Quiz 2 Antihyperlipidemics and Antidiabetics

Question 1

Atorvastatin Brand Name

Answer 1

Lipitor

Question 2

Atorvastatin Class

Answer 2

HMG-CoA Reductace Inhibitor

Question 3

Atorvastatin Indication

Answer 3

1. Hyperlipidemia
2. Primary and secondary prevention of atherosclerotic cardiovascular disease
3. Secondary prevention of cardiovascular events in patients with or at high risk for CAD
4. Familial hypercholesterolemia (homozygous)

Question 4

Atorvastatin MoA

Answer 4

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol also can decrease because of decreased production of VLDL-cholesterol or increased VLDL; removal by LDL receptors.

CLARIFICATION OF WHAT THIS MEANS JUST TO UNDERSTAND THE MECHANISM DEEPER WHATS BELOW WILL EXPLAIN WHAT UP THERE MEANS:

Competitively inhibits the conversion of HMG-CoA to mevalonate

Compensatory increase in low density lipoprotein (LDL) receptors which bind and break down circulating LDL cholesterol and VLDL

Note: LDL and VLDL are both bad cholesterol in liver cells – hepatocytes

Ultimately there is less cholesterol. The LDL is turned into bile, excreted, and recycled.

Note: VLDL is turned into LDL

LDL= Low density lipoprotein
VLDL = Very low density lipoprotein

The reduced intracellular concentrations of cholesterol in hepatocytes secondary to statin use activate the proteases that cleave membrane-bound sterol regulatory element-binding proteins (SREBP), which further migrate to the nucleus and bind to sterol response elements. This binding results in increased transcription of the LDL receptor, which translocates to the liver cell membrane. The LDL and VLDL particles in plasma bind to the LDL receptors and endocytose in hepatocytes, where their cholesterol component gets processed into bile salts, which are then excreted or recycled. This process increases the catabolism of LDL and VLDL cholesterol and results in further reduction of plasma cholesterol concentrations.[3]

Statins reduce the plasma concentrations of total cholesterol, LDL-C, VLDL-C, triglycerides, apo-B, and increase the plasma concentrations of HDL-C.

Question 5

Atorvastatin Pregnancy Category

Answer 5

Pregnancy - contraindicated first trimester, and contraindicated for breastfeeding.

Question 6

Atorvastatin Contraindication

Answer 6

Hypersensitivity to atorvastatin, use in breastfeeding, active liver disease, unexplained persistent elevations of serum transaminases

Question 7

Atorvastatin Black Box Warning

Answer 7

N/A

Question 8

Atorvastatin Counseling points

Answer 8

Avoid excessive alcohol, grapefruit, and grapefruit juice (>1 L/d) consumption while taking drug. Atorvastatin does not take the place of lifestyle changes (diet, exercise) to lower cholesterol levels. Notify prescriber if unexplained muscle tenderness or weakness occurs.

Question 9

Pravastatin Brand Name

Answer 9

Pravachol

Question 10

Pravastatin Class

Answer 10

HMG-CoA Reductace Inhibitor

Question 11

Pravastatin Indications

Answer 11

Cerebrovascular accident (prevention)
Familial hypercholesterolemia
Hyperlipidemia

Question 12

Pravastatin MoA

Answer 12

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol decreases because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.

CLARIFICATION OF WHAT THIS MEANS JUST TO UNDERSTAND THE MECHANISM DEEPER WHATS BELOW WILL EXPLAIN WHAT UP THERE MEANS:

Competitively inhibits the conversion of HMG-CoA to mevalonate

Compensatory increase in low density lipoprotein (LDL) receptors which bind and break down circulating LDL cholesterol and VLDL

Note: LDL and VLDL are both bad cholesterol in liver cells – hepatocytes

Ultimately there is less cholesterol. The LDL is turned into bile, excreted, and recycled.

