Which of the following drugs are the only medications approved for the use in the treatment of Type 1 DM?
Pramlintide (Symlin)
Miglitol (Gylset)
Insulin
Pioglitazone (Actos)
Increntin hormones like GLP-1 and GIP stimulate insulin secretion in response to meals
Specify how each of the following specified areas contribute to the pathophysiology of Type 2 DM
Pramlintide (Symlin) belongs to what drug class?
alpha-glucosidase inhibitors
amylinomimetics
Megltinides
Sulfonylureas
What type of efficacy does the following anti-diabetic drugs have?
Metformin, Sulfonyureas, TZDs, GLP-1
Low efficacy (< 0.5 decrease in A1C)
Intermediate efficacy (~0.5-1 % decrease in A1C)
High efficacy ( ~1-2% decrease in A1C)
What type of efficacy do the following drugs have?
SGLT2, DPP-IV, Alpha-glucosidase inhibitors
High efficacy (~1-2% decrease in A1C)
Intermediate efficacy (~0.5-1% decrease in A1C)
Low efficacy (< 0.5% decrease in A1C)
Of the following anti-diabetic drugs, which have the lowest efficacy in regards to the lowering of the A1C?
Colesvelam
Metformin
Insulins
Bromocriptine
has a BBW for severe HYPOglycemia
Which of the following are contraindications for Pramlintide (Symlin)?
gastroparesis
HYPOglycemic unawareness
poor compliance with drug insulin regimens
pediatric patients
inflammatory bowel disease
colonic ulceration
If taking anti-diabetic drug , the meal time insulin must reduced by 50%.
Pramlintide (Symlin) must be injected immediately prior to each major meal.
Miglitol (Glyset) and Acarbose (Precose) belong to what anti-diabetic drug class?
Amylinomimetics
Biguanides
TZD's
What is the MOA for the alpha-glucosidase inhibitors?
activation of amylin
activates the nuclear transcription factor PPAR-gamma
inhibits intestinal alpha glucosidase
activates GLP-1 receptors
The alpha-glucosidase secretagogues TZDs Biguanides( alpha-glucosidase, secretagogues, TZDs, Biguanides ) drug class slows intestinal carbohydrate digestion/absorption.
Alpha-glucosidase drugs must be taken with the 1st bite of each meal
Which of the following are adverse drug reactions for alpha-glucosidase class?
GI disturbances
flatulence
headache
elevation in hepatic enzymes
Contrainidcations for the alpha-glucosidase inhibitors amylinomimetics DPP-IV Meglitinides( alpha-glucosidase inhibitors, amylinomimetics, DPP-IV, Meglitinides ) include inflammatory bowel disease, colonic ulceration, intestinal obstruction, malabsorption, and CrCL < 25 mL/min
Hypoglycemia must be treated with what when taking an alpha glucosidase inhibitor.
complex carbs
insulins
simple carbohydrates
Which of the following are the mechanisms of action for the biguanides class?
decrease glucose production from the liver
closes a K(ATP) channels on beta-cell plasma membranes
increases insulin sensitivity in muscle
decrease carbohydrate uptake in gut
closes K(ATP) channels on beta-cell plasma membranes
decreases glucose production form liver
decreases uptake in gut
What is the physiological action of the Biguanides class?
increases insulin secretions
decreases hepatic glucose production
increases incretin levels
decreases glucagon secretion
The maximum effective does for Metformin (Glucophage) is 2000 1500 1000 2250( 2000, 1500, 1000, 2250 ) mg/day
Metformin (Glucophage) has a BBW for lactic acidosis
Iodinated contrast media, unstable HF, eGFR < 30 mL/min, hepatic dysfunction, dehydration, pre-renal azotemia, hypoxic states, CKD, and acidosis are all contraindications for
is the first line therapy for T2DM.
Starting metformin in patients with an eGFR between 45-50 mL/min/1.73m is not recommended.
