Term
| Discuss the mechanism of action of statins |
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Definition
| Known as "HMG-CoA Reductase Inhibitors" Inhibit enzymes that convert HMG-CoA to mevalonate (limit cholesterol production) |
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Term
| List the side effects of statins |
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Definition
-weakness
-muscle pain
-elevated blood sugar
-*interaction with grapefruit |
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Term
| What changes in cholesterol would you expect to see when on a statin? |
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Definition
-Decrease in triglycerides 7-30%
-increase in HDL 5-15% |
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Term
| What is the dose range for Atorvastatin/Lipitor and % it lowers LDL |
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Definition
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Term
| What is the dose range for Fluvastatin/Lescol, and percent it lowers LDL, what about Lescol XL |
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Definition
-Lescol: 20-80mg,
-Lescol XL: 80mg
-both reduce 20-35% |
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Term
| What is the dose range of Lovastatin ( Mevacor and Altoprev XL), % they lower LDL |
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Definition
-Mevacor: dose 20-80mg, 20-45%
-Altoprev XL: dose 10-60mg, 20-45% |
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Term
| What is the dose range of Pravastatin/Pravachol, % it lowers LDL |
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Definition
| dose: 10-80mg, lowers 20-45% |
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Term
| What is the dose range of Rosuvastatin/Crestor, % it lowers LDL |
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Definition
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Term
| What is the dose range of Simvistatin/Zocor, % it lowers LDL |
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Definition
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Term
| What is the dose range of Ptavastatin/Livalo |
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Definition
| dose 2-4mg, % decrease not given |
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Term
| What are the bile acids sequestrants and how do they work |
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Definition
-Cholestyramine/Questran, Colesevelam/Welchol, Colestipol/Colestid
-bind bile acid in intestine, decrease chol production, raise HDL |
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Term
| In additional to helping lower chol, what other health benefit does Colesevelam/Welchol have? |
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Definition
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Term
| A patient comes to you with high chol and A1c but is only willing to take one medication, which chol med is a good fit? |
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Definition
| Colesevelam/Welchol, lowers A1c 0.5%, can lower LDL by 15-30%; may raise TGs levels though |
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Term
| A patient is started on a bile acid sequestrants, what do you want to tell them and look for in their lab work. |
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Definition
-Avoid taking w/ other meds as can affect absorption
-monitor TGs as may raise
-Side effects are GI in nature |
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Term
| What are the benefits of bile acid sequestrants |
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Definition
-lower LDL 15-30%
-raise HDL 3-5%
*may also raise TGs |
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Term
| What is the dose range for Cholestyramine/Questran |
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Definition
4-16g per day
powder - 1 scoop = 4g |
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Term
| What is the dose range of Colesevelam/Welchol |
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Definition
3.75 x1/d
1.875 x2/d
(comes in 625mg tablets) |
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Term
| What is the dose range of Colestipol/Colestid |
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Definition
2-16g per day tabs
powder - 1 scoop = 5g
5-20gm/d
mix w/ fluid |
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Term
| A pt is newly dx w/ DM w/ an A1c of 7.8, what medication would you start? |
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Definition
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Term
| A pt is newly dx w/ DM and has an A1c of 9.3, what med/meds would you start? |
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Definition
| Initiate dual therapy: metformin + another oral agent (usually, depends on insurance which type) |
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Term
| A pt is newly dx w/ an A1c of 11.3, what med/meds would you start? |
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Definition
| Consider combination injectable therapy; usually metformin + basal insulin, would start at 10u or 0.1-0.2u/kg/d |
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Term
| An obese patient dx w/ an A1c of 7.8 and started on metformin hasn't met their target after 3 mo, although A1c is close, provider wants to go to dual therapy, pt has good insurance, what is/are good options? |
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Definition
-SGLT2 inhibitor(intermediate effect, low risk hypo, can help w/ wt loss, is expensive)
-GLP1 receptor agonist (high effect, low risk hypo, can help w/ wt loss, is expensive)
