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Block 2.5: Endocrinology > Whittker Drugs > Flashcards

Whittker Drugs Flashcards

1
Q

Biguanides

A

Drugs: Metformin (Fortament, Glucophage, Glumetza, Riomet)

Initial dose: 500 mg daily - 500 mg BID

MOA: Decreases hepatic glucose production, Decreases intestinal absorption of glucose, improves insulin sensitivity

Adverse Events: GI (N/V), flatulence, diarrhea, Lactic acidosis (rare), Decreased Vit B12 levels (leads to anemia)

Warnings: Do not use in DHF and avoid in hypoxemia (this is due to inc in anaerobic metabolism and more lactic acid production). Avoid in renal dysfunction and hepatic dysfunction (again issue with lactic acid)

Renal Recommendations: Do not start is pt eGFR < 45 then D/C if pt eGFR is <30 (do yearly eGFR)

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2
Q

Treatment pearls of Metformin

A

Name brands: Fortamet, Glucophage, Glumetza, Riomet

Reduces A1C y 1-2% (high amount)

Reduces FPG

FIRST LINE TREATMENT

Take with meals to decrease GI effects

DOES NOT CAUSE HYPOglycemia

weigh loss neutral

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3
Q

Alpha Glucosidase inhibitors

A

Drugs: Acarbose (precose), Miglitol (glyset)

MOA: Competitively inhibits a-glucosidase enzymes in small intestine (this causes slow absorption of carbs which helps to keep insulin from spiking)

Adverse Effects: abdominal pain, bloating, flatulence, diarrhea

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4
Q

Treatment pearls of Alpha glucosidase inhibitors

A

Drugs: Acarbose (Precose), Miglitol (Glyset)

Reduces A1C y 0.3-1% (no very good and never given as mono therapy)

Reduces PPG, and must be taken with first bite of meals

Treat hypoglycemia with glucose

Do not give Scr > 2

Weight neutral

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5
Q

GLP-1 Agonists

A

Drugs: Exenatide (Byetta IR, Bydureron (ER)), Liraglutude (Victoza), Dulaglutide (Trulicity), Semaglutide (ozempic)

Dosing:
Byetta - initial 5mcg within 1 hour of meal, max 10 mcg subs BID**do no use is CrCl <30
Bydureon - 2mg Subq weekly ** Don’t use if CrCl < 45

Litaglutide : 0.6mg subq daily for 1 week then up to 1.2 daily

Dulaglutide: 0.7mg SQ weekly

Semaglutide: .25 SQ weekly

MOA: Binds to GLP1 on beta cells, increases glucose- dependent insulin secretion, decreases glucose secretion, slows gastric emptying, dec food intake

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6
Q

Adverse events of GLP1

A

N/V

Decreased appetite

Pancreatitis

Thyroid C-cell tumors

Hypoglycemia (ONLY WHEN USED IN COMBO WITH OTHER MEDS)

Injection site issues

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7
Q

Treatment Pearls of GLP1s

A

Reduces A1C by 0.5-2%

Reduces PPG and some FPG (longer acting products)

Extenatide (IR), Lixisenatide: 1 hour before meals

Exenatide (ER), liraglutide, Semaglutide, Dulaglutide: with or with out meals

Liraglutide (Saxenda) used for weight loss

Has CV benefits

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8
Q

DPP-4 inhibitors drugs and CrCl cut offs

A

Sitagliptin (Januvia)
Cr> 45: 100 mg daily
Cr 30-44: 50 mg daily
Cr< 30 or ESRD: 25 mg daily

Saxagliptin (Onglyza)
Cr> 45: 2.5-5 daily
Cr <45 2.5 daily
ESRD: 2.5 mg daily - give after dialysis

Linagliptin (Tradjenta)
5 mg Po daily

Alogliptin (Nesina) 
Cr> 60 25 daily
30-59: 12.5
15-29: 6.25
<15 or HD 6.25 (without regard for dialysis)
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9
Q

MOA of DPP4 inhibitors and adverse effects

A

Prolongs half-life of GLP1 and glucose dependent insulinotropic polypeptide

Blocks activity of DPP4 enzyme activity for at least 12 hours

Dec glucagon secretion

ADE:
Peripheral edema
Nausea
Arthralgias 
Hypersensitivity reactions
Pancreatitis
Bullous pemphigoid
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10
Q

Treatment pearls of DPP4 inhibitors

A

Reduces A1C by .7-1

Reduces PPG

Weight neutral

Watch saxagliptin n HF (can worsen it)

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11
Q

What are the drugs and dosing in Amylin analogs and MOA

A

Pramlintide (SymlinPen)

Type 1 : 15 mcg SQ before meals

Type 2: 60 mcg SQ before meals

MOA:
Mimics action of amylin
Suppresses high post prandial glucagon secretion - this is due to slowing gastric emptying allowing lower spikes

