Oral Diabetes Medications

Front 1

What is the mechanism of action of Sulfonylureas?

Back 1

Insulin secretagogue - forces pancreatic beta cells to secrete insulin

Front 2

Which oral diabetes medication has a risk of lactic acidosis?

Back 2

-Metformin

most often w/ renal impairment, hypovolemia, low perfusion state, and/or advanced age (> 80 yrs)

Front 3

What is the mechanism of action of Glucagon-like Peptide-1 (GLP-1) agonists?

Back 3

Stimulates insulin production in response to increase in plasma glucose

Inhibits post-prandial glucagon release

Slows gastric emptying --> appetite suppression and weight loss

Front 4

What are examples of Thiazolidinediones (TZDs)?

Back 4

"-glitazones"

-pioglitazone (Actos)

-rosiglitazone (Avandia)

Front 5

Which oral diabetes medication class is potentially photosensitizing?

Back 5

The sulfonylureas

Front 6

What is the MOA of Biguanides (Metformin)?

Back 6

Reduces hepatic glucose production and intestinal glucose absorption

Insulin sensitizer via increased peripheral glucose uptake and utilization

Front 7

Which of the oral diabetes drug classes should be avoided in the presence of HF?

Back 7

-Biguanides (Metformin) & TZD (-glitazones)

*TZD use can cause or exacerbate HF. Do not initiate use in presence of HF. Monitor at-risk patients carefully

Front 8

What are examples of the Alpha-glucosidase inhibitors?

Back 8

-acarbose (Precose)

-Miglitol (Glyset)

Front 9

What are examples of the Dipeptidyl Peptidase-4 (DPP-4) inhibitors?

Back 9

"-gliptins"

-sitagliptin (Januvia)

-saxagliptin (Onglyza)

-linagliptin (Tradjenta)

-alogliptin (Nessina)

Front 10

Which class of oral diabetes drugs should be taken with "the first bite of a meal"?

Back 10

The alpha-glucosidase inhibitors

(acarbose [Precose] and miglitol [Glyset])

Front 11

Which classes of oral diabetes drugs require dose adjustment in renal impairment?

Back 11

-DPP-4 inhibitors ("-gliptins")

-Sulfonylureas ("gl-ides") - risk for hypoglycemia in renal disease

Front 12

Which oral diabetes medication class is helpful in the management of post-prandial hyperglycemia?

Back 12

Alpha-glucosidase inhibitors

(acarbose [Precose] and miglitol [Glyset])

Front 13

Which oral diabetes drug class is well-tolerated with little hypoglycemia risk and is weight neutral?

Back 13

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors ("-gliptins)

Front 14

What are examples of the Glucagon-like peptide-1 (GLP-1) agonists (incretin mimetics)?

Back 14

"-tides"

-exenatide (Byetta, Bydureon)

-liraglutide (Victoza)

Front 15

What is the MOA of the Thiazolidinediones (TZDs)?

Back 15

-Insulin sensitizer via action at PPAR-y receptors found in muscle, adipose, and other tissue

Front 16

What are examples of the Sulfonylureas (SU)?

Back 16

"gl-ide"

-glipizide (Glucatrol)

-glyburide (DiaBeta)

-glimepiride (Amaryl)

Front 17

What is an example of a Biguanide?

Back 17

Metformin (Glucophage)

Front 18

Which oral diabetes drug class should be used with caution in sulfonamide allergy?

Back 18

the Sulfonylureas - use caution w/ sulfonamide allergy, although cross-allergy risk is low

Front 19

What is the MOA of the Alpha-glucosidase inhibitors?

Back 19

-Delay intestinal carbohydrate absorption by reducing post-prandial digestion of starches and disaccharides via enzyme action inhibition

Front 20

What is the indication for use of Dipeptidyl Peptidase-4 (DPP-4) inhibitors?

Back 20

Indicated to improve glycemic control in combination w/ metformin or TZDs ("-glitazones")

Front 21

Which oral diabetes medication does not enhance insulin secretion or sensitivity?

Back 21

-Alpha-glucosidase inhibitors

(acarbose [Precose] and miglitol [Glyset])

Front 22

Which oral diabetes drug classes should not be used with impaired renal function?

