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Endocrine Module > Pharmacotherapy of Oral Diabetes and Non-Insulin Injectable Medications > Flashcards

Pharmacotherapy of Oral Diabetes and Non-Insulin Injectable Medications Flashcards

1
Q

What are the hallmark symptoms of hyperglycemia?

A

Polydipsia, Polyuria, and Polyphagia

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2
Q

What are the reasons for an alternate goal?

A

High risk for hypoglycemia, high risk for complication of hypoglycemia occurs, barriers to drug therapy required for optimal control, lower risk for chronic complications, and elderly

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3
Q

What is the A1c goal of healthy patient with few coexisting chronic illnesses and intact cognitive function?

A

<7-7.5%

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4
Q

What is the A1c goal for a complex patient with multiple coexisting chronic illnesses with mild cognitive impairment?

A

<8%

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5
Q

What is the A1c goal of a very complex end stage chronic illness with mod/severe cognitive impairment?

A

Avoid reliance on A1c

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6
Q

What is the primary action of Metformin?

A

Decreases hepatic glucose production

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7
Q

What is the use of Metformin?

A

Should always be considered in type 2 DM unless there is a CI

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8
Q

What is the dose adjustment of Metformin for eGFR >45?

A

No adjustment

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9
Q

What is the dose adjustment of Metformin for eGFR 30-45?

A

Can initiate at 500 mg QD and titrate to 500 mg BID for new therapy
Continuation of therapy = 50% REDUCTION

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10
Q

What is the max dose of Metformin in eGFR 30-45?

A

1 g/day

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11
Q

What is the dose adjustment of Metformin for eGFR <30?

A

CI due to increased risk of lactic acidosis

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12
Q

What are the A/Es of Metformin?

A

Diarrhea and Decreased B12

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13
Q

What are the warnings/DIs of Metformin?

A

Lactic Acidosis or Age >80 due to decreased renal clearance

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14
Q

What do you monitor for Metformin?

A

Renal Function and B12

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15
Q

What is the place in therapy for Metformin?

A

First Line
A1c Lowering 1.5-2%
Highest lowering effect

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16
Q

What are the pearls of Metformin?

A

Improve HDL and LDL, Max Dose = 2000mg, Weight Neutral

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17
Q

What is the primary action of Sulfonylureas?

A

Increases insulin secretion = glucose INDEPENDENT

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18
Q

What is the brand name of Glimepiride?

A

Amaryl

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19
Q

When do you avoid Amaryl?

A

Avoid eGFR <15 other than that no renal dosing

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20
Q

What is the brand name of Glipizide?

A

Glucotrol

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21
Q

Do you renally dose adjust in Glucotrol?

A

No

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22
Q

What is the brand name of Glyburide?

A

Glynase

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23
Q

When is Glynase not recommended?

A

eGFR <60

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24
Q

What are the A/Es of Sulfonylureas?

A

Hypoglycemia and Weight Gain

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25
Q

What do you monitor in Sulfonylureas?

A

Hypoglycemia and Renal Function

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26
Q

What is the place of therapy for Sulfonylureas?

A

2nd or 3rd line
A1c lowering 1-2% (better as mono therapy and not adjunct)

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27
Q

What 2 Sulfonylurea’s are on the BEER’s List?

A

Glyburide and Glimepiride

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28
Q

What is the primary action of Meglitinides?

A

Increases insulin secretion, glucose DEPENDENT

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29
Q

What is the brand name of Repaglinide?

A

Prandin

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30
Q

What is the brand name of Nateglinide?

A

Starlix

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31
Q

What are the A/E of Meglitinides?

A

Hypoglycemia and Weight Gain

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32
Q

What is the warning associated with Meglitinides?

A

Not recommended to use together with SU

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33
Q

What is the place in therapy of Meglitinides?

A

2nd or 3rd line
A1c lowering 0.8-1%

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34
Q

What are the pearls of Meglitinides?

A

Skip is the patient skips a meal, however useful for patients with inconsistent eating patterns

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35
Q

What is the primary action of Thiazolidinediones?

A

Increased insulin sensitivity, takes 6-12 wks for MAX effect

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36
Q

What is the brand name of Pioglitazone?

A

Actos

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37
Q

What is the brand name of Rosiglitazone?

A

Avandia

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38
Q

When do you DC TZD therapy?

A

When LFTs are elevated

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39
Q

What are the A/Es of TZDs?

A

Peripheral edema/fluid retention, elevated LFTs, and weight gain

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40
Q

What is a CI of TZDs?

A

NYHA III or IV Heart Failure

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41
Q

What is a warning of TZDs?

A

Can exacerbate HF at any stage with fluid retention (black box) and hepatotoxicity

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42
Q

What do you monitor with TZDs?

