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103 Cards in this Set
- Front
- Back
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ACE goal for AIC
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Less than 6.5
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ADA goal for AIC
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Less than 7
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Metformin is a ____________
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Biguanide
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Pioglitazone and rosiglitazone are ___________
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Thiazolidinediones
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Sitagliptin, Saxagliptin and Linagliptin are ____________
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DPP4 Inhibitors
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Glyburide, Glipizide and Glimepiride are ____________
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Sulfonylureas
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Repaglinide and nateglinide are ________________
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Glinides
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Acarbose and miglitol are _____________
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Alpha Glucosidase Inhibitors
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Bromocriptine is a _____________
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Dopamine antagonist
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Colesevelam is a _____________
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Bile acid sequestrant
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MOA of Metformin (Biguanide)
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Insulin sensitizer
Decrease glucose absorption Inhibits hepatic glucose output |
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Site of action of metformin
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Liver,
GI tract (minor) cell |
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Does metformin cause hypoglycemia?
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No
|
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How much does metformin decrease the AIC?
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1 to 2%
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What are some additional benefits of metformin?
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Promotes modest weight loss
Lipid lowering capabilities |
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Metformin is the only oral agent that has been shown to ___________
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Decrease all cause mortality
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Brand names of metformin
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Glucophage
Riomet Glumetza Fortamet |
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________ is the only commercially available liquid formulation of metformin.
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Riomet
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Adverse effects of biguanides
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GI
Reduced B12 absorption Lactic acidosis |
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What is the maximum effective dose of metformin?
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2000 mg/day
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What are the contraindications for taking metformin?
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SCr > 1.4 in women, 1.5 in men
Liver disease Alcohol abuse PMH or lactic acidosis IV iodinated contrast material |
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How long should a dose metformin be held following IV contrast?
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48 hours
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MOA of thiazolidinediones
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Insulin sensitizer
(increases the number of insulin receptors) |
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Site of action of thiazolidinediones
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Cellular increases glucose metabolism
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Do thiazolidinediones cause hypoglycemia?
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No
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How long before patients are considered to have failed thiazolidinediones?
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2 months
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Brand name for rosiglitazone
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Avandia
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Brand name for pioglitazone
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Actos
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__________ is a thiazolidinedione that is now restricted due to cardiovascular effects.
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Avandia
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How much can thiazolidinediones lower AIC?
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0.5 to 1.4%
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What are some additional benefits of thiazolidinediones?
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lower triglycerides
Increase HDL, Decrease LDL-Actose |
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Adverse effects of thiazolidinediones
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Weight gain
Edema Heart failure risk Skeletal risk Hepatotoxicity Macular edema Bladder cancer |
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Why do thiazolidinediones carry a black box warning?
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Heart failure risk
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What should you ask a patient who is taking a thiazolidinedione?
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Are you having any shortness of breath or swollen ankles?
These are signs of heart failure |
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Pioglitazone use for more than 1 year has a FDA warning for __________
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Bladder cancer
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Contraindication to using thiazolidinediones
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Class 3 or 4 heart failure
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Precautions to using thiazolidinediones
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Class 1 and 2 heart failure
History of edema Elevated LFTs Women at risk for fractures History of macular edema History of bladder cancer |
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MOA of DPP4 inhibitors?
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Inhibits breakdown of GLP-1
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What is an incretin?
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Incretins are GI hormones that are released during a meal and cause glucose dependent insulin secretion
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Do DPP4 inhibitors cause hypoglycemia?
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No (low chance since they only lower blood sugar when high)
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Which DPP4 inhibitor does not require renal adjustment?
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Tradjenta (linagliptin)
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Brand name for sitagliptin
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Januvia
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Brand name for saxagliptin
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Onglyza
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Brand name for linagliptin
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Tradjenta
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How should the dose be adjusted when DPP4 inhibitors are used with sulfonylureas?
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The dose of the sulfonylurea should be reduced by half
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Adverse effects of DPP4 inhibitors
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UTI
Upper Repiratory infection Headache Dermatological reactions Pancreatitis |
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Contraindications to using DPP4 inhibitors
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Hypersensitivity
Pancreatitis |
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Precautions to using DPP4 inhibitors
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Renal dysfunction (for sitagliptin and saxagliptin)
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MOA of sulfonylureas
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Insulin secretagogues
Stimulate insulin release from the pancreatic beta cells by blocking potassium ATP channels |
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Site of action of sulfonylureas
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Pancreas
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How much can sulfonylureas decrease AIC?
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1 to 2 %
|
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Factors predicting successful treatment with sulfonylureas
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Diagnosis < 5 years
Age > 40 years Weight within 110 to 160% IBW FBG < 200 Insulin naive or < 40 units/day |
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Name the first generation sulfonylureas (4)
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Tobutamide
Acetohexamide Tolazamide Chlorpropamide |
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All first generation sulfonylureas are ________ eliminated
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Renally
This can lead to drug accumulation and hypoglycemia |
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Most first generation sulfonylureas are BID due to their short half life except _____________
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Chlorpropamide
|
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Which sulfonylurea contains partially active metabolites?
