DM drugs

Question 1

This drug should be given with meals is contraindacted with a eGFR < 30

and the ER formulation can leave a ghost tablet

What boxed warnings: 3

COntraindications: 2

Warnings: 2
SEs: 5

Monitoring 1

Notes; 1

Answer 1

• Metformin
• Boxed: Lactic acidosis with hypoxic states, renal impairment, intravascular iodinated contrast media
• Contra: eGFR <30 and metabolic acidosis
• Warnings: GFR 30-45, Vit B12 Def
• SEs: N/V/D, flatuence, abdominal cramping
• Monitor Renal function
• Decreases A1C bu 1-2%

Question 2

What can increase the risk of lactic acidosis with metformin?

Answer 2

Alcohol

And iodinated contrast dye

Question 3

When should metformin be restarted after contrast dye use?

Answer 3

Stop before prodedure and restart 48 hours after if GFR is stable

Question 4

Should metformin be taken with or without food?

Answer 4

With food to limit GI upset

Question 5

When should meglitinides be taken?

Answer 5

Prandin: 15-30 minutes before meal

Starlix: 1-30 minutes before meals

Question 6

Amaryl

Answer 6

Glimepiride

Question 7

Glynase

Answer 7

Micronized glyburide

Question 8

Main SEs of SUs? 2

Warnings? 1

Contraindications

Answer 8

Wt gain and nausea

Contra: Sulfa-allergy

Warnings: Hypoglycemic

Question 9

What should never be used in combination?

Answer 9

SUs meglinides, and Insulin should not be used together

Question 10

When should SUs be taken?

Answer 10

With breakfast

Glipizide IR should be taken 30 minutes before meals

Question 11

What do TZDs end in?

Answer 11

glitazone

Question 12

What are the two TZDs? Brand and Generic

Answer 12

Pioglitazone: Actos

Rosiglitazone: Avandia

Question 13

What TZD has increased risk of MI and is black boxed with it?

Answer 13

Rosiglitazone: Avandia

Question 14

All TZDs have a black box for what?

Answer 14

Cause or exacerbation of HF

Question 15

TZDs are contraindicated in what?

Answer 15

NYHA Class III/IV HF

Question 16

What are warnings of TZDs? 4

Answer 16

1. Hepatic failure
2. Edema (including macular)
3. Risk of fracctures
4. Urinary bladder tumors with Pioglitazone (Actos)
   
   1. Do not use in pts with active bladder cancer

Question 17

2 main SEs of glitazones

Answer 17

1. Peripheral edema
2. Wt gain

Question 18

What two things should be monitored with glitazones?

Answer 18

LFTs, s/sx of HF

Question 19

TZDs are substrates of what CYP enzyme?

Answer 19

2C8 caution with inducers rifampin

And inhibitors: gemfibrozil

Question 20

What can TZds cause?

Answer 20

Fluid retention

Question 21

What is the MOA of TZDs?

Answer 21

PPAR agonists: increase insulin sensitivity

Question 22

What do SGLT-2 Inhibitors end in?

Answer 22

Gliflozin

Question 23

What SGLT2 inhibitor is approved to reduce risk of cardiovascular mortality in pts with DM2 and ASCVD?

Answer 23

Jardiance

Empagliflozin

Question 24

Main SEs of SGLT2

Answer 24

Gliflozin

Wt loss

Increase urination and thirst

Question 25

What is a contraindication of SGLT2s?

Answer 25

eGFR<30