Note: VLDL is turned into LDL

LDL= Low density lipoprotein
VLDL = Very low density lipoprotein

The reduced intracellular concentrations of cholesterol in hepatocytes secondary to statin use activate the proteases that cleave membrane-bound sterol regulatory element-binding proteins (SREBP), which further migrate to the nucleus and bind to sterol response elements. This binding results in increased transcription of the LDL receptor, which translocates to the liver cell membrane. The LDL and VLDL particles in plasma bind to the LDL receptors and endocytose in hepatocytes, where their cholesterol component gets processed into bile salts, which are then excreted or recycled. This process increases the catabolism of LDL and VLDL cholesterol and results in further reduction of plasma cholesterol concentrations.[3]

Statins reduce the plasma concentrations of total cholesterol, LDL-C, VLDL-C, triglycerides, apo-B, and increase the plasma concentrations of HDL-C.

Question 13

Pravastatin Pregnancy Category

Answer 13

Contraindicated - first trimester

Question 14

Pravastatin Contraindications

Answer 14

Hypersensitivity to pravastatin, do not use in breastfeeding

Question 15

Pravastatin Black Box Warning

Answer 15

N/A

Question 16

Pravastatin Counseling Points

Answer 16

Take in the evening. Avoid concurrent heavy alcohol use. Pravastatin does not take the place of diet and exercise to lower cholesterol levels.

Question 17

Ezetimibe Brand Name

Answer 17

Zetia

Question 18

Ezetimibe Class

Answer 18

Antihyperlipidemic, Cholesterol Absorption Inhibitor

Question 19

Ezetimibe Indications

Answer 19

1. Familial hypercholesterolemia-homozygous, with atorvastatin or simvastatin
2. Mixed hyperlipidemia
3. Primary hypercholesterolemia

Question 20

Ezetimibe MoA

Answer 20

Ezetimibe localizes at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. This causes a reduction of hepatic cholesterol stores and an increase in clearance of cholesterol from the blood; this distinct mechanism is complementary to that of statins and of fenofibrate.

Question 21

Ezetimibe Pregnancy

Answer 21

Pregnancy - limited human data.
Contraindicated breastfeeding

Question 22

Ezetimibe Contraindication

Answer 22

Hypersensitivity to ezetimibe, gallbladder disease, severe hepatic dysfunction, concurrent use with a statin in a pregnant or nursing mother

Question 23

Ezetimibe Black Box Warning

Answer 23

N/A

Question 24

Ezetimibe Counseling Points

Answer 24

Take with or without food and may be taken at the same time as a concurrent statin. In patients receiving a bile acid sequestrant concurrently, ezetimibe should be taken at least 2 h before or 4 h after the bile acid sequestrant is taken.

https://www.verywellhealth.com/what-are-bile-acid-sequestrants-697489

Question 25

Fenofibrate Brand Name

Answer 25

Antara

Question 26

Fenofibrate Class

Answer 26

Antihyperlipidemic

Question 27

Fenofibrate Indication

Answer 27

1. Hypercholesterolemia 2. Hypertriglyceridemia

Question 28

Fenofibrate MoA

Answer 28

Fibric acid derivatives activate peroxisome proliferator-activated receptor α (PPARα), which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III (an inhibitor of lipoprotein lipase activity). The resulting fall in triglycerides produces an alteration in the size and composition of LDL from small, dense particles to large buoyant particles. These larger particles have a greater affinity for cholesterol receptors and are catabolized rapidly.

Question 29

Fenofibrate Pregnancy Category

Answer 29

Pregnancy - limited human data breastfeeding - no human data - potential toxicity

Question 30

Fenofibrate Contraindication

Answer 30

Hypersensitivity, gallbladder disease, severe renal or hepatic dysfunction, nursing mothers

Question 31

Fenofibrate Blackbox warning

Answer 31

N/A

Question 32

Fenofibrate Counseling Points

Answer 32

Fenoglide tablets and Lipofen R capsules should be given with food; others can be taken without food. Take 1 h before or 4-6 h after a bile acid binding resin. Products are not interchangeable. Do not use if you have severe kidney disease or liver disease.

Question 33

Lovastatin Brand Name

Answer 33

Altoprev

Question 34

Lovastatin Class

Answer 34

HMG-CoA Reductace Inhibitor

Question 35

Lovastatin Indications

Answer 35

1. Coronary arteriosclerosis, hypercholesterolemia, primary andmixed 2. familial hypercholesterolemia, heterozygous

Question 36

Lovastatin MoA

Answer 36

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol decreases because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.

