Endo exam 1 Questions With Complete Solutions
euglycemic ketoacidosis
metformin contraindications
creatinine clearance < 45 mL/min (initiation) or < 30 mL/min
(d/c)
severe hepatic, pulmonary, or cardiac (HF) disease
hold for 24 hours before and 48 hours after procedures using
iodinated contrast dyes
metformin advantages
no hypoglycemia as mono-therapy
weight neutral
high initial response rate
positive lipid effects
inexpensive
improved CV outcomes?
,metformin disadvantages
pts eventually stop responding to therapy (2 degree failure)
GI SE's, especially early
lactic acidosis (in inappropriate candidates)
thiazolidinediones (TZDs)
MOA
rosglitazone - avandia, pioglitazone -actos)
PPAR-gamma agonist
-increase peripheral muscle and adipose tissue insulin sensitivity
(decrease insulin resistance)
-some decrease in hepatic glucose production
TZDs efficacy
A1c lowering of 0.8-1.5%
mixed blood glucose lowering effect
long lag time before observed glycemic effect (weeks); maximal
effect 8-12 weeks
increases HDL-C (both) and lowers TGs (pioglitazone)
decreased ASCVD risk?
TZDs adverse effects
weight gain
fluid retention (especially w/ insulin, NSAID, GC, or DHP-CCB
use)
HF exacerbation
"atypical" bone fractures (hands and feet)
very rare hepatotoxicity and macular edema
bladder cancer (pioglitazone)
,TZDs contraindications
ALT >2.5 ULN
HF
TZDs advantages
no hypoglycemia as monotherapy
several favorable metabolic effects (HDL-C, TGs, PAI-1)
can use in renal insufficiency
potential B-cell sparing effect?
inexpensive
can induce ovulation in women w/ PCOS
TZDs disadvantages
delayed onset of action
adverse effects: weight gain, edema, CHF, BMD loss/fractures
colesevelam indications
reduction of elevated LDL-cholesterol
-indicated as adjunct to diet and exercise to reduce LDL-C in
pt's w/ primary hyperlipidemia as monotherapy or in combo w/
statin
reduction of blood glucose
-indicated as an adjunct to diet and exercise to improve glycemic
control in adults w/ T2DM
colesevelam MOA
farnesoid X receptor (FXR) antagonist. bile acids activate the
FXR, which leads to inccreased expression of
phosphoenolpyruvate carboxykinase (PEPCK), the rate limiting
, enzyme necessary for hepatic gluconeogenesis. colesevelam
inhibits bile acid reabsorption, thus preventing FXR activation
and up-regulation of PEPCK, leading to decreased hepatic
glucose production
colesevelam efficacy
hemoglobin A1c lowering of 0.4-0.6%
primarily a fasting blood glucose lowering effect
LDL-C reduction of 15-18%
colesevelam adverse effects
constipation/dyspepsia
potential triglyceride increase (don't use if TG> 300 mg/dL)
colesevelam contraindications
hx of bowel obstruction
triglycerides >500 mg/dL
hx of hypertriglyceridemia-induced pancreatitis
colesevelam advantages
no hypoglycemia as monotherapy
low-density lipoprotein cholesterol lowering of 15-18%
colesevelam disadvantages
modest A1c efficacy
high pill burden
may raise triglycerides
potential for drug absorption interactions (levothyroxine,
ezetimibe, phenytoin - take 4 hours before others)
DPP-IV inhibitor MOA
euglycemic ketoacidosis
metformin contraindications
creatinine clearance < 45 mL/min (initiation) or < 30 mL/min
(d/c)
severe hepatic, pulmonary, or cardiac (HF) disease
hold for 24 hours before and 48 hours after procedures using
iodinated contrast dyes
metformin advantages
no hypoglycemia as mono-therapy
weight neutral
high initial response rate
positive lipid effects
inexpensive
improved CV outcomes?
,metformin disadvantages
pts eventually stop responding to therapy (2 degree failure)
GI SE's, especially early
lactic acidosis (in inappropriate candidates)
thiazolidinediones (TZDs)
MOA
rosglitazone - avandia, pioglitazone -actos)
PPAR-gamma agonist
-increase peripheral muscle and adipose tissue insulin sensitivity
(decrease insulin resistance)
-some decrease in hepatic glucose production
TZDs efficacy
A1c lowering of 0.8-1.5%
mixed blood glucose lowering effect
long lag time before observed glycemic effect (weeks); maximal
effect 8-12 weeks
increases HDL-C (both) and lowers TGs (pioglitazone)
decreased ASCVD risk?
TZDs adverse effects
weight gain
fluid retention (especially w/ insulin, NSAID, GC, or DHP-CCB
use)
HF exacerbation
"atypical" bone fractures (hands and feet)
very rare hepatotoxicity and macular edema
bladder cancer (pioglitazone)
,TZDs contraindications
ALT >2.5 ULN
HF
TZDs advantages
no hypoglycemia as monotherapy
several favorable metabolic effects (HDL-C, TGs, PAI-1)
can use in renal insufficiency
potential B-cell sparing effect?
inexpensive
can induce ovulation in women w/ PCOS
TZDs disadvantages
delayed onset of action
adverse effects: weight gain, edema, CHF, BMD loss/fractures
colesevelam indications
reduction of elevated LDL-cholesterol
-indicated as adjunct to diet and exercise to reduce LDL-C in
pt's w/ primary hyperlipidemia as monotherapy or in combo w/
statin
reduction of blood glucose
-indicated as an adjunct to diet and exercise to improve glycemic
control in adults w/ T2DM
colesevelam MOA
farnesoid X receptor (FXR) antagonist. bile acids activate the
FXR, which leads to inccreased expression of
phosphoenolpyruvate carboxykinase (PEPCK), the rate limiting
, enzyme necessary for hepatic gluconeogenesis. colesevelam
inhibits bile acid reabsorption, thus preventing FXR activation
and up-regulation of PEPCK, leading to decreased hepatic
glucose production
colesevelam efficacy
hemoglobin A1c lowering of 0.4-0.6%
primarily a fasting blood glucose lowering effect
LDL-C reduction of 15-18%
colesevelam adverse effects
constipation/dyspepsia
potential triglyceride increase (don't use if TG> 300 mg/dL)
colesevelam contraindications
hx of bowel obstruction
triglycerides >500 mg/dL
hx of hypertriglyceridemia-induced pancreatitis
colesevelam advantages
no hypoglycemia as monotherapy
low-density lipoprotein cholesterol lowering of 15-18%
colesevelam disadvantages
modest A1c efficacy
high pill burden
may raise triglycerides
potential for drug absorption interactions (levothyroxine,
ezetimibe, phenytoin - take 4 hours before others)
DPP-IV inhibitor MOA
