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Fa: Pharm 3 > 2. Endocrine 1 - Diabetes > Flashcards

2. Endocrine 1 - Diabetes Flashcards

1
Q

poor periop glycemic control risks

A

incr CV
hyper/hypoglycemia
DKA
HHS

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2
Q

DKA is more likely in what pts

A

T1D

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3
Q

what makes DKA worse

A

sress

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4
Q

DKA Glu levels

A

> 250 mg/dL

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5
Q

DKA electrolyte abnormaliteis

A

High K+
low Phos

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6
Q

HHS is more common in

A

T2D

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7
Q

HHS Glu levels

A

Glu > 600 mg/dL

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8
Q

HHS diagnostic criteria

A

hyperglycemia
hyperosmolarity
dehydration

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9
Q

HHS osmolarity

A

plasma osm > 350 mOsm/L

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10
Q

biguanide drug

A

metformin

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11
Q

biguanide indication

A

T2D

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12
Q

biguanide mechanims

A

activated AMP kinase

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13
Q

biguanide SE

A

decr hepatic glu production
incr sk muscle glu metabolism
lactic acidosis
GI symptoms

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14
Q

do biganides have hypoglycemia risk

A

NO

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15
Q

biguanide DOA

A

8-12 hrs

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16
Q

biguanide dosing

A

bid (2x daily)
qd (4x daily)

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17
Q

biguanide CI

A

renal insufficiency (Cr > 1.5 mg/dL)
HF
contrast dye

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18
Q

sulfonurea drug

A

glyburide

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19
Q

sulfonurea mech

A

closes K-ATP channel on beta cell membrane

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20
Q

sulfonurea SE

A

incr insulin secretion
hypoglycemia
weight gain

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21
Q

do sulfonurea have risk of hypoglycemia

A

yes

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22
Q

which drug class has highest risk of hypoglycemia

A

sulfonurea (glyburide)

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23
Q

sulfonurea DOA

A

12-24 hrs

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24
Q

sulfonurea CI

A

renal insufficiency

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25
Q

meglitinides drug

A

Repaglinide

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26
Q

meglitinides mech

A

closed K-ATP channels on beta cell membrane

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27
Q

meglitinide SE

A

incr insulin secretion
hypoglycemia

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28
Q

do meglitinides have risk for hypoglycemia

A

yes

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29
Q

meglitinde DOA

A

12-14 hrs

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30
Q

thizolidinediones drug

A

pioglitazone

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31
Q

thizolidinediones indication

A

T2D

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32
Q

thizolidinediones mech

A

activate nuclear transcription factor PPAR-gama

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33
Q

thizolidinediones SE

A

incr insulin sensitivity
edema

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34
Q

do thizolidinediones have hypoglycemia

A

NO

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35
Q

thizolidinediones DOA

A

12-24 hrs

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36
Q

thizolidinediones CI

A

systolic HF

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37
Q

alpha glucosidase inhibitor

A

acarbose

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38
Q

alpha glucosidase inhibitor mech

A

inhibits intestinal alpha glucosidase

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39
Q

alpha glucosidase SE

A

no intestinal carb digestion/absorption

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40
Q

do alpha glucosidase inhibitors cause hypoglycemia

A

no

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41
Q

DPP4 inhibitor

A

sitagliptin

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42
Q

DPP4 inhibitor mech

A

inhibits DDP4 activity which increases incretins

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43
Q

DPP4 SE

A

incr insulin secretion
decr glucagon secretion
pancreatitis

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44
Q

DPP4 DOA

A

24 hrs

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45
Q

do DPP4 inhibitors cause hypoglycemia?

A

no

46
Q

GLP1 receptor agonist

A

semaglutide

47
Q

GLP1 agnoist mech

A

activates GLP-1 receptors
(incretin mimetic)

48
Q

GLP1 agonist SE

A

incr insulin secretion
pancreatitis

49
Q

GLP1 agonist risk of hyypoglycemia?

A

no

50
Q

GLP1 agonist dosing

A

daily to weekly

51
Q

SGLT2 inhibitors

A

canaglioflozin

52
Q

SGLT2 inhibitor indication

A

diabetes / HF

53
Q

SGLT2 mechanism

A

inhibits sodium glucose transport in proximal tubule

54
Q

SGLT2 SE

A

blocks glu reabs by kidney
incr glucosuria
UTI
hyponatremia
dehydration

55
Q

SGLT2 DOA

A

24 hrs

56
Q

do SGLT2 inhibitor cause hypoglycemia

A

no

57
Q

amylin mimetics

A

pramlintide

58
Q

amylin mimentics mech

A

activates amylin receptors

59
Q

amylin mimetic SE

A

decr glucagon secretion
slow gastric emptying
incr satiety

60
Q

amylin mimemetic hypoglycemia?