Question 37

Lovastatin Pregnancy Category

Answer 37

Contraindicated - first trimester

Question 38

Lovastatin Contraindication

Answer 38

Hypersensitivy to lovastatin, active liver disease, use in breastfeeding, concomitant use with strong CYP3A4/5 inhibitors, and unexplained persistent elevation of liver enzymes

Question 39

Lovastatin Blackbox

Answer 39

N/A

Question 40

Lovastatin Counseling Point

Answer 40

Immediate-release tablets should be taken with the evening meal. Extended-release tablets should be taken at bedtime. Swallow extended-release tablets whole; do not chew, crush, or cut. Avoid alcohol, grapefruit, and grapefruit juice. Report signs/symptoms of rhabdomyolysis, jaundice (yellowing of skin or eyes), or renal failure. There are multiple significant drug-drug interactions with lovastatin. Consult a health-care professional prior to starting any new prescription or OTC medications. Lovastatin does not take the place of lifestyle changes (diet, exercise) to lower cholesterol levels

Question 41

Rosuvastatin Brand Name

Answer 41

Crestor

Question 42

Rosuvastatin Class

Answer 42

HMG-CoA Reductace Inhibitor

Question 43

Rosuvastatin Indication

Answer 43

1. Hyperlipidemia 2. Disorder of cardiovascular system, primary prophylaxis, familial hypercholesterolemia, homozygous, hypertriglyceridemia, mixed dyslipidemia

Question 44

Rosuvastatin MoA

Answer 44

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol can also decrease because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.

Question 45

Rosuvastatin Pregnancy Category

Answer 45

Contraindicated - first trimester

Question 46

Rosuvastatin Contraindication

Answer 46

Hypersensitivity of rosuvastatin, active liver disease, use in breastfeeding

Question 47

Rosuvastatin Blackbox Warning

Answer 47

N/A

Question 48

Rosuvastatin Counseling Points

Answer 48

Do not drink alcohol. Rosuvastatin does not take the place of diet and exercise to lower cholesterol levels.

Question 49

Simvastatin Brand Name

Answer 49

Zocor

Question 50

Simvastatin Class

Answer 50

HMG-CoA Reductace Inhibitor

Question 51

Simvastatin Indication

Answer 51

1. Hyperlipidemia 2. Primary and secondary preventions of atherosclerotic cardiovascular disease 3. Secondary prevention of cardiovascular events 4. Familial hypercholesterolemia (homozygous)

Question 52

Simvastatin MoA

Answer 52

HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol also can decrease because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.

Question 53

Simvastatin Pregnancy Category

Answer 53

Contraindicated - first trimester

Question 54

Simvastatin Contraindication

Answer 54

hypersensitivity of simvastatin, active liver disease, use in breastfeeding

Question 55

Simvastatin Blackbox Label

Answer 55

N/A

Question 56

Simvastatin Counseling Points

Answer 56

Avoid excessive alcohol. There are multiple significant drug-drug interactions with simvastatin. Consult a health-care professional prior to starting any new medications, including OTC and herbal drugs. Simvastatin does not take the place of lifestyle changes (diet, exercise) to lower cholesterol levels.

Question 57

Dulaglutide Brand Name

Answer 57

Trulicity

Question 58

Dulaglutide Class

Answer 58

Antidiabetic Agent, Glucagon-like peptide-1 receptor agonist

Question 59

Dulaglutide Indication

Answer 59

Diabetes mellitus, type 2

Question 60

Dulaglutide MoA

Answer 60

Dulaglutide is an agonist of human glucagon-like peptide-1 (GLP-1) receptor and augments glucose-dependent insulin secretion and slows gastric emptying.

Question 61

Dulaglutide Pregnancy Category

Answer 61

N/A

Question 62

Dulaglutide Contraindication

Answer 62

Family history of medullary thyroid carcinoma, MEN2

Question 63

Dulaglutide Black Box

Answer 63

Risk of thyroid cancers

Question 64

Dulaglutide Counseling Points

Answer 64

Inject subcutaneously into the upper arm, thigh, or abdomen; use a different injection site each week. Administer once weekly on the same day each week, without regard to meals or time of day. Administration day can be changed as long as at least 3 d have passed. If using concomitantly with insulin, administer as separate injections (do not mix); may inject in the same body region as insulin, but do not administer both agents directly adjacent to one another. Keep refrigerated, but is stable at room temperature for 14 d. Be aware of symptoms of thyroid cancer (lump in neck, trouble breathing or swallowing) and kidney problems (decreased urination, blood in urine) and report to HCP.