The following drugs belong to what class?
Glyburide (Micronase) Glyburide (Micronized) - (Glynase) Glipizide (Glucotrol) Glimepiride (Amaryl)
DDP-IV
Closure of the K(ATP) channels on beta-cell plasma membranes is the MOA for what class(es) of drugs?
TZDs
Bile Acid sequestrants
Meglitinides
Which of the following are ADR's for the sulfonylurea class?
HYPOglycemia
SIADH
photosensitivity
B12 deficiency
induced ovulation in PCOS
sulfa-allergy
should NOT be used in elderly patients or patients with hepatic impairment
Which of the sulfonylureas can be used during pregnancy?
Glyburide (Micronase)
Glipizide (Glucotrol)
Glimepiride (Amaryl)
For the sulfonylurea class, 1/2 of the max dose is equal to 80% drug effectiveness
Sulfonylureas can be used in combination with insulin
Glynase can be interchanged with the drug Mirconase.
Of the sulfonylureas, should be utilized in patients with renal impariement.
Which of the following drugs are Meglitinides?
Nateglinide (Starlix)
Repaglinide (Prandin)
Rosiglitazone (Avandia)
Which of the following are ADR's for the Meglitinides?
increased fluid retention
bladder cancer
dizziness
can be antidiabetic drug that can be reccommended for patients who are meal skippers.
Repaglinide (Prandin) is contraindicated with Gemfibrozil
Which drugs listed below belong the Thiazolidinediones (TZDs) class?
Sitagliptin (Januvia)
Linagliptin (Tradjenta)
What is the MOA for the Thiazolidinediones class?
closure of the K(ATP) channels on the beta-cell membranes
activates dopaminergic receptors
What is the physiological action for the TZD class?
increases insulin secretion
increases insulin sensitivity in the skeletal muscle, adipocytes, and liver
TZDs Meglitinides DPP-IV inhibitors Bile Acid Sequestrants( TZDs, Meglitinides, DPP-IV inhibitors, Bile Acid Sequestrants ) have a BBW warning for heart failure
Select the ADRs of the TZD class
increase in fluid retention
peripheral edema
hepatotoxicity
fractures
macular edema
Which patient should not take TZDs for their diabetes?
Patients with Class III or IV heart failure
Patient with Type 1 DM
Patients with the risk of bone fracture
Of the TZD drugs, which has an improved lipid profile?
TZDs can be used in combination with Metformin
is a bile acid sequestrant
Binds bile acids in intestinal tract, increasing hepatic bile acid production and activates the farnesoid X receptor (FXR) in the liver is the MOA for what drug class?
Dopamine agonist
Bile acid sequestrant
DPP-IV inhibitors
Indicate the physiological actions of the bile acid sequestrant class?
Decreases hepatic glucose production
increases insulin sensitivity
Which of the following are ADR's for bile acid sequestrant?
constipation
increases in TG
pancreatitis
decreases absorption of other medications
GI upset
fatigue
Bowel obstructions, TG > 500 mg/dL, and history of hypertriglyceridemia-induced pancreatitis are contraindications for ....
DPP-IV
SGLT-2
Colesevelam (Welchol) can be approved for monotherapy
Bromocriptine (Cycloset) belongs to what anti-diabetic drug class?
GLP-1
What is the MOA for Bromocriptine (Cycloset)?
inhibits DPP-IV activity
inhibits SGLT-2 in the proximal tubule
What are the physiological actions for the Dopamine agonist class?
modulates HYPOthalamic regulation of metabolism
decrease hepatic glucose production
increased incretin levels
increased insulin sensitivity
Postural hypotension, headache, fatigue, hallucinations, psychotic disorder, pleural effusion, pulmonary fibrosis, and GI ulcers are the ADR's for what drug?
Colesevelam (Welchol)
Bromocriptine (Cycloset)
Liraglutide (Victoza)
Which of the following are contraindications for the Bromocriptine (Cycloset)?
