T2Dm Meds

Front 1

Glucophage
a.) class
b.) MOA (3)
c.) route
d.) dosing & titration

Back 1

Metformin
a.) biguanide
b.) decrease liver glucose production and decrease glucose intestinal absorption, increase insulin sensitivity
c.) oral
d.) 500 mg QD for 1 week, then 500mg BID; max 2000mg

Front 2

Glucophage
a) common ADR (2)
b.) serious ADR + risk factor
c.) C/I (3)
d.) monitoring (4)

Back 2

Metformin
a.) weight LOSS, GI upset
b.) lactic acidosis; PHARMDS (poor kidney, hepatic, alcohol, radiocontrast dye, medically managed CHF, dehydration, surgery
c.) renal dysfunction (M: SCr ≥ 1.5; F: SCr ≥1.4, CrCl ≤ 60), HF needing drugs, metabolic acidosis (acute or chronic)
d.) Ac1 quarterly, SMBG each visit, ADRs, Renal function at baseline and annually

Front 3

PHARMDS
a.) indication
b.) what

Back 3

a.) risk factor for lactic acidosis when taking metformin/ glucophage
Poor renal function
Hepatic dysfunction
Alcohol
Radiocontrast dye
Medically managed CHF
Dehydration
Surgery

Front 4

Brand names of Metformin (4)

Back 4

1.) glucophage or glucophage XR
2.) fortamet
3.) riomet

Front 5

Fortamet

Back 5

Metformin

Front 6

Riomet

Back 6

Metformin

Front 7

Lactic acidosis
a.) which drug
b.) symptoms
c.) risk factors

Back 7

a.) metformin/glucophage/ riomet/ fortamet
b.) muscle pain, SOB, weakness, fatigue
Poor renal function (M with SCr ≥ 1.5, F with SCr ≥ 1.4, CrCl ≤ 60)
Hepatic dysfunction
Alochol
Radiocontrast dyes
Medically managed CHF
Dehydration
Surgery

Front 8

Advantages of metformin (4)

Back 8

1.) weight losee
2.) decreases CV risk
3.) does not cause hypoglycemia
4.) decreases macrovascular complications

Front 9

What to do for GI upset of metformin?

Back 9

start with small dose, take with meals, slowly titrate every 1-2 weeks

Front 10

I SEEN

Back 10

Immunizations: Flu yearly and pneumococcal <65 and >65 space 5 years apart
SMBG
Exercise regulary
Education
Nutrition assessment

Front 11

Non-pharm therapy for t2dm

Back 11

Immunizations: Flu yearly and pneumococcal <65 and >65 space 5 years apart
SMBG
Exercise regulary
Education
Nutrition assessment

Front 12

Glipizide
a.) brands

Back 12

a.) Glucotrol or Glucotrol XL

Front 13

Glucotrol

Back 13

Glipizide

Front 14

Glucotrol XL

Back 14

Glipizide

Front 15

The 3 types of sulfonylureas (generic)

Back 15

1.) glipizide (glucotrol)
2.) glyburide (micronase, diabeta)
3.) glimepiride (amaryl)

Front 16

Amaryl

Back 16

Glimepiride (SFU)

Front 17

Diabeta

Back 17

Glyburide

Front 18

Micronase

Back 18

Glyburide

Front 19

Glipizide
a.) class
b.) MOA
c.) route
d.) dosing & titration
e.) renal dosing limit

Back 19

Glucotrol or Glucotrol XL
a.) sulfonylurea
b.) pokes the pancreas. binds to K channel to release Ca to release insulin
c.) oral
d.) 5-40mg total, divided BID 20-30 minutes before meals; XL is 5-20mg toal
e.) stop when CrCl <10

Front 20

Glyburide
a) common ADR (2)
b.) serious ADR
c.) C/I (3)
d.) monitoring (4)

Back 20

Micronase, diabeta
a.) hypoglycemia, weight GAIN
b.) disulfram-like rxns & flushing
c.) T1DM, DKA, sulfa allergy
d.) A1c quarterly, SMBG q visit, ADRs, renal at baseline and annually

Front 21

CrCl of SFUs

Back 21

1.) glipizide: Don't use if CrCl<10
2.) glyburide: don't use if CrCl <50
3.) glimepiride: don't use if CrCl <30 (like exenatide)

Front 22

CrCl <30
a.) what not to use (2 classes, 3 drugs)
b.) what is ok to use (SFU)
c.) metformin?