Question 65

Empagliflozin Brand Name

Answer 65

Jardiance

Question 66

Empagliflozin Class

Answer 66

Sodium-glucose co-transporter 2 (SGLT2) inhibitors

Question 67

Empagliflozin Indication

Answer 67

Diabetes Mellitus 2 Reduce risk of cardiovascular death in adult patients with Diabetes Mellitus 2 and established cardiovascular disease

Question 68

Empagliflozin Pregnancy Risk

Answer 68

2nd and 3rd trim. risk

Question 69

Empagliflozin Contraindication

Answer 69

Severe renal impairment, end-stage renal disease, dialysis Hypersensitivity

Question 70

Empagliflozin MoA

Answer 70

Empagliflozin works by inhibiting the sodium-glucose co-transporter-2 (SGLT-2) found in the proximal tubules in the kidneys. Through SGLT2 inhibition, empagliflozin reduces renal reabsorption of glucose and increases urinary excretion of glucose - Lower plasma glucose levels by blocking renal reabsorption of filtered glucose, which falls as plasma levels fall. - Reduction in blood glucose without stimulating insulin release

Question 71

Empagliflozin Blackbox Warning

Answer 71

Risk of thyroid C-cell tumors, contraindicated in family history of Medullary Thyroid Carcinoma (MTC)

Question 72

Empagliflozin Counseling Points

Answer 72

- If signs / symptoms of ketoacidosis (nausea, vomiting, abdominal pain, tiredness, and labored breathing) occur, seek medical attention. - Contact healthcare provider if signs of HTN occur. Dehydration may increase risk of HTN so pt must maintain adequate fluid intake. - Concurrent use with sulfonylureas or insulin may increase risk of hypoglycemia. - Necrotizing infections of perineum and vaginal / penile yeast infections may occur. (Gyat damn bruh)

Question 73

Glimepiride Brand Name

Answer 73

Amaryl

Question 74

Glimepiride Class

Answer 74

Second-Generation Sulfonylurea, Antidiabetic

Question 75

Glimepiride Indication

Answer 75

Diabetes mellitus, type 2

Question 76

Glimepiride MoA

Answer 76

Sulfonylureas enhance insulin secretion from pancreatic β-cells and potentiate insulin action on several extrahepatic tissues. Long-term sulfonylureas increase peripheral utilization of glucose, suppress hepatic gluconeogenesis, and possibly increase the sensitivity and/or number of peripheral insulin receptors.

Question 77

Glimepiride Pregnancy Category

Answer 77

N/A

Question 78

Glimepiride Contraindication

Answer 78

Hypersensitivity to sulfonylureas, diabetic ketoacidosis

Question 79

Glimepiride Blackbox Warning

Answer 79

N/A

Question 80

Glimepiride Counseling Points

Answer 80

Monitor blood glucose in frequent intervals (2-4 times per d); if <70 mg/dL, eat candy or sugar and contact prescriber. Take with food or milk in the morning. Use a sunscreen and avoid sunlamps and tanning beds. Do not drink alcohol; may cause a disulfiram reaction.

Question 81

Glipizide Brand Name

Answer 81

Glucotrol

Question 82

Glipizide Class

Answer 82

Second-Generation Sulfonylurea, Antidiabetic

Question 83

Glipizide Indication

Answer 83

Diabetes mellitus only type 2

Question 84

Glipizide MoA

Answer 84

Sulfonylureas enhance insulin secretion from pancreatic β-cells and potentiate insulin action on several extrahepatic tissues. Long-term sulfonylureas increase peripheral utilization of glucose, suppress hepatic gluconeogenesis, and possibly increase the sensitivity and/or number of peripheral insulin receptors.

Question 85

Glipizide Pregnancy Category

Answer 85

N/A

Question 86

Glipizide Contraindication

Answer 86

Hypersensitivity to sulfonylureas, diabetic ketoacidosis, type 1 diabetes

Question 87

Glipizide Blackbox Warning

Answer 87

N/A

Question 88

Glipizide Counseling Points

Answer 88

Monitor blood glucose in frequent intervals (2-4 times per d); if <70 mg/dL, eat candy or sugar and contact prescriber. Use a sunscreen and avoid sunlamps and tanning beds. Do not drink alcohol; may cause a disulfiram reaction. Take 30 min before morning meal. Do not chew or crush extended-release formulation.

