NURS 502 Pharm Exam 2
Name the 6 classes of non-insulin diabetes medications. - (correct Answer) - 1) biguanides (metformin)
2) sulfonylureas (the gl- -ides)
3) thiazolidinediones (TZDs; the -glitazones)
4) GLP-1 receptor agonists (exenatide, liraglutide)
5) DPP-4 inhibitors (the -gliptins)
6) SGLT-2 inhibitors (the -gliflozins)
What are the 3 major A1C ADA standards of care goals?
Which patients are appropriate for each A1C goal? - (correct Answer) - <7%, <6.5%, and <8%
1) A1C <7% for many non pregnant adults is a reasonable A1C goal
2) A1C <6.5% for patients who have had T2DM for a short duration, have T2DM treated with lifestyle or
metformin only, long life expectancy, or no significant CVD
3) A1C <8% for its w/ h/o severe hypoglycemia, limited life expectancy, advanced microvascular or
microvascular complications, extensive comorbid conditions, or long-standing diabetes in home the goal
is difficult to achieve
Define hirsutism. - (correct Answer) - unwanted male-pattern hair growth on a woman's face, chest, and
back
How does metformin help control blood glucose? - (correct Answer) - lowers blood glucose by
decreasing hepatic glucose production and increasing insulin
sensitivity in both hepatic and peripheral muscle tissues.
How do thiazolidinediones lower blood glucose? - (correct Answer) - Increases free fatty acids by binding
to PPAR-gamma; increases insulin sensitivity by stimulating PPAR-gamma;
binds to the PPAR-y (gamma) receptor in peripheral tissues to increase glucose transporters (this
increases glucose into the cell)
,What are the 4 contraindications for thiazolidinediones? - (correct Answer) - 1) heart failure (bc TZDs can
cause fluid retention)
2) pregnancy (bc they are Pregnancy Category C)
3) active bladder CA
4) baseline ALT >2.5 times the ULN (upper limit of normal)
What are the side effects of thiazolidinediones? - (correct Answer) - 1) fluid retention and edema
2) hepatotoxicity (but symptoms reverse w/in a few weeks of d/c the med), but check LFTs (liver function
tests) at baseline and periodically)
3) increase risk of heart failure
4) increase risk of upper and lower limb fractures (osteoporosis)
5) may cause premenopausal anovulatory women to start ovulating, so counsel all women capable of
becoming pregnant
6) increased risk of bladder CA
7) rosiglitazone may increase risk of MI and CV disease
8) weight gain
What do all the drugs in the TZD class end in? - (correct Answer) - -glitazone
What do (almost) all the drugs in the Sulfonylurea class start and end in? - (correct Answer) - start with
Gl-
End in -ide
e.g. Glipizide, Glyburide, Glimepiride
What is the most important drug in the Biguanides class? - (correct Answer) - Metformin
What do the drugs in the GLP-1 receptor agonist class end in? - (correct Answer) - -tide
e.g. Exenatide, Liraglutide
What do the drugs in the DPP-4 Inhibitors class end in? - (correct Answer) - -gliptin
e.g. Saxagliptin, Linagliptin, Alogliptin
What do the drugs in the SGLT-2 inhibitors class end in? - (correct Answer) - -gliflozin
e.g. Canagliflozin, Dapagliflozin, Empagliflozin
What are the C/I for the biguanides? - (correct Answer) - 1) Renal dysfunction (GFR < 30)
and SCr<1.5 in males and SCr<1.4 in females
, 2) Heart failure on treatment
3) Age >80 years
4) Hx alcoholism or binge drinking
5) Active liver disease
6) Stop metformin on the day of surgery or radiographic procedures in which nephrotoxic dye is used
and assess renal function 48 hours after procedure before restarting metformin
7) hold for sepsis, dehydration, and hypoxemia
What are the side effects of the biguanides? - (correct Answer) - 1) GI: decreased appetite, N, diarrhea
2) interferes with vitamin B12 absorption; monitor periodically if have anemia or peripheral neuropathy
3) incr risk of lactic acidosis
What is the impact of each class of diabetes med on weight? - (correct Answer) - Biguanides
(metformin)--neutral/loss (not associated with weight gain)
Sulfonylureas--gain
Thiazolidinediones--gain
GLP-1 receptor agonists--loss
DPP-4 inhibitors--neutral
SGLT-2 inhibitors--?
Say whether each class of diabetes med puts pts at risk of hypoglycemia. - (correct Answer) - Biguanides
(metformin)--no
Sulfonylureas--yes
Thiazolidinediones--?