-DPP4 inhibitor (intermediate effect, neutral w/ wt, low risk hypo, expensive) |
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Term
| A patient w/ DM2 is currently on basal/bolus therapy (lantus qHS, Humolog 3x/d) without adequate control, pt states is overwhelmed w/ 4 injections/d, what is a good alternative? |
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Definition
| Switch to pre-mixed insuline, like 70/30 2x/d |
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Term
| A patient w/ DM2 is on metformin 1000BID, glipizide 10mg BID, Lantus 60u qHS, pt weighs 60kg, BG is not well controlled. What should be done? |
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Definition
-Keep metformin, d/c glipizide
-Decrease basal and add bolus to largest meal to start, add additional meals as needed (50/50 rule), can also consider 70/30 |
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Term
| A pt w/ DM2 is well controlled on basal/bolus therapy, they tell you they will be changing insurances and won't be able to afford Levemir/Novolog anymore, what are some good options? |
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Definition
-Switch to NPH BID + regular
-can also consider 70/30 |
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Term
| What is insulin correction factor related to? |
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Definition
| -typically, larger the person less sensitive they are, so more insulin they will need to bring them down (ie 30 for obese, 50 for lean) |
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Term
| What are the rapid acting insulins? What is their onset? Peak? |
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Definition
-Aspart (Novolog), Lispro (Humalog), Glulisine (Apidra), Afrezza
-onset 15-30min
-peak 1-1.5 hours |
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Term
| What are the short acting insulins? What are their onset? Peak? |
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Definition
-Regular insulin (cheap)
-onset 30min
-peak 2-4hrs |
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Term
| What are the intermediate insulins? Onset? Peak? |
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Definition
-NPH
-lasts ~12 hrs, taken BID, cheap |
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Term
| What are the long acting insulins? Onset? Peak? |
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Definition
-Detemir (Levemir), Glargine (Lantus, Basaglar), Degludec (Tresiba)
-onset and peak depends |
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Term
| What is the mechanism of action of metformin? |
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Definition
-reduces hepatic glucose production
-reduces glucose absorption in the intestines
-increases peripheral glucose uptake and utilization, thereby increasing insulin sensitivity |
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Term
| A newly dx DM2 patient w/ an A1c of 8.5 and GFR of 39 comes in, should they be started on metformin? |
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Definition
| No because kidney function is impaired, avoid starting if GFR <40 |
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Term
| You are meeting with an 8 yo dx w/ DM2, the provider wants to start metformin, is metformin indicated in pediatric pops? |
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Definition
| Metformin indicated in kids 10yo+, current recommendations state this pt should not be started on metformin |
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Term
| You're working w/ a woman with DM2, was dx before pregnancy, controlled BG w/ diet and insulin during pregnancy, interested in BF, should she resume metformin? |
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Definition
| No, at this time metformin is not recommended while breast feeding, is unknown if passes into breast milk |
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Term
| A pt w/ DM2 has been on metformin +lifestyle for 6 mo, A1c is still not at target, provider wants to start a second med but is worried about hypo, pt w/ poor insurance, what do you recommend? |
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Definition
| Starting pt on glipizide as is cheap and least likely to cause hypo |
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Term
| What are the most common side effects of metformin? |
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Definition
-GI upset (most common, less w/ the XR)
-muscle pain or cramping
-painful or difficult urination
-sleepiness |
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Term
| What DM medications target the incretin system? |
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Definition
-glucagon-like peptide (GLP)-1 receptor agonists
-dipeptidyl peptidase 4 (DPP-4) inhibitors |
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Term
| What is the dose range for metformin, and when is it usually taken? Is it beneficial to cont to increase the dose? |
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Definition
-Dose range is 500-2500mg, usually taken BID w/ meals
-Is beneficial to increase dose to max as greater dose usually means greater reduction in A1c |
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Term
| How much does metformin lower A1c? |
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Definition
| Metformin lowers A1c 1-2% |
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Term
| What GFR should metformin not be started? D/c? |
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Definition
-Metformin should not be started when GFR <45