Question 89

Insulin aspart Brand Name

Answer 89

Fiasp, Novolog

Question 90

Insulin aspart Class

Answer 90

Insulin (FAST ACTING)

Question 91

Insulin aspart Indication

Answer 91

Diabetes mellitus 1

Question 92

Insulin aspart MoA

Answer 92

Insulin promotes cellular uptake of glucose, fatty acids, and amino acids, and their conversion to glycogen, triglycerides, and proteins.

Question 93

Insulin aspart Pregnancy Category

Answer 93

Compatible

Question 94

Insulin aspart Contraindication

Answer 94

Hypersensitivity

Question 95

Insulin aspart Blackbox Warning

Answer 95

Risk of acute bronchospasm with inhaled formulation

Question 96

Insulin aspart Counseling Points

Answer 96

Monitor blood glucose in frequent intervals (2-4 times/d); if <70 mg/dL, eat non–sugar-free candy, glucose tablets, or drink a glass of juice and contact prescriber. Store unopened vials in refrigerator. Keep open vials at room temperature if it is painful to inject cold insulin. Dispose needles in sharps container. Do not share needles (risk of transmission of infectious diseases). Rotate injection sites.

Question 97

Insulin degludec Brand Name

Answer 97

Tresiba

Question 98

Insulin degludec Class

Answer 98

Insulin (LONG ACTING)

Question 99

Insulin degludec Indication

Answer 99

Diabetes mellitus 1

Question 100

Insulin degludec MoA

Answer 100

Insulin promotes cellular uptake of glucose, fatty acids, and amino acids, and their conversion to glycogen, triglycerides, and proteins.

Question 101

Insulin degludec Pregnancy Category

Answer 101

None

Question 102

Insulin degludec Contraindication

Answer 102

Hypersensitivity

Question 103

Insulin degludec Blackbox Warning

Answer 103

Risk of acute bronchospasm with inhaled formulation

Question 104

Insulin degludec Counseling points

Answer 104

Monitor blood glucose in frequent intervals (2-4 times/d); if <70 mg/dL, eat non–sugar-free candy, glucose tablets, or drink a glass of juice and contact prescriber. Store unopened vials in refrigerator. Keep open vials at room temperature if it is painful to inject cold insulin. Dispose needles in sharps container. Do not share needles (risk of transmission of infectious diseases). Rotate injection sites.

Question 105

Insulin detemir Brand Name

Answer 105

Levemir

Question 106

Insulin detemir Class

Answer 106

Insulin (LONG ACTING)

Question 107

Insulin detemir Indication

Answer 107

Diabetes mellitus type 1

Question 108

Insulin detemir MoA

Answer 108

Insulin promotes cellular uptake of glucose, fatty acids, and amino acids, and their conversion to glycogen, triglycerides, and proteins.

Question 109

Insulin detemir Pregnancy Category

Answer 109

Compatible

Question 110

Insulin detemir Contraindication

Answer 110

Hypersensitivity

Question 111

Insulin detemir Blackbox Warning

Answer 111

Risk of acute bronchospasm with inhaled formulation

Question 112

Insulin detemir Counseling Point

Answer 112

Monitor blood glucose in frequent intervals (2-4 times/d); if <70 mg/dL, eat non–sugar-free candy, glucose tablets, or drink a glass of juice and contact prescriber. Store unopened vials in refrigerator. Keep open vials at room temperature if it is painful to inject cold insulin. Dispose needles in sharps container. Do not share needles (risk of transmission of infectious diseases). Rotate injection sites.

Question 113

Insulin glargine Brand Name

Answer 113

Lantus

Question 114

Insulin glargine Class

Answer 114

Insulin (LONG ACTING)

Question 115

Insulin glargine Indication

Answer 115

Diabetes mellitus Type 1

Question 116

Insulin glargine MoA

Answer 116

Insulin promotes cellular uptake of glucose, fatty acids, and amino acids, and their conversion to glycogen, triglycerides, and proteins.