GLP-1 receptor agonists--no
DPP-4 inhibitors--no
SGLT-2 inhibitors--yes
What are the C/I for Sulfonylureas? - (correct Answer) - 1) require renal dose adjustment or are not
recommended in renal impairment;
glyburide not recommended with renal impairment, glipizide ok; must use with caution in hepatic
impairment or dose adjustment
Name the 6 classes of non-insulin diabetes medications. - (correct Answer) - 1) biguanides (metformin)
2) sulfonylureas (the gl- -ides)
3) thiazolidinediones (TZDs; the -glitazones)
4) GLP-1 receptor agonists (exenatide, liraglutide)
5) DPP-4 inhibitors (the -gliptins)
6) SGLT-2 inhibitors (the -gliflozins)
What are the 3 major A1C ADA standards of care goals?
Which patients are appropriate for each A1C goal? - (correct Answer) - <7%, <6.5%, and <8%
1) A1C <7% for many non pregnant adults is a reasonable A1C goal
2) A1C <6.5% for patients who have had T2DM for a short duration, have T2DM treated with lifestyle or
metformin only, long life expectancy, or no significant CVD
3) A1C <8% for its w/ h/o severe hypoglycemia, limited life expectancy, advanced microvascular or
microvascular complications, extensive comorbid conditions, or long-standing diabetes in home the goal
is difficult to achieve
Define hirsutism. - (correct Answer) - unwanted male-pattern hair growth on a woman's face, chest, and
back
How does metformin help control blood glucose? - (correct Answer) - lowers blood glucose by
decreasing hepatic glucose production and increasing insulin
sensitivity in both hepatic and peripheral muscle tissues.
How do thiazolidinediones lower blood glucose? - (correct Answer) - Increases free fatty acids by binding
to PPAR-gamma; increases insulin sensitivity by stimulating PPAR-gamma;
binds to the PPAR-y (gamma) receptor in peripheral tissues to increase glucose transporters (this
increases glucose into the cell)
,What are the 4 contraindications for thiazolidinediones? - (correct Answer) - 1) heart failure (bc TZDs can
cause fluid retention)
2) pregnancy (bc they are Pregnancy Category C)
3) active bladder CA
4) baseline ALT >2.5 times the ULN (upper limit of normal)
What are the side effects of thiazolidinediones? - (correct Answer) - 1) fluid retention and edema
2) hepatotoxicity (but symptoms reverse w/in a few weeks of d/c the med), but check LFTs (liver function
tests) at baseline and periodically)
3) increase risk of heart failure
4) increase risk of upper and lower limb fractures (osteoporosis)
5) may cause premenopausal anovulatory women to start ovulating, so counsel all women capable of
becoming pregnant
6) increased risk of bladder CA
7) rosiglitazone may increase risk of MI and CV disease
8) weight gain
What do all the drugs in the TZD class end in? - (correct Answer) - -glitazone
What do (almost) all the drugs in the Sulfonylurea class start and end in? - (correct Answer) - start with
Gl-
End in -ide
e.g. Glipizide, Glyburide, Glimepiride
What is the most important drug in the Biguanides class? - (correct Answer) - Metformin
What do the drugs in the GLP-1 receptor agonist class end in? - (correct Answer) - -tide
e.g. Exenatide, Liraglutide
What do the drugs in the DPP-4 Inhibitors class end in? - (correct Answer) - -gliptin
e.g. Saxagliptin, Linagliptin, Alogliptin
What do the drugs in the SGLT-2 inhibitors class end in? - (correct Answer) - -gliflozin
e.g. Canagliflozin, Dapagliflozin, Empagliflozin
What are the C/I for the biguanides? - (correct Answer) - 1) Renal dysfunction (GFR < 30)
and SCr<1.5 in males and SCr<1.4 in females
, 2) Heart failure on treatment
3) Age >80 years
4) Hx alcoholism or binge drinking
5) Active liver disease
6) Stop metformin on the day of surgery or radiographic procedures in which nephrotoxic dye is used
and assess renal function 48 hours after procedure before restarting metformin
7) hold for sepsis, dehydration, and hypoxemia
What are the side effects of the biguanides? - (correct Answer) - 1) GI: decreased appetite, N, diarrhea
2) interferes with vitamin B12 absorption; monitor periodically if have anemia or peripheral neuropathy
3) incr risk of lactic acidosis
What is the impact of each class of diabetes med on weight? - (correct Answer) - Biguanides
(metformin)--neutral/loss (not associated with weight gain)
Sulfonylureas--gain
Thiazolidinediones--gain
GLP-1 receptor agonists--loss
DPP-4 inhibitors--neutral
SGLT-2 inhibitors--?
Say whether each class of diabetes med puts pts at risk of hypoglycemia. - (correct Answer) - Biguanides
(metformin)--no
Sulfonylureas--yes
Thiazolidinediones--?
GLP-1 receptor agonists--no
DPP-4 inhibitors--no
SGLT-2 inhibitors--yes
What are the C/I for Sulfonylureas? - (correct Answer) - 1) require renal dose adjustment or are not
recommended in renal impairment;
glyburide not recommended with renal impairment, glipizide ok; must use with caution in hepatic
impairment or dose adjustment