A

LFT, Alkaline phosphatase, and total bilirubin at baseline

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43
Q

What is the place of therapy for TZDs?

A

3rd line
A1c Lowering 1-1.5%

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44
Q

Why is Rosiglitazone NOT so Rosy?

A

Can increase risk of MI

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45
Q

What is the primary action of GLP-1 Agonists?

A

Increase insulin secretion, decrease glucagon secretion (glucose DEPENDENT), slow gastric emptying, and increase satiety

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46
Q

What is the brand name of Exenatide IR and ER?

A

IR: Byetta
ER: Bydureon

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47
Q

What is the dosing for Byetta/Bydureon

A

Byetta: BID
Bydureon: once weekly

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48
Q

What is the renal dosing for Byetta/Bydureon?

A

CrCl < 30 = DC

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49
Q

What is the brand name of Liraglutide?

A

Victoza

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50
Q

What is the dosing of Victoza?

A

QD for 1 week before titrating up dose strength

51
Q

What is the brand name for Dulaglutide?

52
Q

What is the dosing for Trulicity?

A

Once weekly

53
Q

What is the brand name for Lixisenatide?

54
Q

What is the dosing for Adlyxin?

55
Q

What is the brand name of Semaglutide?

A

Ozempic or Rybelsus

56
Q

What is the dosing for Ozempic/Rysbelsus?

A

Ozempic: once weekly
Rysbelsus: QD

57
Q

What are the A/Es of GLP-1 Agonists?

A

GI upset, nausea, vomiting, diarrhea

58
Q

What are the CIs of GLP-1 Agonists?

A

Personal or FH of medullary thyroid carcinoma (black box) EXCEPT for Lixisenatide

59
Q

What are the warnings for GLP-1 Agonists?

A

Acute pancreatitis, gallbladder disease, and gastroparesis

60
Q

What is the place in therapy for GLP-1 Agonists?

A

1st or 2nd line
A1c lowering 0.5-1.9%
CVD: Liraglutide, Dulaglutide, and Semaglutide

61
Q

Do GLP-1 Agonists promote weight loss?

62
Q

LEADER Result

A

Liraglutide-Risk reduction of major CV events in adults with type 2 DM and established CVD

63
Q

SUSTAIN 6 Results

A

Semaglutide-Risk reduction of major CV events in adults with type 2 DM and established CVD

64
Q

REWIND Results

A

Dulaglutide-Risk reduction of major CV events in adults with type 2 diabetes who have established CVD or multiple CV risk

65
Q

What is the primary action of DPP4 Inhibitors?

A

Indirectly increases insulin secretion and decreases glucagon secretion, glucose DEPENDENT

66
Q

What is the brand name of Sitagliptin?

67
Q

What is the brand name of Saxagliptin?

68
Q

What is the brand name of Linagliptin?

69
Q

What is the brand name of Alogliptin?

70
Q

How are DPP4-Inhibitors dosed?

71
Q

What are the A/E and Monitoring concerns of DPP4-Inhibitors?

A

Increased LFTs, monitor LFT and renal function

72
Q

What are the warnings for DPP4-Inhibitors?

A

HF: Saxagliptin and Alogliptin
Renal Impairment
Hepatotoxicity

73
Q

What is the place of therapy for DPP4-Inhibitors?

A

2nd or 3rd line
A1c lowering 0.6-0.8%

74
Q

Do DPP4-Inhibitors cause weight gain?

75
Q

What is the primary action of SGLT2 Inhibitors?

A

Blocks glucose reabsorption by the kidney

76
Q

What is the brand name of Canagliflozin?

77
Q

What is the brand name of Dapagliflozin?

78
Q

What is the brand name of Empagliflozin?

79
Q

What is the brand name of Ertugliflozin?

80
Q

How are SGLT2-Inhibitors dosed?

A

QD and orally

81
Q

What are the A/Es of SGLT-2 Inhibitors?

A

UTI, Genital mycotic infections

82
Q

What are warnings for SGLT2 Inhibitors?

A

Increased risk of bone fractures, ketoacidosis, lower limb amputations, fournier’s gangrene, and pancreatis

83
Q

What is the place in therapy for SGLT2 Inhibitors?

A

1st or 2nd line
A1c Lowering 0.5-1%

84
Q

Does SGLT2 Inhibitors cause weight gain?

85
Q

Which SGLT2 Inhibitors have CVD benefits?

A

Canagliflozin, Empagliflozin, and Dapagliflozin

86
Q

Which SGLT2 Inhibitors have HF benefits?

A

Empagliflozin
Dapagliflozin for HFrEF

87
Q

What SGLT2 Inhibitors have CKD benefits?