Question 117

Insulin glargine Pregnancy Category

Answer 117

Compatible

Question 118

Insulin glargine Contraindication

Answer 118

Hypersensitivity

Question 119

Insulin glargine Blackbox Warning

Answer 119

Risk of acute bronchospasm with inhaled formulation

Question 120

Insulin glargine Counseling Points

Answer 120

Monitor blood glucose in frequent intervals (2-4 times/d); if <70 mg/dL, eat non–sugar-free candy, glucose tablets, or drink a glass of juice and contact prescriber. Store unopened vials in refrigerator. Keep open vials at room temperature if it is painful to inject cold insulin. Dispose needles in sharps container. Do not share needles (risk of transmission of infectious diseases). Rotate injection sites.

Question 121

Insulin Lispro Brand Name

Answer 121

Amdelog, Humalog

Question 122

Insulin Lispro Class

Answer 122

Insulin (FAST ACTING)

Question 123

Insulin Lispro Indication

Answer 123

Diabetes mellitus Type 1

Question 124

Insulin Lispro MoA

Answer 124

Insulin promotes cellular uptake of glucose, fatty acids, and amino acids, and their conversion to glycogen, triglycerides, and proteins.

Question 125

Insulin Lispro Pregnancy Category

Answer 125

Compatible

Question 126

Insulin Lispro Contraindication

Answer 126

Hypersensitivity

Question 127

Insulin Lispro Blackbox Warning

Answer 127

Risk of acute bronchospasm with inhaled formulation

Question 128

Insulin Lispro Counseling Points

Answer 128

Monitor blood glucose in frequent intervals (2-4 times/d); if <70 mg/dL, eat non–sugar-free candy, glucose tablets, or drink a glass of juice and contact prescriber. Store unopened vials in refrigerator. Keep open vials at room temperature if it is painful to inject cold insulin. Dispose needles in sharps container. Do not share needles (risk of transmission of infectious diseases). Rotate injection sites.

Question 129

Metformin Brand Name

Answer 129

Glucophage

Question 130

Metformin Class

Answer 130

Biguanide, Hypoglycemic

Question 131

Metformin Indication

Answer 131

Diabetes mellitus type 2

Question 132

Metformin MoA

Answer 132

Metformin is a biguanide antihyperglycemic agent. It does not affect insulin secretion; rather, it reduces hepatic glucose production and enhances glucose utilization by muscle.

Question 133

Metformin Pregnancy Category

Answer 133

Pregnancy - Low risk

Question 134

Metformin Contraindication

Answer 134

Hypersensitivity to metformin, contrast media, eGFR <30 mL/min/1.73 m2, metabolic acidosis

Question 135

Metformin Blackbox Warning

Answer 135

Lactic acidosis

Question 136

Metformin Counseling Point

Answer 136

Take with meals. Drink plenty of liquids to improve elimination of metformin. Avoid alcohol; this increases the risk of lactic acidosis.

Question 137

Metformin;Sitagliptin Brand Name

Answer 137

Janumet

Question 138

Metformin;Sitagliptin Class

Answer 138

Antidiabetics, Biguanides/Dipeptyl Peptidase-IV Inhibitors

Question 139

Metformin;Sitagliptin Indication

Answer 139

Diabetes Mellitus Type 2

Question 140

Metformin;Sitagliptin MoA

Answer 140

Combination of Metformin and Sitagliptin Metformin is a biguanide antihyperglycemic agent. It does not affect insulin secretion; rather, it reduces hepatic glucose production and enhances glucose utilization by muscle. Stagliptin phosphate is a DPP-4 enzyme inhibitor that inhibits the degradation of incretin hormones by DPP-4, and enhances the function of GLP-1 and GIP to increase insulin release and decrease glucagon levels in the circulation in a glucose-dependent manner.

Question 141

Metformin;Sitagliptin Pregnancy Category

Answer 141

Caution advised

Question 142

Metformin;Sitagliptin Contraindication

Answer 142

- DM1 - Severe renal impairment (eGFR > 30 mL / min / 1.73 m^2) - Acidosis - Ketoacidosis - Dehydration - Liver disease - Hypersensitivity to Janumet, sitagliptin, or metformin

Question 143

Metformin;Sitagliptin Blackbox Warning

Answer 143

May cause lactic acidosis

Question 144

Metformin;Sitagliptin Counseling Points

Answer 144

- Take with meals. - Swallow whole. Do not break or crush. - If you miss a dose, take as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do not take 2 doses of JANUMET at the same time. - Call your doctor for instructions if you are dehydrated, plan to have surgery, or are going to get an injection of dye / contrast agent for x-ray procedure.

