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34 Cards in this Set
- Front
- Back
Biguanide class medication
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Metformin/Glucophage
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What is the MOA of Metformin?
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Decreases hepatic glucose production and enhances insulin sensitivity in skeletal muscle
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What is the only diabetes medication that can cause a reduction in weight?
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Metformin
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What are the most common complaints with the use of Metformin?
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Abdominal cramping and nausea
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What deficiency is related to the use of Metformin?
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B12 deficiency
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What is the most serious side effect of metformin use?
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Lactic acidosis
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Contraindications for metformin use include:
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impaired renal function, decompensated cardiac failure or liver failure, major surgery, iodinated contrast material, alcohol use.
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What is the MOA for sulfonylureas?
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Stimulates intact beta cells to release more insulin via ATP sensitive K channels
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What are the adverse effects of sulfonylurea drug use?
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Hypoglycemia, weight gain
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First generation sulfonylureas
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Chlorpropamie/Diabinese
Tolbutamide/Orinase |
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Second generation sulfonylureas
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Glipizide/Glucotrol
Glyburide/Micronase Glimepriride/Amaryl (3rd) |
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non-sulfonylurea secretagogues
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Meglitinides
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Meglitinides
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Neteglinide/Starlix
Repaglinide/Prandin |
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What is the MOA of Thiazolindinedoines/Glitazones?
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Improve insulin sensitivity in skeletal muscle, fat, and liver. Decrease hepatic glucose production.
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What drugs belong to the Glitazone class?
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Rosiglitazone/Avandia
Pioglitazone/ACTOS |
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What labs need to be monitored when using a glitazone?
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LFTs at initiation, 1 month and 3 months looking for a rise in ALT
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What are the adverse effects of glitazones?
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increased risk for CHF, reduced bone density, weight gain
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How do Alpha-glucosidase inhibitors work?
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inhibition of the alpha-glucosidase enzymes in the brush border and interference with hydrolysis of carbohydrates.
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What two drugs belong to the Alpha-glucosidase inhibitor class?
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Acarbose/Precose
Miglitol/Glyset |
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Acarbose in high dose is associated with
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moderate transaminase elevations and can cause fatal hepatic faliure
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Unabsorbed carbs can cause:
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abdominal pain
diarrhea flatulence |
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Alpha-glucosidase inhibitors are contraindicated in:
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chronic intestinal disease, IBD, colonic ulceration, any degree of intestinal obstruction
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How does the use of alpha-glucosidase inhibitors complicate treatment for hypoglycemia.
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Due to it's inhibition of carbohydrate hydrolysis, pure glucose is needed to raise blood sugar levels
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What is the MOA of Sitagliptin/Januvia?
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Competitive inhibition of dipeptidyl peptidase 4 which breas down incretins (GLP-1 and GIP)
GLP-1 and GIP potentiate the secretion of insulin and suppress the release of glucagon by the pancreas driving blood glucose levels toward normal. |
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What are Dr. Miller's recommendations for treatment of type 2 diabetes?
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Use Metformin, give B12, monitor kidney function
If blood glucose levels are still high, consider adding a sulfonylurea |
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Synthetic amylin injected separately from insulin with meals
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Pramlintide/Symlin
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Synthetic exendin-4 (Gila monster) that acts as an incretin mimetic
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Exanatide
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Rapid acting insulin
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Lispro/Asparat
Humulog/Novalog |
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Short Acting Insulin
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Regular
Humulin R |
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Intermediate acting insulin
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NPH, Humulin N
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long acting insulin
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Glargine
Lantus |
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Potent hyperglycemic agent used to treat severe hypoglycemia
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Glucagon
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Increases native glucagon secretion
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decreased glucose levels
increased catecholamines increased amino acids acetylcholine Cholecystokinin |
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Inhibits glucagon production and secretion
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increased glucose
increased somatostatin increased insulin increased free fatty acids and ketones Increased urea production |