Card Set Information
diabetes and medications
Name 2 alpha-glucosidase inhibitors.
Acarbose (Precose) and Miglitol (Glyset)
Name a biguanide.
Metformin ( glucophage)
Name the 2 DPP-4 inhibitors.
Sitagliptin (Januvia) and Saxagliptin ( Onglyza)
Name the 2 incretin mimetics.
Exenatide (Byetta) and Liraglutide (Victoza)
Name the 2 Meglitinides.
Repaglinide (Prandin) and Nateglinide (Starlix)
Name 3 sulfonylureas.
Glipizide (Glucotrol) and Glyburide (Diabeta) and Glimepiride (Amaryl)
Name the 2 glitazones.
Rosiglitazone (Avandia) and Pioglitazone (Actos)
Which class is most known for causing lactic acidosis?
Which class has been known to cause heart failure?
Which is the only class that is injected?
Which 2 drugs is Janumet made of?
Sitagliptin and Metformin
Which 2 drugs is Duetact made of?
Pioglitazone and Glimepiride.
Which 2 classes of drugs can cause wt gain and hypoglycemia?
Sulfonylureas and Meglitinides.
Name 3 of the most popular glucometer brands
OneTouch, Accu-check, Freestyle.
Name the 3 rapid acting insulin analogues by brand name.
Humalog, Novolog, Apidra.
Name the short acting insulin.
Name the intermediate acting insulin.
Name the 2 long acting insulins by brand name.
Lantus and Levemir.
Name the 2 long acting insulins by generic name.
Insulin glargine and insulin detemir
Name the 3 rapid acting insulin analogues by generic name.
Insulin lispro, aspart, gluisine
What is insulin lispro?
What is insulin aspart?
What is insulin glulisine?
What is insulin glargine?
What is insulin detemir?
How does biguanides work?
Reduced liver release of glc (decrease gluconeogenesis) also increase glc uptake.
How does DPP-4 Inhibitors work?
Blocks DPP-4 ( which degrades incretins like GLP-1)
How does incretin mimetics work? AKA?
Increase insulin from beta cells, suppress glucagon, delays gastric emptying and promote satiety. AKA GLP-1 receptor agonists.
How does Meglitinides work? Similar to what other class?
Binds to sulfonylurea receptors on beta cells, stimulating insulin release. Similar to sulfonylureas.
How does sulfonylureas work?
Binds to sulfonylurea receptors on beta cells, stimulating insulin release. Similar to Meglitinides.
How to glitazones work?
Makes peripheral tissues more sensitive to insulin.
Which class works on the liver?
Which class makes peripheral tissues more sensitive to insulin? Name 2 drugs in the class.
Rosiglitazone (Avandia) and
Which class can cause swelling leading to wt gain?
In which class is there possible cause of angioedema, urticaria and Stevens Johnson's syndrome?
DPP-4 inhibitors , but generally very good side effect profile.
Compare onset and duration btw sulfonylureas and Meglitinides.
Meglitinides faster onset, shorter duration, less likely to cause hypoglycemia.
When should one take sulfonylureas? Meglitinides?
: 30 min AC
: 0-30 min AC
In Who is Metformin contraindicated?
Renal insuffic (Cr>1.4 in women, 1.5 in men)
Unstable CHF, hepatic dysfct, alcoholism
What are common side effects of Glucophage?
Which class of drugs may take 6-12 weeks to see an effect?
Which lipid lowering drug is the only one approved for DM?
Which classes have pancreatitis been reported especially with Metformin?
DPP-4 inhibitors and incretin mimetics.
What's the target range for glc in DM?
Which classes of med are effective when pt is eating?
Alpha-glucosidase inhibitors, biguanides GLP-1 agonists and DPP-4 inhibitors.
What's normal, prediabetic and diabetic based on A1c levels?
What's normal, prediabetic and diabetic based on 2 hr OGTT? (75 g)
: 140-199 (IGT)
If hyperglycemic Sx what Random glucose level is enough to make the diagnosis of DM?
Capillary glc is what % lower than venous glc?
What are contraindications for glitazones?
ALT> 2.5x ULN
Which 2 classes of drugs promote wt maintenance/ loss?
Biguanides and incretin mimetics.
In what size vials do all insulins come? 1 cc= how many units?
All in 10 cc vials. 1 cc= 100 units. So each vial = 1000 U
What are the 3 choices after Metformin?
TZDs, DPP-4s or sulfonylurea
What's the recommended therapy for FBS btw 151-250
Diet/exercise and 1 oral agent
What's the recommended therapy for FBS btw 251-350
Diet/exercise and 2 oral agents
What are 4 drugs shown to delay/ prevent DM?
: metformin, acarbose, rosiglitazone and pioglitazone
( but not FDA approved for this indication)
What does both ADA and EASD Recommend for ppl w/ IFG or IGT?
Mod intensity exercise 30 min q day & 5-10% wt loss
When does the onset of rapid acting insulin? Peak?
: 10-15 min
When does the onset of regular insulin? Peak?
: 0.5-1 hr
: 2-4 hrs
When does the onset of intermediate insulin? Peak?
: 1-3 hrs
: 4-10 hrs
Insulin sensitizers or secretagogues as 1st line?
Sensitizers (Metformin/ TZDs)
Who should stringent glc control be considered?
Younger, shorter DM duration, no CVD since w/ older tight control may actually increase mortality (from hypoglycemia?)
What's the ideal bp for diabetics?
In general how long are the insulin vials good for at room temp?
Which is the only insulin that's cloudy?
Intermediate ( NPH or Humulin N or Novolin N)
Which sulfonylureas is thought to have a higher incidence of hypoglycemia, ESP irregardless of BS?
How does ETOH consumption affect BS?
Can lower. (depletes glycogen and inhibits gluconeogenesis)
What is the main side effect of Exenatide?
nausea (40%) but doese dependent and decreases over time
When adding insulin, which drugs should be d/c
the secretagogues (sulfonylureas/glinides). And glitazones shouldn't be continued. DPP4/ GLP1 agonists shouldn't be combined either.... so essentially only metformin OK!
In whom should you consider insulin as initial therapy?
Those with fasting glc >250 or A1C >10% or those w/ ketonuria.
Exercise and wt loss can lower A1c by how much?
1-2%! so do first
Which glitazone now not recommended due to cV effects?
Why tight glc control initially?
studies have shown will result in normoglycemia better later on, even possibly w/o needing meds
What is a common starting dose for insulin?
10 units/day either qd or divided BID. OR 0.2 units/ kg BW
When should pts check their BG esp. on insulin?
pre-breakfast and pre-dinner
What are 2 names of regular insulin?
Humulin and Novolin
In general when is insulin injected?
15-30 min before a meal
Those w/ DM and also HTN/ dyslipidemia should also take what?
Should DM II pts not on insulin self monitor glc?
evidence not conclusive on benefit, but there IS a stat. sig. decrease of ~0.4% in A1c levels when monitoring at least once.
: $$, cause worry, possible more hypoglycemia?)