-Metformin should be d/c when GFR <30 |
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Term
| T/F: The dose range for Glucophage XR is the same as regular |
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Definition
| False- dose range for Glucophage XR is 500-2000mg, for metformin regular it is 500-2500 |
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Term
| How much do sulfonylureas lower A1c? |
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Definition
| Sulfonylurease lower A1c 1-2% |
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Term
| A pt comes in on metformin w/ A1c still not controlled, they are at risk of hypoglycemia, their provider started them on glyburide, is this the best choice? |
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Definition
| No, since glyburide is most likely to cause low BG, glipizide would be a better option as least likely to cause low BG |
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Term
| What is the dose range for glipizde (Glucotrol)? |
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Definition
| Dose range of Glucotrol is 2.5-40mg |
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Term
| What is the dose range of glipizide (Glucotrol XL)? |
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Definition
| Dose range of Glucotrol XL is 2.5-20mg |
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Term
| What organ are sulfonylureas eliminated through? |
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Definition
| Sulfonylureas are eliminated through the kidneys |
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Term
| What is the function of SGLT2 Inhibitors |
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Definition
SFLT2 Inhibitors decrease glucose reabsorption in the kidneys
-"glucoretics" |
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Term
| What are the SGLT2 Inhibitors? |
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Definition
-Canagliflozin (Invokana)
-Dapagliflozin (Farxiga)
-Empagliflozin (Jardiance) |
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Term
| What class of med is Canagliflozin (Invokana) and what is the dose range? |
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Definition
-SFLT2 Inhibitor
-100-300mg 1x/d |
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Term
| What class of med is Dapagliflozin (Farxiga) and what is the dose range? |
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Definition
-SGLT2 Inhibitor
-dose range 5-10mg 1/d |
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Term
| What med class is Empagliflozin (Jardiance) and what is the dose range? |
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Definition
-SGLT2 Inhibitor
-dose range 10-25mg 1x/d |
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Term
| A pt comes in w/ an A1c of 8.8, they are on 2500mg BID metformin, 20mg/d glipizide, would you consider increasing glipizide or adding another med? |
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Definition
| -Since usually reach max benefit of glipizide at 1/2 max dose, and A1c is nearly 9, would likely start on additional DM med |
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Term
| T/F: When a pt is started on an SGLT2 Inhibitor, you should wait to check GFR until they have been on it for 6mo |
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Definition
False - should get GFR before starting and yearly
-Invokana: stop if GFR <45
-Jardiance: do not start if GFR <45
-Farxiga: stop if GFR <60, don't use in pts w/ bladder cancer |
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Term
| What are the benefits of SGLT2 Inhibitors |
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Definition
-Invokana, Farxiga, Jardiance
-no hypo or wt gain
-Jardiance lowers all-cause mortality by 32% |
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Term
| How much do the SGLT2 Inhibitors lower A1c? |
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Definition
| SGLT2 Inhibitors lower A1c 1-2%, lowers wt 1-3# |
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Term
| What are the side effects of SGLT2 Inhibitors? |
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Definition
-Invokana, Farxiga, Jardiance
-hypotension
-UTIs
-increased urination
-genital infections
-ketoacidosis |
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Term
| What is IDegLira (Xultophy) |
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Definition
-Insulin degludec (IDeg or Tresiba)+ Liraglutide (Victoza-GLP1-RA)
-once daily injection
-dose range 10 to 50 units (10-50units IDeg+0.36-1.8mg liraglutide)
-starting dose 16units, titrate up or down by 2 units q3-4d
-once opened, good for 21 days |
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Term
| What is iGLarLixi (Soliqua)? |
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Definition
-Insulin glargine (Lantus)+Lixisenatide (Adlyxin - GLP1-RA)
-once daily injection, 1 hr b4 first meal
-dose range 15-60units (15-60units glargine, 5-20ug lixisenatide)
-starting dose: 15u pts not controlled on 30units basal or GLP1RA; 30 units not controlled on 30-60units
-titrate up/down by 2-4units qwk
-once opened, good for 14d |
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Term
| What DM medication combines ultra long acting insulin and Victoza? |
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Definition
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Term
| What DM med contains Lantus and Adlyxin? |
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Definition
| iGLarLixi - contains Lantus and Lixisenatide (Adlyxin) |
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