Term
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Definition
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Term
|
Definition
sulfonylureas
meglitinides |
|
|
Term
| glyburide, glipizide, glimepiride |
|
Definition
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
| rosiglitazone, pioglitazone |
|
Definition
|
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Term
|
Definition
| alpha-glucosidase inhibitors |
|
|
Term
| What type of oral diabetic agents are inexpensive and used to be first line treatment? |
|
Definition
|
|
Term
| Why can sulfonylureas be problematic in elderly patients? |
|
Definition
long acting
(elderly have slower metabolism) |
|
|
Term
| sulfonylureas mechanism of action |
|
Definition
| stimulate insulin secretion from pancreatic beta cells |
|
|
Term
| side effects of sulfonylureas |
|
Definition
|
|
Term
| Why are 1st generation sulfonylureas not used much anymore? |
|
Definition
| lots of drug interactions |
|
|
Term
| Sulfonylureas are often used... |
|
Definition
| in combination with other drugs |
|
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Term
| contraindications for sulfonylureas |
|
Definition
ketoacidosis or diabetic coma
known hypersensitivity to this class |
|
|
Term
| black box warning for sulfonylureas |
|
Definition
| cardiovascular disease (may increase cardiovascular mortality) |
|
|
Term
| mechanism of action of other secretagogues |
|
Definition
| bind to sulfonylurea receptor to get the same effect as sulfonylureas |
|
|
Term
| What is a main different between sulfonylureas and other secretagogues? |
|
Definition
| other secretagogues are short acting |
|
|
Term
| When would another secretagogue not be effective? |
|
Definition
| when sulfonylureas have already been used and were not effective |
|
|
Term
| side effects of other secretagogues |
|
Definition
|
|
Term
| contraindications for other secretagogues |
|
Definition
DM-1
diabetic ketoacidosis |
|
|
Term
| Which secretagogues might be better to use in the elderly and why? |
|
Definition
repaglinide or nateglinide
because they are short acting |
|
|
Term
| Why is metformin such a good drug? |
|
Definition
| does not cause hypoglycemia |
|
|
Term
| mechanism of action for metformin |
|
Definition
-decreases hepatic gluconeogenesis
-decreases GI absorption of glucose
-increases glucose intake by skeletal muscle |
|
|
Term
| side effects of metformin |
|
Definition
GI disturbance (dose related)
weight loss |
|
|
Term
| contraindications for metformin |
|
Definition
renal dysfunction
CHF
metabolic acidosis |
|
|
Term
| black box warning for metformin |
|
Definition
lactic acidosis
monitor creatinine in all pts, check GFR in elderly pts, beware in CHF |
|
|
Term
| What oral diabetic agents do not cause hypoglycemia? |
|
Definition
biguanides
thiazolidinediones (TZDs)
alpha-glucosidase inhibitors |
|
|
Term
| mechanism of action for TZDs |
|
Definition
increase insulin sensitivity in muscle, liver, and adipose tissue
decrease insulin resistance |
|
|
Term
| black box warning for TZDs |
|
Definition
warning in CHF (contraindicated for class III and IV)
myocardial ischemia |
|
|
Term
|
Definition
change in serum lipids (LDL and HDL)
macular edema |
|
|
Term
| What do you need to monitor before and during treatment with a TZD? |
|
Definition
| HbA1c and transaminases (ALT, AST) |
|
|
Term
| What is the main use for alpha-glucosidase inhibitors? |
|
Definition
| increased post-prandial glucose |
|
|
Term
| mechanism of action for alpha-glucosidase inhibitors |
|
Definition
decrease glucose absorption
decrease post-prandial glycemic excursion |
|
|
Term
| side effects of alpha-glucosidase inhibitors |
|
Definition
|
|
Term
| contraindications for alpha-glucosidase inhibitors |
|
Definition
ketoacidosis
GI problems
kidney/liver disease |
|
|
Term
| What is the problem with oral diabetic combination meds? |
|
Definition
| if pt has a reaction, you don't know which med caused it |
|
|
Term
|
Definition
|
|
Term
|
Definition
-stimulate insulin release in the presence of glucose
-slow gastric emptying
-suppress inappropriate glucagon secretion
-enhance satiety |
|
|
Term
| mechanism of action for DPP-4 inhibitors |
|
Definition
| slow incretin metabolism which increases insulin synthesis/release and decreases glucagon levels |
|
|
Term
|
Definition
|
|
Term
| What kind of HbA1c decrease will you typically see with a DPP-4 inhibitor alone and with metformin? |
|
Definition
0.5% alone
almost 2% with metformin |
|
|
Term
| What risk is there with DPP-4 inhibitors? |
|
Definition
pancreatitis
If pt. comes in with abdominal or back pain and they are on a DPP-4 inhibitor, get an amylase and lipase to check for pancreatitis. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| side effects with liraglutode |
|
Definition
hypoglycemia with secretagogues
pancreatitis |
|
|
Term
| black box warning for liraglutide |
|
Definition
| thyroid C-cell tumors in rats and mice; hyperplasia observed in humans |
|
|
Term
| contraindications for liraglutide |
|
Definition
