Therapeutics - T2DM

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kyleannkelsey
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290290
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Therapeutics - T2DM
Updated:
2014-11-30 18:18:29
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Therapeutics T2DM
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Therapeutics - T2DM
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Therapeutics - T2DM
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  1. What is the brand name for Metformin?
    Glucophage
  2. What is the Generic name for Glucophage?
    Metformin
  3. What are the benefits of Metformin (Glucophage)?
    • No hypoglycemia
    • Weight loss
    • Slight TG decrease
    • Controls hyperglycemia by >90%
    • Obese: better CV outcomes
  4. What are the AE of Metformin (Glucophage)?
    • Anorexia upon initiation
    • B12 deficiency overtime (supplement)
    • Lactic acidosis
  5. What are the CIs/Precautions of Metformin (Glucophage)?
    • Renal impairment: male >1.5, female >1.4
    • Hypoxia (severe cardiac or pulmonary disease), alcohol abuse, > 80 years
    • CHF
    • Hypothyroidism
  6. What are the DDIs of Metformin?
    • Alcohol
    • Iodinated contrast materials
    • Cimtidine
  7. Which Sulfonylurea is preferred in renal impairment?
    Glipizide
  8. What are the adverse reactions of Sunfonylureas?
    • Hypoglycemia
    • Rash/Photosensitivity/pruritis/hypersensitivity
    • GI disturbance
    • Increased mortality as first line
    • Increased risk for bone fractures
    • Weight gain
  9. What are the sulfonylureas?
    • Glipizide (Glucotrol)
    • Glimepiride (Amaryl)
    • Glyburide (Micronase, Glynase or Diabeta) – Don’t use
  10. What is the brand name for Glipizide?
    Glucotrol
  11. What is the brand name for Glimepiride?
    Amaryl
  12. What is the generic name for Glucotrol?
    Glipizide
  13. What is the generic name for Amaryl?
    Glimepiride
  14. What are the Glinides?
    • Repaglinide (Prandin)
    • Nateglinide (Starlix)
  15. What is the brand name for Repaglinide?
    Prandin
  16. What is the brand name for Nateglinide?
    Starlix
  17. What is the generic name for Prandin?
    Repaglinide
  18. What is the generic name for Starlix?
    Nateglinide
  19. What are the kinetics of Glinides?
    • OOA: 15 minutes
    • Peak: 60–90 minutes
    • DOA: less than 4 hours
    • Metabolized by: CYP 3A4
  20. What are the advantages of Glinides?
    • Rapid onset and short duration of action compared with sulfonylurea.
    • Elimination is primarily through feces= good in renal insufficiency
    • May be useful in patients who skip meals.
  21. What are the Alpha-glucosidase inhibitors?
    • Acarbose (Precose)
    • Miglitol (Glyset)
  22. What are the AE of Alpha-glucosidase inhibitors?
    • Abdominal pain, flatulence, diarrhea
    • Acarbose: increased liver function tests at doses of 100 mg and more than TID
  23. Which T2DM drugs are Weight neutral?
    • Alpha-glucosidase inhibitors
    • Gliptins
    • SGLT2 inhibitor
  24. What are the CI/precautions to using Alpha-glucosidase inhibitors?
    GI disorders including inflammatory bowel disease, chronic ulceration, and partial obstruction
  25. How do you treat hypoglycemia in a patient taking an Alpha-glucosidase inhibitor?
    Use glucose tablets, not sucrose like in a candy bar or any other complex carbohydrate
  26. What is the MOA of Thiazolidinediones?
    • Peroxisome proliferator activated receptor agonist to promote glucose uptake into target cells (skeletal muscle/adipose)
    • 1. Decreases insulin resistance
    • 2. Increases insulin sensitivity
    • 3. No effect on insulin secretion
  27. What are the Thiazolidinediones?
    • Pioglitazone (Actos)
    • Rosiglitazone (Avandia)
  28. What is the brand name for Pioglitazone?
    Actos
  29. What is the brand name for Rosiglitazone?
    Avandia
  30. What is the generic name for Actos?
    Pioglitazone
  31. What is the generic name for Avandia?
    Rosiglitazone
  32. What are the adverse effects of Thiazolidinediones?
    • Hepatotoxicity
    • Edema
    • Fracture risk is increased
    • Weight gain
    • Resumption of ovulation
    • Bladder cancer risk
    • macular edema
  33. What are the DDIs of Thiazolidinediones?
    Decrease conc. of oral estrogens
  34. What are the CIs/Precautions of Thiazolidinediones?
    • Edema may cause worsensing of CHF
    • CI: LFTs >2.5 or >3x UL of normal
  35. What is the MOA of incretin mimetics?
    • Stimulates glucagon-like peptide 1 receptor.
    • Stimulates the production of insulin in response to high glucose concentrations
    • Inhibition of the release of glucagon after meals
    • Slows the rate of gastric emptying
  36. What are the incretin mimetics?
    • Exenatide (Byetta)
    • Liraglutide (Victoza)
    • Exenatide-Extended Release (Bydureon)
    • Albiglutide (Tanzeum)
    • Dulaglutide (Trulicity)
  37. What is the brand name for Exenatide?
    Byetta
  38. What is the brand name for Liraglutide?
    Victoza
  39. What is the brand name for Exenatide-Extended Release?
    Bydureon
  40. What is the brand name for Albiglutide?
    Tanzeum
  41. What is the brand name for Dulaglutide?
    Trulicity
  42. What is the generic name for Byetta?
    Exenatide
  43. What is the generic name for Victoza?
    Liraglutide
  44. What is the generic name for Bydureon?
    Exenatide-Extended Release
  45. What is the generic name for Tanzeum?
    Albiglutide
  46. What is the generic name for Trulicity?
    Dulaglutide
  47. What are the AE of Exenatide (Byetta)?
    • Hypoglycemia (greater in combination with sulfonylurea than with metformin)
    • Nausea
    • Diarrhea, feeling jittery, dizziness, headache, dyspepsia
    • Anti-exenatide antibodies
    • Possible increased risk of pancreatitis; class effect?
  48. What are the DDIs of Exenatide Byetta?
    May affect the drug absorption that requires peak concentrations (oral contraceptives and antibiotics)
  49. What are the precautions of Exenatide (Byetta)?
    • Cannot be used as a substitute for insulin in type 1 diabetes.
    • Hypoglycemia in combination with a sulfonylurea.
    • Do not use in severe renal impairment (ClCr < 30 mL/minute or
    • end-stage renal disease); caution in ClCr 30-50 mL/min.
    • Do not use in patients with severe GI disease.
    • Pregnancy Category C

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