Question 145

Liraglutide Brand Name

Answer 145

Victoza

Question 146

Liraglutide Class

Answer 146

Glucagon-Like Peptide-1-Receptor Agonist

Question 147

Liraglutide Indication

Answer 147

1. Diabetes mellitus type 2 2. Chronic weight management

Question 148

Liraglutide MoA

Answer 148

Analog of glucagon-like peptide-1, which increases glucose-dependent insulin secretion, decreases inappropriate glucagon secretion, slows gastric emptying, and increases satiety.

Question 149

Liraglutide Pregnancy Category

Answer 149

N/A

Question 150

Liraglutide Contraindication

Answer 150

Hypersensitivity, multiple endocrine neoplasia syndrome type 2, history or family history of medullary thyroid carcinoma

Question 151

Liraglutide Blackbox Warning

Answer 151

Increased risk of thyroid cancer

Question 152

Liraglutide Counseling Points

Answer 152

Monitor blood glucose periodically (typically daily, more frequently if administered with sulfonylurea or insulin). If <70 mg/dL, eat non–sugar-free candy, glucose tablets, or drink a glass of juice and contact prescriber. Administer in upper arm, thigh, or abdomen. Change needle for each injection; do not share pens, even if needle is changed. If also using insulin, administer with separate injection in a nonadjacent area. Can be injected without regard to meals.

Question 153

Pioglitazone Brand Name

Answer 153

Actos

Question 154

Pioglitazone Class

Answer 154

Thiazolidinedione Antidiabetic

Question 155

Pioglitazone Indication

Answer 155

Diabetes mellitus type 2

Question 156

Pioglitazone MoA

Answer 156

Pioglitazone is a thiazolidinedione antihyperglycemic and a potent peroxisome proliferator-activated receptor-𝛾 (PPAR-𝛾) agonist used to improve insulin sensitivity in patients with diabetes mellitus type 2. Insulin-dependent glucose disposal in skeletal muscle is improved and hepatic glucose production is decreased; both actions contribute to pioglitazone’s glucose-lowering effects.

Question 157

Pioglitazone Pregnancy Category

Answer 157

N/A

Question 158

Pioglitazone Contraindication

Answer 158

Hypersensitivity to pioglitazone, NYHA III/IV heart failure

Question 159

Pioglitazone Blackbox Warning

Answer 159

Heart failure risk

Question 160

Pioglitazone Counseling Points

Answer 160

Monitor blood glucose in frequent intervals (2-4 times per d). May take without regard to food. May require several weeks for maximum effect. Seek care for bone pain, yellowing of skin or eyes, eye pain, or shortness of breath.

Question 161

Sitagliptin Brand Name

Answer 161

Januvia

Question 162

Sitagliptin Class

Answer 162

Dipeptidyl Peptidase-4 Inhibitor, Antidiabetic

Question 163

Sitagliptin Indication

Answer 163

Diabetes mellitus type 2 (prolly lolz)

Question 164

Sitagliptin MoA

Answer 164

Stagliptin phosphate is a DPP-4 enzyme inhibitor that inhibits the degradation of incretin hormones by DPP-4, and enhances the function of GLP-1 and GIP to increase insulin release and decrease glucagon levels in the circulation in a glucose-dependent manner.

Question 165

Sitagliptin Pregnancy Category

Answer 165

N/A

Question 166

Sitagliptin Contraindication

Answer 166

Hypersensitivity to sitagliptin

Question 167

Sitagliptin Blackbox Warning

Answer 167

N/A

Question 168

Sitagliptin Counseling Points

Answer 168

Monitor blood glucose in frequent intervals (2-4 times/d). Take with morning meal if once-daily dosing. Take with morning and evening meal if twice-a-day dosing. When used in combination with insulin or sulfonylureas, risk of hypoglycemia may be increased.

Question 169

Answer 169