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91 Cards in this Set

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What is the goal for PPG in a pt with DM?
<180mg/dL
What is the goal for preprandial glucose?
90-130
What is the HDL goal in DM in men? women?
>40; >50
What are the 1st generation sulfonylurea?
tolbutamide
chlorpropamide
tolazemide

**don't use these!
What are the 2nd generation sulfonylureas?
glyburide
glipizide
glimepiride
Which oral agent is third choice?
glyburide
Which sulfonylurea (2nd generation oral) is best for pt with mild renal insufficiency?
glimepiride
Which oral agent goes thru 2C9?
glimepiride
What is the only biguanide currently available?
metformin
Which oral agent is absolutely contraindicated in renal insufficiency?
glyburide
How do biguanides work?
reduce glucose production

reduce glucose absorption in the intestine

increase insulin sensitivity
Which oral agent does not cause hypoglycemia?
metformin
does metformin tend to cause weight loss or weight gain?
mild loss
Is metformin a sulfonylurea?
no!
What are the contraindications to using metformin?
Creat of 1.4 in a woman or 1.5 in a man

CHF

ketoacidosis
What oral DM drug must you withold 48hrs before and after contrast?
metformin
Name two TZDs
pioglitazone
rosiglitazone
What lengthens the half life of metformin?
renal insufficiency
What lengthens the half life of rosiglitazone
hepatic impairment
What oral besides glimepiride goes thru 2C9?
rosiglitazone
What are the contraindications to using TZDs?
CHF/edema (can precipitate)
What oral drugs go thru 3A4?
pioglitazone
nateglinide (also 2C9)
repaglinide
Which oral DM med has active metabolites (including sulfate conjugates)?
pioglitazone
What pts will have a longer elimination half life of pioglitazone?
elderly
Name 2 meglitinides
nateglinide
repaglinide
What is the MOA of nateglinide or repaglinide?
stimulates release of insulin by interacting with ATP-sensitive K channels (depolarization)
Which meglitanide is very similar to a sulfonylurea?
nateglinide
WHat are the contraindications to using the meglitinides?
DKA
type I DM
Which needs to be taken on an empty stomach, nateglinide or repaglinide?
nateglinide
Which meglitinide is better if impaired renal fcn?
repaglinide
Name 2 alpha-glucosidase inhibitors.
acarbose
miglitol
How does acarbose work?
lowers post prandial glucose by inhibiting alpha amylase from the pancrease and alpha-glucoside hydrolases from the intestine

basically .. . inhibit the enzyme in the gut that digests starch and glucose
What effect do alpha glucosidase inhibitors have on insulin secretion/utilization
none!
What oral besides metformin, when used as monotherapy should not cause hypoglycemia?
acarbose
miglitol
WHat are the contraindications for use of acarbose?
cirrhosis
colon ulcerations
DKA
malabsorption
IBD
bowel obstruction/predisposition to obstruction
Cirrhosis and colon ulcerations are contraindications to use of which alpha-gluc inhibitor?
acarbose
What are teh side effects of Miglitol?
bloating/flatulence/diarrhea
rash
low serum iron
Is low serum iron a side effect of acarbose or miglitol?
miglitol
How can the side effects of acarbose be combatted?
low carb diet
Name the intermediate acting insulins.
NPH
Lente
Name the long acting insulins
glargine
detemir
Ultralente (not used much)
What are the advantages of glargine?
no peak!
less hypoglycemia than NPH
less dosage adjustment for NPO status
How do you roughly determine whether you are dosing glargine right?
AM and HS sugars should be the same
What is a disadvantage to using glargine (lantus) or detemir (levemir)?
cannot mix w/other insulins
Rank these in terms of amount of peak: NPH, glargine, and detemir
NPH > detemir > glargine
What are the advantages of detemir?
less hypoglycemia than NPH
less peak than NPH
less variation between subjects
less weight gain than NPH
Name a short acting insulin
regular
Name the rapid acting insulins
lispro
aspart
glulisine
What are the forms of human premix available?
70/30
50/50
(NPH/Regular)
What is the dosing parameter of insulin units for type I DM?
0.2-0.4 units/kg/day