| PMHx or FHx of MTC or MEN-2 |
|
|
Term
|
Definition
| pancreatic beta cells (islet of Langerhans) |
|
|
Term
| Insulin is catabolized by the _______ and _______. |
|
Definition
|
|
Term
| Insulin binds to insulin receptors in the _______, ______ and _____. |
|
Definition
|
|
Term
|
Definition
-promotes fuel storage
-prevents breakdown and release of stored fuel |
|
|
Term
|
Definition
| interacts with many other meds |
|
|
Term
| What site of administration of SC insulin yields the fastest absorption? |
|
Definition
| abdomen (not within 2 inches of umbilicus) |
|
|
Term
| When might IV insulin be used? |
|
Definition
| emergency situations (ketoacidosis) |
|
|
Term
| major side effect of insulin |
|
Definition
|
|
Term
| What oral diabetic agent cannot be used with insulin? |
|
Definition
| rosiglitazone (Avandia)--TZD |
|
|
Term
| What must you watch when treating DKA with insulin? |
|
Definition
|
|
Term
| aspart novolog, lispro humalog, glulisine apidra |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| glargine lantus, detemir levemir |
|
Definition
|
|
Term
| What combination of insulin is usually best? |
|
Definition
|
|
Term
| treatment of hypoglycemia |
|
Definition
oral glucose
rectal glucose
glucagon
D-50 |
|
|
Term
|
Definition
|
|
Term
| Levothyroxine is converted to ____ intracellularly. |
|
Definition
|
|
Term
|
Definition
once daily (half life of 7 days)
take on empty stomach |
|
|
Term
|
Definition
|
|
Term
| Thyroid meds promote __________. |
|
Definition
|
|
Term
| contraindications for levothyroxine |
|
Definition
untreated thyrotoxicosis
acute MI
hypothyroidism with untreated Addison's |
|
|
Term
| treatment of hyperthyroidism |
|
Definition
thioamides
adrenergic blocking agents (propranolol)
removal of all or part of thyroid |
|
|
Term
| mechanism of action for thioamides in hyperthyroidism |
|
Definition
| inhibit thyroid hormone synthesis |
|
|
Term
| mechanism of action for adrenergic blocking agents in hyperthyroidism |
|
Definition
| blunt sympathetic stimulation caused by hyperthyroidism |
|
|
Term
| drug of choice for hyperthyroidism |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the preferred treatment of hyperthyroidism in pregnancy (especially in the 1st trimester)? |
|
Definition
|
|
Term
| major side effect of thioamides |
|
Definition
|
|
Term
| What class of drugs are mainstay for osteoporosis treatment? |
|
Definition
|
|
Term
| alendronate, risedronate, ibandronate |
|
Definition
|
|
Term
| special instructions for taking oral bisphosphonates |
|
Definition
|
|
Term
|
Definition
| SERM (selective estrogen receptor modulator) |
|
|
Term
| mechanism of action for bisphosphonates |
|
Definition
| inhibit bone resorption by osteoclasts |
|
|
Term
| contraindications for bisphosphonates |
|
Definition
| if pt is unable to remain upright for 30-60 min after taking medication |
|
|
Term
| contraindications for androgens |
|
Definition
| breast or prostate cancer |
|
|
Term
| major side effect of androgens |
|
Definition
| increases LDL and decreases HDL which increased risk of CAD |
|
|
Term
| finasteride (Proscar, Propecia) |
|
Definition
5 alpha reductase inhibitor
for BPH and male androgenic hair loss |
|
|
Term
| mechanism of action for finasteride |
|
Definition
| blocks conversion of testosterone to dihydrotestosterone |
|
|
Term
|
Definition
-promote endometrial growth to support embryo implantation
-inhibit ovulation during 2nd half of menstrual cycle |
|
|
Term
| major side effect of progestins |
|
Definition
thrombophlebitis
pulmonary embolism |
|
|
Term
|
Definition
|
|
Term
| contraindications for mifepristone |
|
Definition
IUD in place
ectopic or adnexal mass
clotting problems
LT steroid use
porphyria |
|
|
Term
| contraindications for estrogens |
|
Definition
|
|
Term
| side effects of estrogens |
|
Definition
-nausea/vomiting
-increased risk of endometrial hyperplasia/cancer
-increased risk of DVT |
|
|
Term
|
Definition
anti-estrogen
induces ovulation |
|
|
Term
|
Definition
anti-estrogen
used in breast cancer
potent anti-estrogen effects |
|
|
Term
| What positive side effects do SERMs have? |
|
Definition
improve lipid profile
decrease bone resorption
decrease breast cancer risk |
|
|
Term
| What anti-inflammatory actions do corticosteroids have? |
|
Definition
-decrease inflammatory response and suppress immunity
-decrease and inhibit peripheral lymphocytes and macrophages |
|
|
Term
| What effects on other systems do corticosteroids have? |
|
Definition
-exacerbation of peptic ulcers
-mental status changes
-bone loss and myopathy with chronic use |
|
|
Term
| side effects of long-term glucocorticosteroid use |
|
Definition
osteoporosis
impaired wound healing/increased risk of infection
peptic ulcers
psychoses |
|
|
Term
| action of dexamethasone in normal patients |
|
Definition
suppresses ACTH and CRH
lowers serum cortisol |
|
|
Term
| uses for desmopressin (DDAVP) |
|
Definition
| anti-diuretic for diabetes insipidus and nocturnal enuresis |
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