Back 22

-Monitor Creatinine with use of Biguanides (Metformin), do not initiate or continue w/ impaired renal function (generally Cr ≥ 1.5 in males & Cr ≥ 1.4 in females)

-Use of Alpha-glucosidase inhibitors (acarbose [Precose] and miglitol [Glyset]) should be avoided in impaired renal function

-Do not use GLP-1 agonists ("-tides") with CrCl < 30 mL/min (use w/ caution in pts w/ mild-moderate renal impairment [CrCl = 30-50 mL/min)

Front 23

Exenatide has been approved as add-on therapy with which other diabetes medications?

Back 23

Exenatide approved as add-on therapy w/ insulin glargine, with or without metformin in T2DM w/ inadequate glycemic control on insulin glargine alone

Front 24

In what patients may use of metformin therapy be considered for prevention of type 2 diabetes?

Back 24

Metformin therapy for prevention of T2DM can be considered for those at highest risk for DM such as:

-those w/ multiple risk factors, especially if demonstrating progression of hyperglycemia (i.e., A1C ≥ 6%) despite lifestyle interventions

-those w/ BMI > 35 kg/m2

-Age < 60 yrs

-Women with prior GDM

Front 25

Use of which oral diabetes medication class carries a rare risk (<5%) of hepatic toxicity?

Back 25

Thiazolidinediones (TZDs) ("-glitazones")

Front 26

With which oral diabetes medication(s) is pancreatitis a concern?

Back 26

1) Exenatide (Glucagon-like peptide-1 [GLP-1] agonists [incretin mimetics, "-tides"])

-Per FDA advisory, clinicians are advised to promptly d/c exenatide use and to advise pts using product to seek care if acute pancreatitis sxs (persistent abdominal pain, usually w/ vomiting)

-Exenatide is not recommended in pts w/ h/o pancreatitis

2) Sitagliptin (DPP-4 Inhibitors ["-gliptins"])

-Per FDA advisory, monitor patients carefully for the development of pancreatitis after initiation or dose increase of sitagliptin or sitagliptin/metformin

-DPP-4 use has not been studied in pts w/ h/o pancreatisis

Front 27

What is the MOA of Dipeptidyl Peptidase-4 (DPP-4) inhibitors?

Back 27

Increase levels of incretin, increasing synthesis and release of insulin from pancreatic beta cells and decreasing release of glucagon from pancreatic alpha cells

Front 28

With use of which oral diabetes medication class are GI adverse effects an issue?

Back 28

Alpha-glucosidase inhibitors

(acarbose [Precose] and miglitol [Glyset])

Front 29

What oral diabetes drug class may be added on to a patients treatment regimen if T2DM is not adequately controlled with a biguanide and/or SU?

Back 29

GLP-1 agonists (incretin mimetics, "-tides") are an adjunct to improve glycemic control in T2DM when not adequately controlled w/ a biguanide and/or SU

Front 30

Which oral diabetes drug class caries a risk of edema?

Back 30

TZDs ("'glitazones") - edema risk, particularly when used w/ insulin or SU

Front 31

Which oral diabetes medication has little risk of hypoglycemia when used as a solo product?

Back 31

Metformin (Glucophage)

Front 32

Which oral diabetes medication is typically less effective after ≥ 5 years w/ T2DM, in older adults, and/or in the presence of severe hyperglycemia?

Back 32

Sulfonylureas ("gl-ides")

Front 33

In the case of radiocontrast use, surgery, or other conditions that can potentially alter hydration status, what is required for a patient taking metformin?

Back 33

With radiocontrast use, surgery, or other conditions that can potentially alter hydration status, omit metformin day of and ≥ 48 hrs post-study, -procedure, condition

Reinitiate once baseline renal function has been re-established

Front 34

Use of which oral diabetes medication increases the risk of Vitamin B12 deficiency?

Back 34

Metformin use increases the risk of Vitamin B12 deficiency due to B12 malabsorption

Risk appears dose- and length- or therapy-dependent

Front 35

Use of insulin or nitrates is not recommended with which oral diabetes drug class?

Back 35

TZDs ("-glitazones") - in consideration of CV risk, use w/ insulin or nitrates is not recommended

Front 36

What are the major Adverse Effects of GLP-1 agonists (incretin mimetics)?