but may need up to 0.6-0.7 units/kg/d
What are the dosing parameters for insulin in type 2 DM?
up for 1.5-2 units/kg/d
WHat is the standard intermediate acting basal insulin now?
lente
When should NPH be taken?
breakfast and bedtime
Why should NPH be taken at bedtime instead of with supper?
risk of nocturnal hypoglycemia
What insulin is ultra rapid acting?
glulisine
what are the newer long acting basal insulin?
glargine and detemir
What is the MOA of glargine?
less soluble than human insulin -> precipitates in skin after injxn -> delayed absorption
What are the disadvantages of glargine?
cannot mix
slower onset
if OD -> prolonged hypoglycemia risk
pen is difficult to use
Which long acting insulin causes less weight gain than NPH?
detemir
Which has an easier pen to use, glargine or detemir?
detemir
How do you switch from NPH to glargine (lantus) or detemir (levemir)?
give 80-100% of dose
How do you switch between lantus and levemir
no adjustment, dose is the same
what is the inhaled insulin called?
exubera
Can inhaled insulin be used w/basal insulin or oral meds?
yes
WHen is inhaled insulin given?
with each meal
Is exubera used more for type I or type II DM?
type II
Which pts will have higher absorption of exubera?
COPD
Which pts will have lower absorption of exubera?
asthma
What are the baseline tests, restrictions to using exubera?
no smoking for 6 mo prior
not for asthma/COPD/etc
baseline PFTs and q6mo-yr
When must pt d/c exubera?
if the FEV1 drops 20% or more from baseline
What is GLP-1?
secreted by L cells in the ileum and colon -> modulate insulin secretion in response to nutrients in bowel
What is GIP?
secreted in the duodenum and jejunum -> modulate insulin secretion in response to nutrients in bowel
What does GLP-1 do to beta cells?
enhances glucose-dependent insulin secretions acutely; then stimulates synthesis of insulin and expression of GLut-2 and glucokinase; chronically stimulates synthesis of new beta cells
How does pramlintide work?
delays gastric emptying
may regulate glucagon release
What drug is an analogue of endogenous amylin?
pramlintide
What does amylin do? Which drug uses this mechanism to tx DM?
secreted in response to food intake - slows gastric emptying w/o altering overall absorption of nutrients and suppresses glucagon; pramlintide
What drug slows gastric emptying w/o altering absorption of nutrients?
pramlintide
What is pramlintide titration mostly limited by?
nausea
Why isn't pramlintide used much in DM type I?
it is SQ . . they don't want 3 more shots
With which drug must you make sure to lower the short acting/rapid insulin dose by 50%?
pramlintide
THis DM drug is NOT for pts with gastroparesis and is NOT monotherapy.
pramlintide
WHat is the MOA of exenatide?
incretin mimetic - acts as agonist at GLP-1 receptor

possible effects:
-> enhance glucose dependent insulin secretion
-> supress inappropriately high glucagon secretion
-> slow gastric emptying
-> reduces food intake
-> promotes beta cell neogenesis
-> reduces adiposity
The effects of which drug are related to GLP-1?
exenatide
What drug is from the Gila monster?
exenatide
Exenatide is only indicated for which type of DM?
type II
What is the MOA of sitagliptin phosphate?
inhibits DPP-4 - which is the enzyme that turns active GLP-1 and GIP into inactive enzymes
What is the newest oral agent for type 2 DM?
sitagliptin phosphate
Is sitagliptin phosphate indicated for monotherapy?
yes; or combo with TZDs (e.g. pioglitazone) or metforming
Which pts should not take sitagliptin phosphate?
Type I or DKA
Which drugs are non-sulfonylurea secretagogues?
repaglinide
nateglinide
Name the sulfonylureas
chlorpropamide
tolazamide
tolbutamide
glimepiride
glipizide
glyburide