Diabetes Pharm 2

通報

問題一覧

Drugs that may reduce the effects of Sulfa drugs

Atypical antipsychotics, Corticosterioids, Diuretics, Niacin, Phenothiazines, Sympathomimetics

Drugs that may increase the effects of Sulfa drugs

Azole Antifungals, Beta-Blockers, Clarithromycin, MAOIs, Probenecid, Salicylates, Sulfonamides

You are seeing a patient with diabetes, albuminuria and a blood pressure of 155/94. He is currently on no medications. According to the latest diabetes guidelines, which of the following will you prescribe first?

ACEIorARB

You are seeing a 35 y/o diabetic with a calculated ASCVD risk of >20%. You have decided to prescribe a high intensity statin—what is your desired outcome?

Lower LDL cholesterol by 50%

Current diabetes guidelines recommend drug selection based on the presence or absence of which conditions?

CVD, HF, renal disease

The sensitivity factor is calculated by dividing by ________ by the total daily dose of insulin

2000 [or 1800 if the patient is going for tight control]

You are prescribing NPH insulin to your diabetic patient. You tell the patient that the onset of this type of insulin is:

1-2 hours

Sarah is your patient with Type II diabetes, and she is on insulin detemir. You are going to add another insulin to control her after meal excursions. Which agent are you going to prescribe?

Insulin lispro

Basal metabolic needs can be achieved from exogenous source by all of the following except:

Regular insulin

You are educating Katie, who has just been started on meal- time insulin. Education related to injectable therapy includes all of the following except:

Fluid retention

-It is given SQ right before meals -When started—the dose of mealtime insulin should be decreased by 50% to avoid severe low BS

Pramlintide

ADEs—nausea, anorexia, vomiting, dizziness, pharyngitis -Avoid in those with gastroparesis or hypoglycemic unawareness

Pramlintide

GLP-1 should not be used in those with renal impairment

Exenatide

GLP-1 that reduces the risk of composite outcome of CV death, nonfatal MI and stroke by 13%

Liraglutide

Do not use this GLP-1 in those with GFR <15 cc/min, pregnancy (all GLP-1s), and also in gallbladder disease

Lixisenatide

What condition is a contraindication of Pramlintide therapy because of its effect of gastric slowing?

Gastroparesis

Which of the following has FDA indication to reduce the risk of major CV events in Type II diabetics with cardiovascular disease?

Liraglutide

Which of the following can be seen when initiating GLP-1 agonists?

Nausea and vomiting

Should NOT be used with Sulfonylureas or Gemfibrozil; use caution in liver disease

Repaglinide or Nateglinide

Will LOWER cholesterol, triglycerides and LDL and causes weight loss in most

Metformin

-It is excreted in the feces -Can be used as monotherapy or with Metformin, TZD or both

Repaglinide or Nateglinide

The drug does not cause low BS—unless the patient is taking insulin or another secretagogue

Metformin

-1⁄2 life of both formulations is 4-9 hours -Not metabolized by the liver; renal tubular secretion is route of elimination

Metformin

Onset of action is not known; peak effect is in 2 hours [this is delayed by food]; 1⁄2 life is 16-24 hours Excreted into the bile unchanged and eliminated in the feces

Pioglitazone and Rosiglitazone

Poorly absorbed—excreted in the urine

Acarbose

Is very well absorbed—but no systemic effects—excreted unchanged by the kidney

Miglitol

-Taken right before each meal -Onset of action is immediate; peaks in 1 hour; duration is near 6 hours; 1⁄2 life of the drug is 2 hours

Acarbose

-Take at the beginning of each meal -Rapid onset of action; peaks in 2 hours; duration of action is near 4 hours

Miglitol

All gliptins [DPP-4 Inhibitors] except _____ require dose adjustments for renal disease

Linagliptin

Metabolized by CYP450-3A4/5 to an active metabolite; metabolite is excreted renally

Saxagliptin

Which of the following diabetes drugs is most appropriately paired with the ADE associated with its use?

Canagliflozin—UTIs

Which of the following agents has been shown to reduce risks when the diabetic has renal dysfunction?

Canagliflozin

Although rare, there are some serious side effects linked to the use of SGLT2 inhibitors. One of the agents in the class [Canagliflozin] has a BB warning for:

Lower limb amputation

Your patient, Mr. George has Type II diabetes, HTN and HF—which is currently stable. Based on the most recent evidence, you know that you can reduce this risk of HF hospitalization by prescribing:

Dapagliflozin

Potential side effects of sulfonylureas include all of the following except:

Liver failure

All of the following are actions of Metformin therapy, except:

Increases beta cell production of insulin

All of the following are potential side effects of Acarbose and Miglitol except:

Dry mouth

The onset of action for regular insulin is:

15-30 minutes

Helen is a 50 y/o obese woman who has had Type II diabetes for 8 years. She is on Metformin ER, but her A1C is still above goal. She has a history of COPD and LE edema from venous insufficiency. You want to prescribe something that will not cause her to gain weight. Which of the following would you prescribe?

Linagliptin

Philip has Type II diabetes and chronic pancreatitis. Which of the following diabetes medications should not be prescribed to Phillip?

Do not prescribe Linagliptin or Exenatide

Which class of oral agents for diabetes is paired most closely with its primary mechanism of action?

SGLT2 inhibitors—increase the urinary excretion of glucose

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