Back 36

Major A/E = Nausea and vomiting

These are usually better with dose adjustment, continued use

Front 37

Gastroparesis is a contraindication for use of which oral diabetes drug class?

Back 37

GLP-1 agonists ("-tides")

Front 38

Use of Pioglitazone in excess of 1 year, may be associated with an increased risk of what condition?

Back 38

-Increased risk of bladder cancer

Front 39

Which classes of oral diabetes medications have an anticipated A1C reduction of 1-2% with intensified use?

Back 39

-Sulfonylureas ("gl-ides")

-Biguanide (Metformin)

-Thiazolidinediones (TZDs, "-glitazones")

-Glucagon-like peptide-1 (GLP-1) agonists (Incretin mimetics, "-tides")

Front 40

What is the anticipated A1C reduction with intensified use of a dipeptidyl peptidase-4 (DPP-4) inhibitor?

Back 40

0.6 - 1.4%

Front 41

What is the anticipated A1C reduction with intensified use of a alpha-glucosidase inhibitor?

Back 41

0.3 - 0.9%

Front 42

Use of which oral diabetes drug class should be avoided in Inflammatory Bowel Disease?

Back 42

Alpha-glucosidase inhibitors

(acarbose [Precose] and miglitol [Glyset])

Front 43

Which oral diabetes medication class causes weight gain?

Back 43

Thiazolidinediones (TZDs, "-glitazones)

Front 44

What are examples of the Meglitinides?

Back 44

"-glinides"

-repaglinide (Prandin)

-nateglinide (Starlix)

Front 45

What is the MOA of meglitinides?

Back 45

-Stimulates pancreatic secretion of insulin

Front 46

What is the indication for use of meglitinides?

Back 46

Indicated for T2 diabetics w/ post-prandial hyperglycemia

Front 47

What are characteristics of meglidinides?

Back 47

Not recommended for monotherapy

Weight-neutral

Rapid acting w/ a very short half-life

Take before meals or up to 30 mins after a meal; hold dose if skipping a meal

Front 48

What are side effects of meglidinides?

Back 48

Bloating, abdominal cramps, diarrhea, flatulence

Front 49

Which oral diabetes medications require monitoring of amylase and lipase?

Back 49

Due to risk of pancreatitis, amylase and lipase must be monitored in the following:

The GLP-1 agonists (Exenatide [Byetta] & liraglutide [Victoza])

AND

The DPP-4 inhibitors (sitagliptin [Januvia] & saxagliptin [Onglyza])

Front 50

Which medications work on incretin and should not be combined?

Back 50

*Do not combine incretin mimetics (GLP-1 agonists) with any incretin enhancers (DPP-4 inhibitors) as both act on incretin

Front 51

Which antidiabetic medications cause weight loss?

Back 51

-Metformin

-GLP-1 agonists (incretin mimetics; e.g., Exenatide [Byetta])

-Amylin analogs (Symlin [Pramlintide])

Front 52

Which antidiabetic medications cause weight gain?

Back 52

-Sulfonylureas ("gl-ides")

-TZDs ("-glitazones")

-Insulin

Front 53

Which antidiabetic medications are weight neutral?

Back 53

-Meglitanides (repaglinide [Prandin] & nateglinide [Starlix])

-Bile-acid sequestrants (colesevelam [Welchol])

Front 54

What are examples of the Bile Acid Sequestrants?

Back 54

"C(h)oles-"

-cholestyramine (Questran)

-colesevelam (Welchol)

-colebystipol (Colestid)

Front 55

What is the MOA of of the Bile Acid Sequestrants?

Back 55

Reduce hepatic glucose production and may reduce intestinal absorption of glucose

*lowes LDL

Front 56

How should the bile acid sequestrants be taken?

Back 56

With meals

Front 57

What are side effects of of the Bile Acid Sequestrants?

Back 57

Side effects are GI related, such as nausea, bloating, constipation, increased triglycerides

-common reason for non-compliance. Start patient on a low dose and titrate up

Front 58

What lab need to be monitored with use of a Bile Acid Sequestrant?

Back 58

Have kidney and liver effects

Check serum creatinine, GFR, LFTs