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Glyburide
This makes it not a good choice for a renally compromised patient |
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What is an important counseling point for glipizide XL
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The shell from the capsule will pass into the stool
|
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Adverse effects of sulfonylureas
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Hypoglycemia
Weight gain Photosensitivity reactions GI |
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Which sulfonylurea causes a disulfiram like flushing reaction and hyponatremia secondary to NIADH
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Chlorpropamide
|
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Sulfonylurea drug interactions
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1. Sulfonamide derivatives
2. Salicylates 3. Beta blockers (block symptoms of hypoglycemia) |
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Contraindications to using sulfonylureas
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Hypersensitivity to sulfonamides
Poor hypoglycemic awareness Poor renal function except glipizide |
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Can sulfonylureas be used in a patient with T1DM?
|
No
|
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Will sulfonylureas cause hypoglycemia?
|
Yes
|
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MOA of glinides
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Insulin secretagogues
or increase insulin secreation from pancreas |
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Site of action of glinides
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Pancreas
|
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If a patient fails a ______ they will also fail a glinide
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Sulfonylurea
|
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What is the target for glinides?
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Post prandial hyperglycemia
|
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When must glinides be taken?
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Before each meal
A meal = anything over 250 calories or containing more than 30 grams of carbohydrates |
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True or false.
Glinides have the same risk of hypoglycemia as sulfonylureas. |
False.
The incidence of hypoglycemia in lower in glinides since the half life is shorter |
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Which glinide is the most potent?
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Repaglinide (Prandin)
|
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Brand name for repaglinide
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Prandin
|
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Brand name for Nateglinide
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Starlix
|
|
How much can glinides lower AIC?
|
0.5 to 1.5%
|
|
Adverse effects of glinides
|
Hypoglycemia
Weight gain Upper respiratory infections |
|
Can glinides cause hypoglycemia?
|
Yes
|
|
Which drug cannot be taken with repaglinide (Prandin)?
|
Gemfibrozil (8 fold increase in prandin levels leads to a very high risk of hypoglycemia)
|
|
Contraindications to glinides treatment
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Hypersensitivity
|
|
MOA of alpha glucosidase inhibitors
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Delays the breakdown of complex carbohydrates into glucose
|
|
Site of action of alpha glucosidase inhibitors
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small intestine
|
|
Brand name of acarbose
|
Precose
|
|
Brand name of miglitol
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Glyset
|
|
When do alpha glucosidase inhibitors have to be taken?
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Before the first bite of a meal
|
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How do you treat hypoglycemia in patients taking alpha glucosidase inhibitors?
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With milk or glucose tablets
|
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How much can alpha glucosidase inhibitors lower AIC?
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0.5 to 0.8%
|
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Alpha glucosidase inhibitors work best with _________ diets
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Higher carbohydrate
|
|
Adverse effects of alpha glucosidase inhibitors
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GI upset
Elevated Liver Enzymes Gas (limits use) |
|
Contraindications to alpha glucosidase inhibitors treatment
|
Inflammatory bowel disease
Ulcerative colitis Intestinal obstruction **Any condition that affects GI absorption |
|
MOA of bile acid sequestrant
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Not completely understood
Possibly decreases the absorption of glucose |
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How much can bile acid sequestrant lower AIC?
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0.3 to 0.5% in combination with insulin or other oral agents
|
|
Adverse effects of bile acid sequestrant
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Constipation
Dyspepsia Hypoglycemia (not by itself) Nausea |
|
What are the two uses for bile acid sequestrants?
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1. High cholesterol
2. Diabetes |
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Considerations to using bile acid sequestrants
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Huge tablets
Must take 6/day Expensive |
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Brand name for colesevelam
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Welchol
|
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Precautions to using bile acid sequestrants
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Triglycerides > 300
Gastroparesis GI motility disorders |
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Contraindications to using bile acid sequestrants
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TG > 500 (risk of pancreatitis)
PMH of pancreatitis Bowel obstruction |
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Drugs that interact with bile acid sequestrants
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Warfarin
Levothyroxine Oral contraceptives Vitamins Narrow index drugs |
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MOA of dopamine receptor agonists
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Increase dopaminergic activity in CNS
|
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How much can dopamine receptor agonists lower AIC
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0.1 to 0.4%
|
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Adverse reactions of dopamine receptor agonists
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Nausea/Vomiting
Dizziness Headache Fatigue |
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How must dopamine receptor agonists be taken for the treatment of diabetes?
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Within 2 hours of awakening
|
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Precautions to using dopamine receptor agonists
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Hypotension
Psychiatric disorders Somnolence |
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Contraindications to using dopamine receptor agonists
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Syncope migraines
Lactation/breast feeding |
|
Drugs that interact with dopamine receptor agonists
|
Dopamine receptor antagonists
Strong CYP3A4 inhibitors |