Back 22

a.) SFUs: glimepiride (30), glyburide (50), GLP-1 agonist: exenatide
b.) glipizide (10)
c.) No (CrCl <60)

Front 23

CrCl <50
a.) what not to use (SFU)
b.) what is ok to use (SFU)
c.) metformin?

Back 23

a.) glyburide
a.) glimepiride (30), glipizide (10)
b.) no (CrCl <60)

Front 24

CrCl <10
a.) what not to use (SFU)
b.) what is ok to use (SFU)
c.) metformin?

Back 24

a.) al SFUs!
b.) none
c.) no (CrCl <60)

Front 25

What t2dm drug is contraindicated in t1dm patients?

Back 25

Sulfonylureas

Front 26

What t2dm drug is contraindicated in DKA patients?

Back 26

Sulfonylureas

Front 27

1.) What is the max effective dose of SFUs?
2.) name them

Back 27

1.) 60% of their max dose
a.) glipizide: max is 40mg daily in divided doses = 24mg most effective
b.) glyburide: max is 20mg daily in divided doses = 12mg effective dose
c.) glimepiride: max is 8mg, 4.8mg effective dose

Front 28

Short-acting insulin secretagogues (2)

Back 28

Nateglinide - Starlix
Repaglinide - Prandin

Front 29

Prandin
a.) generic
b.) class
c.) dose
d.) d-d rxn

Back 29

a.) Repaglinide
b.) short-acting insulin secretagogue
c.) 0.5-1mg TID with food or up to 30min before
d.) gemfibrozil, trimethoprim

Front 30

Starlix
a.) generic
b.) class
c.) dose

Back 30

a.) Nateglinide
b.) short acting insulin secretagogue
c.) 120mg TID with food or up to 30min before

Front 31

Glinides
a.) class
b.) MOA & target
c.) route
d.) dosing & titration

Back 31

Repaglinide/prandin & starlix/nateglinide
a.) short-acting insulin secretagogue
b.) glucose dependent insulin secretion, targets BG post-prandial
c.) oral
d.) 0.5-1mg TID (prandin) or 120mg TID (starlix) with meals or up to 30 min before

Front 32

Glinides
a) common ADR (2)
b.) drug interactions
c.) monitoring

Back 32

a.) hypoglycemia & weight gain (like SFUs)
b.) gemfibrozil and trimethoprim for repaglinide/prandin (causes increased half-life = hypoglycemia)
c.) A1c quarterly, SMBG q visit, ADRs

Front 33

Which drug causes disulfram-like rxns/ flushing?

Back 33

SFUs (mainly 1st gen)

Front 34

Which drugs do NOT need renal dosing? (3)

Back 34

1.) Glinides
2.) liraglutide - victoza
3.) trajenta/liragliptin

Front 35

Major difference between glinides and SFUs?

Back 35

Glinides are shorting acting for meal time dosing. Glinides also cause less hypoglycemia. This is good for patients who don't need good glycemic control (bc glinides are less effective) and have renal problems

Front 36

GLP-1 agonists
a.) types (2)
b.) MOA (2.)
c.) route
d.) dosing & titration

Back 36

a.) exenatide (byetta, bydureon) & liraglutide (Victoza)
b.) slows gastric emptying, enhances glucose-dependent insulin secretion
c.) SQ injection at ab, thigh, upper arm
d.) exenatide: 5mcg SQ BID within 60 minutes of breakfast and dinner; liraglutide 0.6 mcg SQ daily x 1wk, then 1.2 mcg SQ daily

Front 37

What is a SQ drug?

