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Endocrinology/Nutrition > 04c: Diabetes Part II > Flashcards

04c: Diabetes Part II Flashcards

1
Q

List the diabetes meds that are “insulin sensitizers”

A
  1. Biguande (Metformin)

2. Thiazolidinediones

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2
Q

Main mechanisms by which Metformin workds

A
  1. Increases insulin sensitivity

2. Decreases gluconeogenesis

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3
Q

(X) drug is first-line for essentially all patients with DM II

A

X = Metformin

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4
Q

Two main side effects of Metformin. Star the more common one

A
  1. GI (abd cramping, nausea, etc)*

2. Lactic acidosis

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5
Q

Contraindications for Metformin use:

A
  1. DM I
  2. Renal insufficiency (drug is renally cleared)
  3. Liver failure
  4. CHF
  5. Prior lactic acidosis on metformin
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6
Q

Thiazolidinediones (TZDs), such as (X), have which mechanism of action?

A

X = Piogiltazone

Bind PPAR-y and alpha receptors; increase glucose uptake and decrease gluconeogen

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7
Q

Which “insulin sensitizer” med preferred in patients with high lipid profile?

A

TZDs

Lower TG and increase HDL

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8
Q

List the diabetes meds that are “secretagogues”

A
  1. Sulfonylureas

2. Meglitinides

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9
Q

Primary mechanism of action of sulfonylurea

A

Secretagogue (increases beta cell insulin release)

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10
Q

DM II: You start your patient on Glipizide and get 80% max effect at half the max dose of the drug. You (do/don’t) decide to increase the dose because:

A

Don’t; you won’t improve effect, but increase risk for side effects (hypoglycemia, weight gain, drug interactions)

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11
Q

(X) DM II meds have black box warning on all first-gen meds since 1970. This is due to which side effect?

A

X = sulfonylureas (esp glyburide)

Increase CV mortality

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12
Q

Meglitinide mechanism of action

A

Secretagogue

Beta cell depolarization (by closing K-ATP channel) and insulin release

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13
Q

(Glipizide/meglitinide) is more useful for post-prandial hyperglycemia than for fasting glucose reduction.

A

Meglitinide

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14
Q

List the “hormone replacement” diabetes meds

A
  1. Alpha-glucosidase inhibitors

2. Amylin replacement

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15
Q

Alpha-glucosidase inhibitors mechanism of action

A

Competitively inhibit hydrolytic enzymes in gut (slows glucose absorption)

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16
Q

Alpha-glucosidase inhibitors side effects

A

Many GI issues (flatulence, diarrhea, cramping) - no longer popular in US

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17
Q

List the “incretin mimetics” diabetes meds

A
  1. GLP-1 R agonist

2. DPP-4 inhibitors

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18
Q

GLP-1 is a(n) (X) hormone released from (Y). It stimulates:

A 
X = incretin
Y = L cells (in ileum and colon)

Insulin response from beta-cells in glucose-dependent manner

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19
Q

GIP is a(n) (X) hormone released from (Y). It stimulates:

A 
X = incretin
Y = K cells (in duodenum)

Insulin response from beta-cells in glucose-dependent manner

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20
Q

(GLP1/GIP) (stimulate/inhibit) glucagon secretion from alpha cells.

A

GLP-1

GIP has no effect on glucagon

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21
Q

Exenatide, GLP-1 R agonist, differs in which ways from endogenous GLP-1?

A
  1. Resistant to DDP-4 degradation (so long duration in plasma following SC injection)
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22
Q

(X) is the most popular GLP-1 agonists due to its (Y) effects, independent of glucose-lowering effects.

A 
X = Liraglutide
Y = Cardiac benefits
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23
Q

(X) DM II meds are associated with medullary thyroid cancer.

A

X = GLP-1 agonists

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24
Q

DM II patient presents with severe RUQ pain, esp after eating fatty meal. She’s diagnosed with cholelithiasis. Which DM II medication may be in her regimen, if this is a side effect of meds?

A

GLP-1 agonist

25
Q

T/F: GLP-1 agonists are all injectible

A

True

26
Q

DDP-4 inhibitors are (injectable/oral) meds and should be avoided in which patients?

A

Oral

Patients with heart failure

27
Q

Black box warning on (X) DM II meds for arthralgia.

A

X = DDP-4 inhibitors

28
Q

(X) meds for DM II work by increasing urinary glucose excretion. These work in which part of kidney?

A

X = SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin)

Prox tubule

29
Q

Recent data shows that (X) DM II med causes 2x increase in amputations in patients with CV disease.

A

X = Canagliflozin (SGLT2 inhibitor)

30
Q

List the human insulin preparations used for DM

A

Regular, NPH, U500

31
Q

Insulin U500 is used for which patients?

