Diabetes Medication Therapy

class 1

What is the only biguanide

metformin

true or false: metformin showed a reduced nonfatal MI

true

Major side effect of biguanaides

• GI upset

• vitamin B12

• Lactic acidosis

metformin _____ the development of microvascular disesase

true or false: you do not need to titrate the dose to minimize side effects

false

metformin is contraindicated if the eGFR is what level

<30mL/min

what is the goal dose of metformin per day

1500-2000 mg per day

what is the needed eGFR to initiate a dose of metformin of 500-850mg QD with meals

>45ml/min

what is the max dose of metformin

2550mg

what is the role of metformin

low cost oral therapy with CV benefit compared to sulfonylurea therapy

what are the secretagogues

1. sulfonylureas

2. meglitinides

what is the MOA of sulfonylureas

tell the pancreas to release more insulin by inhibiting K channel in pancreatic beta cells

true or false: the hypoglycemia risk for sulfonylureas is low

false; high due to active metabolite

True or false: sulfonylureas have a weight gain effect

true

true or false: sulfonylureas have no ASCVD benefits

true

what medication do you need to avoid in CKD/DKD due to the increased hypoglycemia risk

sulfonylureas

what sulfonylurea is preferred in CKD/DKD if used

glipizide

what is the role of sulfonylureas

low ccost oral therapy with hypoglycemia risk

what are the meglitinides

repaglinide

nateglinide

what is the MOA of the meglitinides

tells the pancreas to release more insulin around meal time

true or false: the sulfonylureas have a lower binding affinity than meglitinides

false

what is the hypoglycemia risk for meglitinides

high

what is the weight effect of meglitinides

weight gain

take meglitinides ______ minutes before food

15-30 minutes

with meglitinides, the dose needs to be adjusted in what disease states

CKD/DKD

what is the role of meglitinides

low cost oral therapy

what are the thiazolidinediones

1. pioglitazone

2. rosiglitazone

what is the MOA of the TZDs

makes the body’s cells more sensitive to insulin

TZDs are agonists for what

PPARy

side effects of TZDs

peripheral edema, fluid retention, bone fractures

true or false: there is no weight gain with TZDs

false (fluid retention)

in what medication class is there a BBW regarding HF

TZD

which TZD has warnings for bladder cancer

pioglitazone

while pioglitazone may have warnings for bladder cancer, it may be beneficial in _____

ASCVD

what is the role of TZD

low cost oral therapy with low hypoglycemia risk but edema risk (worse with insulin)

What are the SGLT2 inhibitors

the -Flozins

what is the MOA for SGLT-2 inhibitors

kidneys remove excess glucose

what is a major side effect of SGLT2 inhibitors

euglycemia DKA

true or false: SGLT2 inhibitors have a high cost

true

what is the weight effect of SGLT2 inhibitors

beneficial

SGLT2 inhibitors are contraindicated in what

• stage 4 kidney disease

• hx of frequent genitourinary/yeast infections

what is the conflicting data with canagliflozin

increased risk of lower limb amputations and bone fractures

what are some warning for SGLT2- inhibitors

• urosepsis

• yeast infection

• fournier’s gangrene

• DKA

• lower limb amputation

what is Canagliflozin’s FDA indications

• T2D

• Reduce MACE

• CKD progression

what is empagliflozin’s FDA indications

• T2D

• CV death if risk

• HF death

• CKD progression

what is dapagliflozin’s FDA indications

• T2D

• CV death if risk

• HF death

• HF admission

• CKD progression

what is ertugliflozin’s and Bexagliflozin’s FDA indications

T2D

what are incretins

GI hormones that are released after meals

true or false: GLP-1s can cross the BBB

true

incretins are degraded by what

DDP4

why do GLP1s have a low risk of hypoglycemia

they only work in response to meals

what is the MOA of GLP1s

enhance glucose-dependent insulin secretion, slow gastric emptying, decrease glucagon secretion, and improve satiety

what complication can GLP1s worsen

diabetic retinopathy

GLP1s are contraindicated in

gastroparesis

semaglutide improves symptoms in patients with

HFpEF

what are the BBW for GLP1s

• pancreatitis

• risk of thyroid tumors

what is the role of GLP1s

ASCVD/DKD risk reduction, low hypoglycemia risk, high A1c lowering but high drop out rate due to gastrointestinal effects

what is the dual GLP-1 and GIP agonists on the market

tirzepatide

what is a caution regarding tirzepatide

use oral hormonal contraception

what clinical trial examined the efficacy between tirzepatide and semaglutide

SUPRASS-2

what are the DPP4-inhibitors

the -gliptins

what is the MOA of the DPP4 inhibitors

increases insulin release and decreases glucagon levels in a glucose-dependent manner

True or false: DPP4 inhibitors have a high cost

true

which DPP4 inhibitor does NOT require renal dose adjustment

linagliptin

there is a potential HF risk with which DPP4 inhibitors

saxagliptin and alogliptin

ture or false: islet cell transplantation for T1D

true

what is the immunosuppressive therapy for patients with “stage 2” T1D

teplizumab

what is the name of the islet cell transplantation therapy

donislecel (lantidra)