Increases satiety

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12
Q

ADE of Amylin products and treatment pearls

A 
ADE:
N/V
Anorexia
Headache (common)
Hypoglycemia (ONLY because you give this product with insulin)

Treatment pearls:
Reduces A1C by .3-.5

Reduces PPG

USED SO THAT YOU CAN REDUCE INSULIN REQUIREMENTS

weight loss

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13
Q

Sulfonylurea drugs and dosing

A

Glimepiride (Amaryl)
1-2 mg daily with breakfast or first meal

Glipizide (Glucotrol and XL)
5mg daily (same for XL)

Glyburide (Glynase PresTab)
Regular tabs: 2.5-5 with first meal of the day
Micronized tabs: 1.5-3 with first meal of the day

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14
Q

MOA and Adverse effects of sulfonylureas

A

Binds to sulfonylurea receptors on Beta cells, this closes K channels which decreases K efflux and depolarizes the membrane

This leads to opening of Ca channels and Ca enters which causes insulin secretion

ADE:
Hypoglycemia (huge risk)
Weight gain
Dizziness
Hyponatremia (SIADH)
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15
Q

Treatment Pearls of sulfonylureas

A

Reduces A1C by 1.5-2

Reduces PPG and FPG

Glyburide is not recommenced on AFA

Watch for severe hypoglycemia

Can cause weight gain

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16
Q

What are the meglitinides and their MOA

A

Nateglinide (Starlix)

Repaglinide (Prandin)

MOA:
Blocks ATP-dependent K channels, depolarizing the membrane and caused Ca to enter and increase insulin release
**not as strong of an effect as sulfonylureas

17
Q

What are the ADE and treatment pearls of meglitinides

A

ADE:
Weight gain
Hypoglycemia
URTI (this is something that is common in diabetics so it might not really cause it)

Treatment pearls:
Reduces A1C by around 1%
Reduces PPG
Always take before meals, skip dose with you cant
Weight gain
18
Q

What are the TZD drugs their dosing and the MOA

A

Pioglitazone (Actos)
15-30 mg daily

Rosiglitazone (Avandia)
4 mg daily

MOA:
Binds and activates PPAR gamma, this improves peripheral muscle and adipose tissue sensitivity to insulin. And allows for more glucose to be taken up not fat and muscle. Can take weeks to months in order to get the full effect of this drug

19
Q

What are the ADE and treatment pearls of TZDs

A

ADE:
Peripheral edema, HF, weight gain (Can be do to the fact you retain H2O)

Increased Transaminases

Fractures

Anemia

**DO not use in NYHA III or IV HF

Treatment pearls:
Reduces A1C by 1-1.5%
Reduces FPG + PPG
Increased HDL, decreased TG (pioglitazone)
Increased HDL, LDL and TC (rosilitazone)
Benefits takes months and can cause weight gain

20
Q

What are the SGLT2 inhibitors their dose and MOA

A

Canagliflozin (Invokana)
100mg daily
eGFR 45-59: 100 mg MAX
<45: D/C

Dapagliflozin (Farxiga)
5mg daily
eGFR<45: D/C

Empagliflozin (Jardiance)
10mg daily
EGFR< 45: D/C

Ertugliflozin (Steglatro)
5mg Daily
eGFR< 60: D/C

MOA: blocks SGLT2 in proximal renal tubes and blocks the reabsorption of glucose and results in increases renal excretion of glucose

21
Q

What are the ADE and treatment pearls of SGLT2 inhibitors

A 
ADE:
Genital mycotic infections 
UTIs
Hypotension (due to fluid loss)
HyperK
Lipid abnormalities 
Renal insufficiency 
Keto acidosis 
Bone fractures 
Treatment Pearls:
Reduce A1C by .7-1%
Reduces PPG
Take without regard to meals but recommended to take drug before first meal of the day
Weight loss 
HAS CV BENEFITS
22
Q

Bile Acid sequestrants drug and MOA

A

Colesevelam (Welchol)

MOA:
Unknown how it actually works in diabetes but may reduce hepatic glucose production

May increase incretin lvls

23
Q

ADE and Treatment pearls of BAS

A 
ADE:
Constipation
Dyspepsia 
Nausea
Can cause an increase in hypertriglyceridemia 
Treatment Pearls:
Reduces A1C by .4-.6%
Reduces PPG
Take with meals
Lowers LDL, inc TG
Do not use when TG > 500
Weight neutral
24
Q

Bromocriptine name brand, MOA, ADE and pearls

A

Cycloset

MOA:
Unknown, but this that DA effects circadian rhythm which plays a role in obesity and insulin resistance. Giving it in the morning may correct circadian activities which were effecte day obesity which will result in reversal of insulin resistance and decrease glucose production with inc insulin

ADE:
N/V
Dizziness
Fatigue
Headache
Weakness
Pearls:
A1C < 0.5%
Take with food 
Take within 2 hours of waking up in the morning 
Weight neutral

Block 2.5: Endocrinology (3 decks)

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