A

Very Obese

It’s regular insulin, 5x concentrated

32
Q

Insulin analogues are divided into which subcategories?

A

Long-acting (glargine, detemir, degludec)

Short-acting (aspart, glulisine, lispro)

33
Q

Goal HbA1c for adult diabetic patients:

A

Less than 7%

34
Q

Goal pre-prandial/fasting glucose level for diabetic patients:

A

80-130 mg/dL

35
Q

Goal post-prandial glucose level for diabetic patients:

A

under 180 mg/dL

36
Q

Why is goal HbA1c for peds diabetic patients (lower/higher) than that for adults?

A

Higher (7.5% or so)

Safe value since kids may not express hypoglycemia symptoms as clearly

37
Q

T/F: All-cause mortality is lower in DM patients who undergo “intensive” therapy (bring glucose levels down to near-normal values).

A

False! Higher mortality in this group

38
Q

First stage of diabetic retinopathy is called (X) and is characterized by which changes?

A

X = background diabetic retinopathy

  1. Pericyte and Endothelial cell loss (apoptosis)
  2. Microaneurysms
  3. Vascular BM thickening
39
Q

(Increased/decreased) (X) growth factor levels play critical role in diabetic neuropathy. What causes these pathologic levels?

A

Increased
X = angiogenic -
FGF, IGF, TGFbeta,
VEGF (neovascularization)

Ischemia (impaired retinal blood flow, capillary occlusion)

40
Q

Neovascularization: why are new vessels a bad thing?

A 
Vessels are leaky (abnormal) 
Uncontrolled growth (grow into macula - a forbidden area with no vessels normally)
41
Q

List the three key complications/changes in diabetic retinopathy

A
  1. Retinal detachment
  2. Uncontrolled angiogenesis
  3. Leaky cap’s (macular edema)
42
Q

Which tools/tests can be used to inspect eye for changes in diabetic retinopathy

A
  1. Retinal angiography (inject dye, observe/take pics of retina)
  2. OCT scanner
43
Q

Diabetic retinopathy: which tool used to assess retinal thickening?

A

OCT scanner

44
Q

Macular edema in diabetic patient can be easily diagnosed via (X) tool

A

X = OCT scanner

45
Q

T/F: Glaucoma is the leading cause of blindness worldwide.

A

False - second leading cause

46
Q

Aqueous humor formation involves which 3 stages?

A
  1. Blood flows (in cap’s) to ciliary process
  2. Ultrafiltration (plasma into interstitium and ciliary epithelia)
  3. Secretion (from ciliary epithelial cells into post chamber)
47
Q

Aqueous humor outflow path is to (X) compartment, passing one-way valve formed by which structures?

A

X = anterior chamber

Lens and iris

48
Q

From (anterior/posterior) chamber, aqueous humor pass through (X), enters (Y) canal and then out into venous circulation

A

Ant
X = trabecular meshwork (TMW)
Y = canal of schlemm

49
Q

What’s the mechanism behind (open/closed)-angle glaucoma in diabetic patients?

A

Open-angle (angle between iris and lens still open);

High glucose-induced excess synthesis of ECM in TMW and Schlemm’s canal blocks aqueous humor outflow

50
Q

Diabetic patient presents with visual complaints. He reports spotty blank areas in visual field. This is consistent with which diabetic eye complication?

A

Retinopathy

51
Q

Diabetic patient presents with visual complaints. She feels like her vision has been reduced to a small area in the center (decreased vision on all sides). This is consistent with which diabetic eye complication?

A

Glaucoma

52
Q

List some meds used to treat open-angle glaucoma by decreasing aqueous humor production

A

Timolol, Dorzolamide

53
Q

List some meds used to treat open-angle glaucoma by increasing outflow of aqueous humor

A

Latanoprost, pilocarpine

54
Q

DM patients have (X)-fold increased risk of developing cataracts. The key mechanism behind this is excess (Y).

A 
X = 4
Y = sorbitol (due to high glucose levels) - disrupts osmotic balance in lens
55
Q

High (X) levels in DM causes lens to (swell/shrink), damaging lens fibers and forming cataract

A

X = sorbitol

Swell (hydropic lens)

56
Q

Increased free radical formation in diabetes has been shown to cause which eye complication?

A

Cataracts

57
Q

Diabetic patient presents with visual complaints. She feels like she’s been having “misty” vision. This is consistent with which diabetic eye complication?

A

Cataract

58
Q

Rx of cataracts for DM

A

Early cataract extraction

59
Q

(Duration/severity) of diabetes/hyperglycemia is key to development of ocular complications.

A

Both; note that severity of hyperglycemia can be controlled

Endocrinology/Nutrition (10 decks)

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