A

Canagliflozin and Dapagliflozin

88
Q

EMPA-REG Results

A

Empagliflozin-Risk reduction of CV mortality in adults with type 2 and established CVD

89
Q

CANVAS Results

A

Canagliflozin-Risk reduction of CV mortality in adults with type 2 and CVD

90
Q

CREDENCE RESULTS

A

Canagliflozin-Risk reduction in ESRD, doubling of serum creatinine, CV death, and hospitalization for HF in adults with type 2 DM and diabetic nephropathy with urinary albumin excretion >300 mg/day

91
Q

DECLARE TIMI 58 RESULTS

A

Dapagliflozin-Risk reduction for hospitalization for HF in patients with type 2 diabetes and established CVD or multiple CV risk factors

92
Q

DAPA-HF RESULTS

A

Dapagliflozin-SEPARATE INDICATION, HFrEF to reduced the risk of hospitalization or death

93
Q

EMPEROR-Reduced RESULTS

A

Empagliflozin-August, 18, 2021 FDA approved indication for use in HF in adults with HFrEF

94
Q

EMPEROR Reserved RESULTS

A

Empagliflozin-February 4, 2022: FDA approved use in HF in adults with HFpEF

95
Q

DAPA-CKD RESULTS

A

Dapagliflozin-Adjunct therapy for CKD

96
Q

What the primary action of Alpha Glucosidase Inhibitors AGi?

A

Slows intestinal CHO digestion/absorption

97
Q

What is the brand name of Acarbose?

98
Q

What is the brand name of Miglitol?

99
Q

How are AGi’s dosed?

A

TID with meals

100
Q

What are the A/E’s of AGi’s?

A

Significant in GI upset and Increased LFTs (Acarbose)

101
Q

What are the CIs of AGi?

A

Inflammatory bowel disease, colonic ulceration, intestinal obstruction, malabsorption disorders

102
Q

What is the place in therapy for AGi?

A

A1c lowering 0.3-1%

103
Q

What are the clinical pearls for AGi?

A

Minimal hypoglycemia, no weight gain, and TID dosing, and hepatotoxicty

104
Q

What is the primary action of Amylin Analogue?

A

Reduces postprandial elevations by prolonging gastric emptying, suppresses glucagon secretion, and produces satiety

105
Q

What is the brand name of Symlin?

A

Pramlintide?

106
Q

What are the A/E of Amylin Analogue?

A

Significant hypoglycemia (black box), HA, nausea, and anorexia

107
Q

What is the CI and warning associated with Amylin Analogues?

A

CI: gastroparesis
Warning: hypoglycemia

108
Q

What is the place of therapy for Amylin Analogues?

A

A1c lowering 0.6-0.8%

109
Q

What are the pearls for Amylin analogue?

A

Weight loss and decrease mealtime insulin by 50%

110
Q

What is the primary action for Dopamine 2 Agonists?

A

Increases insulin sensitivity

111
Q

What drug is a Dopamine 2-Agonist and its place in therapy?

A

Bromocriptine, A1c lowering 0.6-1.2% not commonly used

112
Q

What is the primary action for Bile Acid Sequestrant BAS?

A

Decrease hepatic glucose production and increase incretin levels

113
Q

What drug is a BAS and what is its place in therapy?

A

Colesvelam/Welchol, A1c lowering 0.5%

114
Q

What drugs are utilized for a therapy target of fasting blood glucose?

A

Biguanide, TZDs, SU, SGLT-2, Dopamine Agonists, Bromocriptine, DPP4, and GLP-1

115
Q

What drugs are utilized for therapy target postprandial blood glucose?

A

Meglitinide, DPP4, GLP-1, and AGi

116
Q

When do you measure for therapy target for postprandial blood glucose?

A

Pre and 2 hours after same meal or before the next meal

117
Q

When should you consider metformin for prediabetes patients?

A

BMI >35, Age <60, and Women with prior GDM

118
Q

What drugs categories should you avoid with HF?

A

TZDs and DPP4

119
Q

What drugs categories should you avoid with Renal Impairment?

120
Q

What drugs categories should you avoid with GI Disorders?

A

AGi and GLP-1

121
Q

What drugs categories should you avoid with Bone Fractures?

A

SGLT2 and TZD

122
Q

What drugs categories should you avoid with Hepatotoxicity?

A

TZD, DPP4, and AGi

123
Q

What drugs categories should you avoid with Thyroid Carcinoma?

124
Q

What are the common barriers to monitoring and control?

A

Concurrent health conditions, life stressors with higher priority, inadequate knowledge, inadequate access, poor adherence, fear of hypoglycemia

Endocrine Module (16 decks)

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