A

no

61
Q

insulin analog mech

A

activate insulin receptor
- incr glu disposla
- decr hepatic glu production
- suppress ketogenesis

62
Q

rapid insulin analog

A

lispro
aspart
glulisine

63
Q

short acting insulin analgo

A

human regular

64
Q

intermed acting insulin analog

A

human NPH

65
Q

basal insulin analog

A

glargine
detemir
degludec

66
Q

which insulin can you give IV

A

regular insulin

67
Q

does insulin cause hypoglycemia

A

yes

68
Q

risk for hypoglycemia is related to

A

mechanism of action

69
Q

HOLD/STOP day prior to sx

A

SGLT2 inhibitors

70
Q

HOLD/STOP day of sx

A

secreatagogues- sulfonureas
SGLT2 inhibior: gliflozins
GLP1 agonist

71
Q

TAKE day of sx

A

DPP4 inhibitors
thiazolinediones
metformine (unless dye admin)

72
Q

what meds do T1D need during sx

A

insulin and glu

73
Q

Insulin DAY before sx

A

continue

74
Q

insulin NIGHT before sx

A

basal insulin reduce up to 25%

75
Q

what insulin is held before sx

A

prandial/short acting

76
Q

Insulin day of sx

A

80% basal insulin dose

77
Q

BG should be checked every ______ in T2D

A

2 hrs

78
Q

BG should be checked every _______ in T1D

A

1 hr

79
Q

goal BG

A

90-180 mg/dL

80
Q

less tight BG

A

decr risk of hypoglycemia

81
Q

more tight BG reg

A

more hypoglycemia w/o benefits

82
Q

BG 100-140 mg/dL insulin dose

A

0.025 units/kg/hr

83
Q

BG 140-220 mg/dL insulin dose

A

0.05 units/kg/hr

84
Q

BG 220-270 mg/dL insulin dose

A

0.075 units/kg/hr

85
Q

BG > 270 mg/dL insulin dose

A

0.1 units/kg/hr

86
Q

DM1 pts perio-op insulin

A

1-2 units/hr
(Do Not Stop)

87
Q

DM2 pts perio-op insulin

A

higher rates due top insulin resistance

88
Q

perio-op hypoglycemia treatment

A

decr rate to 0.5 units/hr
incr glu infusion rate

89
Q

what should you pair with insulin?

A

dextrose to prevent hypoglycemia

90
Q

dextrose IV dose

A

4-6 g /hr

91
Q

dextrose D5W dose

A

75-125 mL/hr

92
Q

dextrose IV indication

A

pts on IV insulin
maybe: pts w/preop hypoglycemia

93
Q

restart metform

A

do not restart if:
- renal insufficient
- hepatic impairement
- CHF

94
Q

restart sulfonurea

A

after eating

95
Q

thiazolidieodinsae CI

A

CHF
impaired liver function

96
Q

how long should you continue IV insulin post-op

A

until resume eating

97
Q

when do you start subq insulin post-op

A

once tolerating solid foods
GIVE PRIOR TO STOPPING IV INSULIN

98
Q

blood glu goals

A

avoid hypoglycemia
prevent DKA/HHS
avoid hyperglycemia
fluid/electrolyte balance
decr infection risk

99
Q

hypo0glycemia

A

< 40 mg/dL

100
Q

when should you start treating low Blood Glu

A

< 70 mg/dL

101
Q

anesthetics do what

A

mask hypoglycemia symtpoms

102
Q

treat hypoglycemia

A

IV dextrose 25 g
glucagon 1 mg IV
15-20 g juice

103
Q

treat hyperglycemia

A

give insulin

104
Q

DKA diagnosis

A

AG > 10 mEq/L

105
Q

DKA treatment

A

1-2 L fluids
IV insulin
K+/Phos replacement

106
Q

DKA IV bolus

A

0.1 Unit/kg

107
Q

DKA IV infusion

A

0.1 unit/kg/hr

108
Q

what indicates DKA has resolved

A

AG < 12 mEq/L
pH > 7.3
bicarb 15 mEq/L

109
Q

HHS treatment

A

fluid resuscitation 1-1.5L hypotonic saline
insulin
supp electrolytes

110
Q

hypotonic saline

A

0.45% NaCl
0.225% NaCl

111
Q

HHS diagnosis

A

plasma osm > 320 mOsm/L

Fa: Pharm 3 (10 decks)

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