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45 Cards in this Set

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Sulfonylureas mean A1c reduction
1.5-2%
Sulfonylureas AE's
-hypoglycemia
-weight gain
-hyponatremia w/ 1st gen agents
Sulfonylureas monitoring
Efficacy
-A1c quaterly
-SMBG at each visit

Safety
-wt. and sx of hypoglycemia at each visit
-renal function at baseline, if suspected change, atleast annually
Sulfonylureas administration
20-30 mins prior to a meal
Sulfonyureas precautions
-glyburide should not be used if CrCl <50

-glipizide and glimeperide should not be used if CrCl <30

-sulfa allergy
Sulfonylureas clinical pearls
-1st line agents for non-overweight or elderly patients

-glipizide or glimeperide in elderly because of lower CrCl
Meglitinides mean A1c reduction
0.6-1%
Meglitinides AE's
-hypoglycemia (less than SU)
-weight gain
Meglitinides drug interactions
-Gemfibrozil more than doubles t1/2 of repaglinide
Meglitinides monitoring
Efficacy
-A1c quarterly
-SMBG at each visit

Safety
-signs and sx of hypoglycemia at each visit

-renal function baseline, if suspected change, atleast annually
Meglitinies administration
Just prior to each meal 3-4 times/day, skip dose if meal skipped
Meglitinides precautions
elderly and malnourished more likely to develop hypoglycemia
Meglitinides clinical pearls
-advantage = decreased incidence of hypoglycemia

-disadvantage = less efficacy than SU, expensive, and require TID/QID dosing
Biguanides A1c reduction and lipid effects
1.5-2%

-decrease TGs=16%
-decrease LDL-C=8%
-increase HDL=2%
Biguanides AE's
-Weight loss
-GI (diarrhea, NV, abdominal cramps, flatulence) may subside after 2-3 weeks of use

Lactic acidosis (muscle pain, weakness, fatigue, shortness of breath, slowed heartbeat)
Biguanides lactic acidosis risk factors
PHARMDS
Biguanides monitoring
Efficacy
-A1c quarterly
-SMBG at each visit
-Weight at each visit

Safety
-Renal function at baseline, if recent change suspected, atleast annually
-Hepatic function at baseline, if recent change suspected and atleast annually
-Electrolytes if suspected acidosis and atleast annually
Biguanidies contraindications
-Renal dysfunction
*SCr >1.5 males; >1.4 females
*CrCl <30

-medically managed CHF
Biguanides clinical pearls
-1st line agent for overweight/obest patients

-only medication shown to decrease macrovascular complications in obese DM patients

-Does not generally cause hypoglycemia
Thiazolidinediones A1c reduction
1.5%
Thiazolidinediones lipid effects
-Both drugs increase HDL 3-9mg/dl

-Rosiglitazone increases LDL 5-15%

-Pioglitazone decrease TG 10-20%
Thiazolidinediones AE's
-weight gain
-edema
-headache
-increased liver transaminases
-anemia
Thizolidinediones contraindications
-CHF class III or IV

-AST or ALT > 3x UNL at baseline
Alpha glucosidase inhibitors A1c reduction
0.25-0.5%
Alpha glucosidase inhibitors AE's
-abdominal cramping
-flatulence
Alpha glucosidase inhibitors monitoring
Efficacy
-A1c quarterly
-SMBG at each visit

Safety
-renal function at baseline, if suspect recent change, atleast annually
Incretin (GLP1) mimetic MOA
enhances glucose-dependent insulin secretion, slows gastric emptying
Incretin efficacy
-most effective for reducing PPG
-A1c reduction by 0.5-1.5% when in combo with metformin or SU
Incretin AE's
-NV
-Weight loss
Incretin monitoring
Efficacy
-A1c quarterly
-SMBG at each visit
Incretin clinical pearls
-approved for use in combo with metformin and SU only

-advantages = glucose-dependent insulin release and weight loss
Amylinomimetic MOA
-slows gastric emptying, prevents postprandial glucagon secretion, promotes satiety
Amylinomimetic efficacy
-most effective for reducing PPG

-decreases A1c by about 0.5%
Amylinomimetic monitoring
Efficacy
-A1c quarterly
-SMBG at each visit
Amylinomimetic contraindications
-gastroparesis
-hypoglycemic unawareness
Amylinomimetic clinical pearls
-approved for use ONLY in combo with mealtime insulin (+/- SU and/or metformin)

-Advantage = potential for weight loss
Insulin AE's
-hyperglycemia
-weight gain
-lipohypertrophy
-lipoatrophy
Insulin drug interactions
-Corticosteroids
-thiazides
-Beta-blockers
Insulin monitoring
A1c quarterly, SMBG for every patient on insulin, weight at each visit
Sulfonylureas (Glipizide) starting dose and maximum dose
Starting dose = 5mh po BID before meals

Max dose = 40mg/day (20mg BID)
Meglitinide (Nateglinide) starting dose and maximum dose
Starting dose = 120mg with each meal (TID)

Max dose = 120mg TID
Biguanide (Metformin) starting dose and maximum dose
Starting dose = 500mg w/ evening meal; increase to 500mg BID in one week

Max dose = 2550mg/day (divided doses either BID or TID)
TZD (Pioglitazone) starting dose and maximum dose
Starting dose = 15mg po daily

Max dose = 45mg po daily
Alpha glucosidase inhibitor (Acarbose) starting dose and maximum dose
Starting dose= 25mg daily to TID (titrate slowly)

Max dose= 100mg TID
Incretin mimetic (Exenatide) starting dose and maximum dose
Starting dose = 5mcg subcutaneously BID

Max dose = 10mcg subcutaneously BID