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First Aid for the USMLE Step 1 (2024)
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First Aid for the USMLE Step 1 (2024) | Medicine (MD/DO) School Study Aid

Page 359 -
10 Picmonics to Learn | 20 mins
Metformin
Indications
Diabetes Mellitus Type 2
Polycystic Ovary Syndrome (PCOS)
Mechanism of Action
Decreased Gluconeogenesis
Increased Insulin Sensitivity
Side Effects
Lactic Acidosis
GI Distress
Weight Loss
B12 Deficiency
Contraindication
GFR < 30 ml/min
picmonic thumbnail
2 mins
Pioglitazone (Thiazolidinediones)
-glitazones Suffix
Mechanism
Binds PPAR-Gamma
Decreases Insulin Resistance
Indications
Type 2 Diabetes
Side Effects
Weight Gain
Heart Failure
Myalgia
Hypoglycemia
Upper Respiratory Infection
Considerations
Increased Risk of Bladder Cancer
Increased Fracture Risk in Women
Monitor Liver Enzymes
picmonic thumbnail
2 mins
Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)
Mechanisms
1st Generation Sulfonylureas
Stimulate Release of Insulin
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Possible Cardiovascular Toxicity
Weight Gain
Considerations
Exacerbated Hypoglycemia with Beta-blockers
Avoid During Pregnancy and Breast Feeding
Avoid Alcohol
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2 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
Mechanisms
2nd Generation Sulfonylureas
Blocks Potassium Channels in Beta Cells
Stimulate Release of Insulin
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Considerations
More Potent
Beta Blockers Reduce Effects
Avoid Alcohol
Avoid Breastfeeding
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2 mins
Repaglinide and Nateglinide (Meglitinides)
Mechanisms
Meglitinides
Increased Insulin Release
Indications
Type 2 Diabetes
Side Effect
Hypoglycemia
Considerations
Eat Within 30 Minutes
Gemfibrozil Increases Risk of Hypoglycemia
Short Half-Life
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2 mins
Exenatide (Byetta)
Mechanism
Incretin Mimetic
GLP-1 Synthetic Analog
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Nausea and Vomiting
Diarrhea
Thyroid Cancer
Pancreatitis
Renal Failure
Considerations
(Give Exenatide) One Hour After Other Medications
Adjunct Therapy
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3 mins
Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)
-gliptin Suffix
Mechanisms
DPP-4 Inhibitor
Increases Insulin Release
Indications
Type 2 Diabetes
Side Effects
Pancreatitis
Upper Respiratory Infection and Inflammation
Stevens-Johnson Syndrome
Considerations
Used as Add-on Agents
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2 mins
SGLT2 Inhibitors
"-gliflozin" Suffix
Mechanism of Action
Blocks Glucose Reabsorption in Proximal Tubule
Indications
Type 2 Diabetes Mellitus
Side Effects
Weight Loss
Lower Blood Pressure
Hyperkalemia
Urinary Tract Infections (UTIs)
Considerations
Contraindicated in Chronic Kidney Disease
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1 min
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
Mechanisms
Alpha Glucosidase Inhibitors
Delays Absorption of Carbohydrates
Indications
Type 2 Diabetes
Side Effects
Flatulence
Diarrhea
Anemia
Cramps
Considerations
Monitor LFTs
Oral Glucose for Hypoglycemia
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2 mins
Pramlintide (Symlin)
Mechanism
Synthetic Amylin Analog
Indications
Diabetes Type 1 and 2
Supplement Mealtime Insulin
Side Effects
Nausea
Skin Reactions at Injection Site
Considerations
Hypoglycemia When Combined with Insulin
Delayed Absorption of Oral Drugs
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2 mins

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