg PO daily

Question 28

DDP-IV MOA

Answer 28

inhibit DDP-4 enzyme-> prolong incretin (GLP-1)-> released in response to meal-> up insulin synthesis and release from β cells, decreased glucagon secretion from α cells

Question 29

Renal dose adjustment is needed in these three DDP-4 inhibtors

Answer 29

sitagliptin, saxagliptin, alogliptin (no dose adjustment for linagliptin)

Question 30

DDP4 inhibitors interact with

Answer 30

CYP3A4

Question 31

DDP4 AEs

Answer 31

acute pancreatitis, joint pain, increased risk of HF exacerbations

Question 32

FDA approved GLP-1 agonists

Answer 32

semaglutide, lixisenatide, dulaglutide, liraglutide, exenatide

Question 33

GLP1 agonist MOA

Answer 33

enhance glucose dependent insulin secretion. slows gastric emptying.

Question 34

Don’t prescribe GLP-1 agonists in people with

Answer 34

hx of pancreatitis, c-cell thyroid cancer, multiple endocrine neoplasia syndrome type 2 (MEN2)

Question 35

What are AEs of GLP-1 agonists

Answer 35

GI side effects (N/V, diarrhea), injection site, acute pancreatitis risk?

Question 36

SGLT2 inhibitor MOA

Answer 36

inhibits reabsorption of filtered glucose and lower renal threshold for glucose by inhibit SGLT2 in proximal renal tubules

Question 37

Don’t use SGLT2 inhibitors in individuals with

Answer 37

Hx of DKA, amputations, frequent UTIs, severe renal impairment (ESRD, dialysis)

Question 38

AEs of SGLT2 inhibitors

Answer 38

bone fractures, DKA, GI/GU infections, UTIS, risk hypotension, Fournier’s gangrene, amputation risk for canagliflozin

Question 39

Bypass the algorithm and just give insulin if

Answer 39

a1c>9 and need to get it down fast

or someone comes in with catabolic features (weight loss, ketosis)