Back 37

GLP-1 agonists (exenatide/byetta & bydureon & liraglutide/ victoza)

Front 38

GLP-1 agonists
a) common ADR
b.) serious ADR (2)
c.) C/I (4)
d.) monitoring (3)

Back 38

a.) GI upset
b.) acute pancreatitis like DPP IV (also thyroid C-cell tumors in liraglutide/victoza
c.) exenatide = severe GI disease & CrCl <30 (like glimepiride); liraglutide = cancer (thyroid and endocrine neoplasia type 2)
d.) A1c quarterly, SMBG q visit, ADRs

Front 39

What drug causes acute pancreatitis? (2)

Back 39

GLP-1agonists: Liraglutide/victoza & exenatide/byetta/bydureon

also DPP IV inhibitors (sitagliptin/januvia, saxagliptin/onglyza, liragliptin/trajenta

Front 40

What drug causes thyroid C-cell tumors?

Back 40

Liraglutide/victoza, a GLP-1 agonist

Front 41

Which drug is C/I if pt has severe GI disease?

Back 41

Exenatide

Front 42

Which drug is C/I if pt has endocrine neoplasia type 2?

Back 42

Liraglutide

Front 43

Gliptin brands (3)

Back 43

1.) Onglyza - Saxagliptin
2.) Januvia - Sitagliptin
3.) Trajenta - Liragliptin

Front 44

Gliptins
a.) names (3)
b.) MOA
c.) route
d.) dosing & titration
e.) renal (general dose)

Back 44

a.) sitagliptin - janivia, saxagliptin - onglyza, liragliptin - trajenta
b.) DPP IV inhibitor = increase GLP-1
c.) oral
d.) 100mg QD (januvia), 5mg QD (onglyza or trajenta)
e.) 50mg januvia if CrCl 30-50 or 25mg if CrCl<30, SCr >3, dialysis.
saxagliptin 2.5mg if CrCl <50 or using cyp3a4 inhibitor (ketoconazole)

Front 45

Gliptins
a) common ADR (3)
b.) serious ADR
c.) monitoring (3)

Back 45

a.) headache, nasopharyngitis, URI (upper respiratory infection)
b.) acute pancreatitis like GLP-1 agonists (tides)
c.) A1c quarterly, SMBG q visit, ADRs

Front 46

Which drug causes nasopharyngitis?

Back 46

DPP IV inhibitors (gliptins)

Front 47

Which drug causes URI?

Back 47

DPP-IV inhibitors (gliptins)

Front 48

Which drug causes headache?

Back 48

DPP IV inhibitors (gliptins)

Front 49

Onglyza
a.) generic
b.)class
c.) dose
d.) avoid
e.) renal dosing

Back 49

a.) saxagliptin
b.) DPP IV inhibitor
c.) 5mg daily
d.) strong CYP3A4/5 inhibitors
e.) 2.5mg PO daily if using ketaconazole (strong CYP3A4 inhibitor) or CrCl <50

Front 50

Januvia
a.) generic
b.)class
c.) dose
d.) renal dosing if mild
e.) renal dosing if bad

Back 50

a.) sitagliptan
b.) DPP IV inhibitor
c.) 100 mg daily
d.) 50mg PO daily if CrCl 30-50 and SCr 1.7-3mg;
e.) 25mg PO daily if CrCl <30 or dialysis

Front 51

Trajenta
a.) generic
b.)class
c.) dose
d.) renal dosing

Back 51

a.) liragliptin
b.) DPP IV inhibitor
c) 5mg daily
d.) none

Front 52

Saxagliptin should not be administered with what?

Back 52

CYP 3A4/5 inhibitors

Front 53

Which drugs DO need renal monitoring

Back 53

1.) biguanide (C/I when CrCl <60, SrCr <1.5M or <1.4F)
2.) SFU (C/I when CrCl 10, 50, 30)
3.) exenatide (C/I when CrCl <30)
4.) DPP IV (alter dose based on renal function)

Front 54

CYP3A4/5 inhibitors avoid with

Back 54

saxagliptin

Front 55

Patient is taking gemfibrozil
a.) Drug to avoid?
b.) why?

Back 55

a.) Repaglinide/ Prandin
b.) increased half-life of repaglinide = more hypotension

Front 56

Patient is taking trimethoprim:
a.) Drug to avoid?
b.) why?

Back 56

a.) Repaglinide/Prandin
b.) increased half-life of prandin = more hypoglycemia