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Thera XI > 12 Type 2 DM Ma > Flashcards

12 Type 2 DM Ma Flashcards

1
Q

What is the approximate average glucose with an A1c of 7%?

A

~150, each percentage increase or decrease add/subtract 30

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2
Q

How should you manage your insulin if you’re sick?

A

Check blood glucose every 3-4 hours. Adjust by 1-2 units of regular or lispro insulin for every 30-40 mg/dL above target goal. If blood glucose > 240, check urine for ketones

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3
Q

What is required for T2DM diagnosis?

A

A1c > 6.5 OR 2hr OGTT > 200 OR FPG > 126 (8hr fast): any of the previous three need a repeat. Symptoms of DM + RBG > 200

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4
Q

According to the ADA, what are the DM Glycemic Goals?

A

A1c < 7%. FPG 70-130. PP < 180

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5
Q

What is the new BP goal for DM?

A

<140/80

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6
Q

What are the common symptoms of HYPOglycemia?

A

SWEATING! Shaky, increased HR, dizzy, anxious, hungry, blurry vision, weakness or fatigue, HA, irritable

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7
Q

What are the brand names of Metformin (Biguanides)?

A

Glucophage, Glucophage XR, Fortamet, Glumetza

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8
Q

How should Metformin be titrated to avoid GI effects?

A

Week 1: 1 tablet PO. Week 2: 1 tablet BID. Week 3: 2 tablets QAM, 1 tab QPM. Week 4: 2 tabs BID

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9
Q

What is the BBW with Biguanides (Metformin)?

A

Lactic acidosis. Blood lactate > 5, decreased blood pH, electrolyte disturbances; malaise, rapid breathing, SOB, severe weakness, coma

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10
Q

What are the contraindications to Metformin use?

A

Renal: SCr > 1.5 in men, > 1.4 in women. Acute/chronic metabolic acidosis. Radiological studies with iodinated contrast (48hrs prior and after procedure - hold)

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11
Q

What are some precautions before Metformin use?

A

Chronic hepatic dysfunctino (decreases lactate CL), Alcoholism. CHF

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12
Q

What are the current recommendations for primary prevention of CVD in patients with DM at CV risk (10 year risk > 10%)?

A

ASA 75-162mg/day (in case of allergy, Clopidogrel 75mg/day may be substituted)

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13
Q

What vaccines must DM patients be up to date on?

A

Annual influenza vaccine indicated to all DM patients > 6 months of age. Pneumococcal vaccine recommended for all DM patients > 2 years x1 dose

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14
Q

What is response like for doses of Sulfonylureas?

A

Response plateaus after half max dose for each respective SFU

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15
Q

What are the common side effects with SFUs?

A

Hypoglycemia (NEVER administer to fasting patient, skip meal skip dose). Weight gain. GI upset. Photosensitivity, skin rash, erythema, pruritus

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16
Q

When are Sulfonylureas contraindicated?

A

Type 1 DM. DKA (want to use insulin)

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17
Q

Which Sulfonylureas should be avoided with sulfa allergies?

A

Glipizide, Glyburide

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18
Q

Which Sulfonylureas should be avoided with renal problems?

A

Glipizide: CrCl < 10, Glyburide: CrCl < 50, Glimepiride: CrCl < 22

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19
Q

What are the Meglitinides used?

A

Nateglinide (Starlix). Repaglinide (Prandin)

20
Q

What is the MOA of Meglitinides?

A

Cause glucose-dependent insulin release

21
Q

What are the common ADRs with Meglitinides?

A

Hypoglycemia (NEVER administer when fasting, avoid meal avoid dose). Weight gain

22
Q

What are the advantages of Meglitinides?

A

Less hypoglycemia than sulfonylureas. Reduced post-prandial glucose

23
Q

What are the disadvantages of Meglitinides?

A

AE. Cost $$$. More frequent dosing

24
Q

What are the Thiazolidinediones (TZDs) used?

A

Pioglitazone (Actos). Rosiglitazone (Avandia) - MI risk

25
Q

What is important to remember about TZDs PK?

A

DELAYED (may not be apparent for 3 months)

26
Q

What is the MOA of TZDs?

A

Increase insulin sensitivity in muscle, adipose and liver. Little risk of hypoglycemia, give w/o regards to meals

27
Q

What is the BBW associated with TZDs?

A

CHF (not recommended for patients w/ HF (Class III, IV)). MI (Rosiglitazone only)

28
Q

When are TZDs contraindicated?

A

HF (class III, IV). DMI, DKA. ALT > 2.5x ULN

29
Q

When should you use precaution with TZDs?

A

Cardiac disease. Edema. Hepatic disease

30
Q

What are the common ADRs with TZDs?

A

Edema (fluid retention). Weight gain. Increased LFTs

31
Q

What are the advantages of TZDs?

A

Reduce insulin resistance. Improved lipid profile (pioglitazone)

32
Q

What are the disadvantages of TZDs?

A

MI risk (Rosiglitazone). ADRs: CHF, Liver disease. Cost $$$

33
Q

What are the Alpha-Glucosidase Inhibitors used?

A

Acarbose (Precose), Miglitol (Glyset)

34
Q

What is the MOA of Alpha-Glucosidase Inhibitors?

A

Decrease post-prandial glucose levels: inhibits alpha-glucosidase in small intestine –> delayed hydrolysis of disaccharides/complex carbohydrates. Not very useful in patients on high protein, low carb diets (Atkins)

35
Q

What are the ADRs with Alpha-Glucosidase Inhibitors?

A

GI effects (flatulence, diarrhea, cramps), increased LFTs

36
Q

When are Alpha-Glucosidase Inhibitors contraindicated?

A

Hypersensitivity. Severe digestive problems (IBD, ulcerations, obstructions, etc.)

37
Q

What is some counseling to do for TZDs?

A

Take with first bite of meal. DO NOT TAKE if meal is skipped. Treat hypoglycemia w/ GLUCOSE, not sucrose. SLOW titration to avoid GI effects

38
Q

When are Alpha-Glucosidase Inhibitors useful?

A

If close to goal with elevated post-prandial BG and do not want to start insulin

39
Q

What are the Dipeptidyl Peptidase-4 (DPP4) Inhibitors used?

A

Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Trajenta)

40
Q

What are the ADRs associated with DPP-4 Inhibitors?

A

HA, Nasopharyngitis, URTI, Pancreatitis

41
Q

Which DPP-4 Inhibitor does NOT require renal adjustment?

A

Linagliptin (Trajenta)

42
Q

What are the advantages of DPP-4 Inhibitors?

A

No hypoglycemia. Weight neutral/loss

43
Q

What are the disadvantages of DPP-4 Inhibitors?

A

Limited efficacy. Adverse effects. Cost $$$

44
Q

What is the only non-insulin medication approved for T1DM?

A

Amylin Analogue (Pramlintide (SymlinPen). Adjunct for mealtime insulin users. Injected SC immediately before meals

45
Q

What are the Incretin Mimetics used?

A

Exenatide (Byetta), Liraglutide (Victoza)

Thera XI (16 decks)

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