Hypersensitivity to ergot derivation or dopamine
lactation
syncopal migraines
severe renal impairment
Bromocriptine (Cycloset) is not approved for monotherapy.
What drug class do the following drugs belong to?
Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Nesina)
SGLT2 inhibitors
GLP-1 agonist
Inhibits DPP-IV activity, increasing postprandial active incretin concentrations is the MOA for what drug class?
What are the physiological actions for the DPP-IV inhibitors? (select all that apply)
increases insulin secretion (glucose-dependent)
increase renal excretion of glucose
decrease glucagon secretion (glucose-dependent)
slows gastric emptying
Of the DPP-IV inhibitors, which one does not need to be adjusted in renal and hepatic impairment?
Alogliptin (Nesina)
Saxagliptin (Onglyza)
ADR's for DPP-IV's include which of the following
upper respiratory infection
decreased BP
SJS
rhabdomyolysis
FDA warns that DPP-4 inhibitors SGLT-2 GLP-1 inhibitors TZDs( DPP-4 inhibitors, SGLT-2, GLP-1 inhibitors, TZDs ) may cause severe joint pain that can be severe or diabiling
Which of the DPP-IV inhibitors can cause heart failure?
The following drugs belong to what drug class?
Exenatide (Byetta) Liraglutide (Victoza) Abiglutide (Tanzeum) Dulagultide (Trulicity)
Select the physiological actions of the GLP-1 class
decreases glucagon (glucose-dependent)
increases satiety
Of the GLP-1 agonist, which one can not be used if the CrCL is < 30 mL/min?
Exenatide (Byetta)
Abiglutide (Tanzeum)
Dulaglutide (Trulicity)
Of the GLP-1 inhibitors, which ones have a BBW warning for thyroid carcinoma?
History of pancreatitis, gastroparesis or GI disease, and caution in renal impairment are all contrainidcations for the GLP-1 agonist DPP-IV TZDs SGLT-2( GLP-1 agonist, DPP-IV, TZDs, SGLT-2 )
Canagliflozin (Invokana) Dapagliflozin (Farxiga) Empagliflozin (Jardiance)
SGLT-2 inhibitors
Which of the following are ADR's for the SGLT-2 inhibitor drug class?
female & male genital mycotic infections
increased urination
increased BP
hypovolemia
hyperkalemia
Hypovolemia must be corrected prior to starting a SGLT-2 inhibitor
Increased risk of bladder cancer and bone fracture with Dapagliflozin (Farxiga) Canagliflozin (Invokana) Empagliflozin (Jardiance)( Dapagliflozin (Farxiga), Canagliflozin (Invokana), Empagliflozin (Jardiance) )
Empagliflozin (Jardiance) Canagliflozin (Invokana) Dapagliflozin (Farxiga)( Empagliflozin (Jardiance), Canagliflozin (Invokana), Dapagliflozin (Farxiga) ) is assocaited with an increase in CV events
Canagliflozin (Invokana) Dapagliflozin (Farxiga) Empagliflozin (Jardiance)( Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance) ) may be associated with an increase in lower extremity amputations
Which drug classes target fasting BG only!
Which drug classes targets post-prandial blood glucose only!
dopamine agonist
DPP-4 inhibitors
meglitinides
What drug classes target BOTH fasting and postprandial BG levels?
Bile acid sequestrants
GLP-1 agonist, Metformin, SGLT-2, Amylinmimetics all cause weight loss weight gain weight neutral( weight loss, weight gain, weight neutral )
Metformin, alpha-glucosidase inhibitors, DPP-IV inhibitors all cause weight gain weight loss weight neutral( weight gain, weight loss, weight neutral )
Suflonylureas, Meglitinides, insulins, and TZDs all cause weight loss weight gain weight neutral( weight loss, weight gain, weight neutral )
Which drug classes are high cost agents?
Which drugs classes are low cost agents?
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