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Pharm exam 5 chapters > Ch 48 highlights > Flashcards

Ch 48 highlights Flashcards

1
Q

insulin needs increase when

A 
stress
infection
obesity
adolescent growth spurts
2nd and 3rd trimester pregnancy
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2
Q

insulin needs decrease when

A

increased exercise

1st trimester

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3
Q

insulin that can be mixed in the same syringe

A

Only NPH and short acting insulin

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4
Q

criterion for the diagnosis of DM

A 
fasting blood glucose > = 126 mg/dl
or
Random plasma glucose > = 200mg/dl  plus symptoms of D.M.
or 
oral glucose tolerance test:
2 hour plasma glucose >= 200
or 
HA1C 6.5% or higher

2 separate tests for diagnosis

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5
Q

what do you treat gestational DM with

A

Insulin

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6
Q

what type of DM management does not cause hypoglycemia and which oral agent does

A

Metformin
(sensitivity to insulin)

Sulfonylureas - does cause hypoglycemia
causes stimulation of insulin production

Meglinitinides (Glinides) - does cause hypoglycemia
works similar to Sulfonylureas

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7
Q

what pt population can you not use Metformin

A

renal impairment - blackbox warning

severe metabolic acidosis can occur with accumulation of metformin. Highest risk occurs in diabetic patients with significant renal impairment

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8
Q

Can you give someone who is Pregnant Metformin

A

yes

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9
Q

what antidiabetic causes weight loss and which causes weight gain

A

Metformin - Weight loss

Sulfonylureas - Weight Gain

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10
Q

When do you take Metformin in r/t meals

A

Metformin is not taken in r/t meals

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11
Q

Can you use Sulfonylureas in pregnancy

A

no

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12
Q

How do you take Sulfonylureas

A

Daily or BID

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13
Q

How are Glinides taken
Repaglinide
Nateglinide

A

Taken with each meal

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14
Q

what class are these meds in?
Repaglinide
Nateglinide

A

Glinides

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15
Q

Metformin decreases absorption of

A

Vit B12
folic acid

deficiencies in these vitamins can contribute to peripheral neuropathy

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16
Q

what vitamin deficiency is a diabetic taking metformin prone to that would be concerning if that pt became pregnant?

A

Folic acid

can cause neural tube defects

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17
Q

What antidiabetic holds a cardiac risk

A

Thiazolidinediones (Glitazones) - TZDs

can cause fluid retention and put a pt in heart failure or exacerbate heart failure

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18
Q 
What class is this drug?
Pioglitazone (Actos)
A

Thiazolidinediones (Glitazones) - TZDs

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19
Q

what is the indication for TZDs

A

antidiabetic for type 2 mainly as an add on to metformin

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20
Q

How do TZDs work

A

decreases insulin resistance

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21
Q

How do Alpha Glucosidase inhibitors work

A

act in intestines to delay absorption of carbs

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22
Q

what drug class is
Acarbose (Precose)
Meglitol

A

Alpha Glucosidase Inhibitors

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23
Q

how is Acarbose prescribed? monotherapy or adjunct?

A

adjunct

use with insulin, metformin or sulfonylurea

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24
Q

what is the indication for using Dipeptidyl Peptidase-4 Inhibitors (Gliptins) - DPP-4

A

optional second line therapy as an add on to metformin in the treatment of type 2 DM
can be monotherapy but usually adjunct

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25
Q 
What class is 
Sitagliptin (Januvia)
A

Dipeptidyl Peptidase-4 Inhibitors (Gliptins) - DPP-4

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26
Q

Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor) could cause weight gain or weight loss?

A

weight loss

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27
Q 
what drug class
Canagliflozin (invokana)
A

Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor)

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28
Q

common side effect for Canagliflozin (Invokana)

A

female genital fungal infections, urinary tract infections, and increased urination

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29
Q

A diabetic on Beta blockers

A

dangerous bc it can mask the signs of hypoglycemia\

avoid placing diabetics on beta blockers

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30
Q

Glucagon-like Peptide -1 (GLP-1) Receptor Agonists therapeutic goal

A

improvement of glucose control for patients with DM type 2

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31
Q

What drug class is Exenatide (Byetta))

A

Glucagon-like Peptide -1 (GLP-1) Receptor Agonists

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32
Q

What baseline data do you need to prescribe an antidiabetic

A

Random plasma glucose, fasting plasma glucose, Hemoglobin A1C, Serum electrolytes, urinary glucose and ketones

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33
Q

What hypersensitivity reactions have been seen for Glucagon-like Peptide -1 (GLP-1) Receptor Agonists

A

anaphylaxis

angioedema

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34
Q

Can you use Glucagon-like Peptide -1 (GLP-1) Receptor Agonists in pregnancy

A

use in caution with pregnancy

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35
Q

what patient population do you need to avoid when prescribing Glucagon-like Peptide -1 (GLP-1) Receptor Agonists

A

renal dysfunction
renal transplant patients
history of pancreatitis

36
Q

what class is Pramlintide (symlin)

A

Amylin Mimetic

37
Q

What is Pramlintide (symlin) approved for

A

DM type 1 or 2
adjunct therapy to use at mealtime in patients who have failed to achieve glucose control despite optimal insulin therapy

hypoglycemia is the biggest concern esp in type 1

38
Q

what type of DM is Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor) used for

A

type 2

39
Q

What is the therapeutic goal for Dipeptidyl Peptidase-4 inhibitors (Gliptins)

A

management of glucose control as an adjunct treatment for type 2 DM

40
Q

what pt population is high risk for Dipeptidyl Peptidase-4 inhibitors (Gliptins)

A

pt with history of pancreatitis

41
Q

Therapeutic goal for Meglinitinides (Glinides)

A

glycemic control with type 2 dm in combination with diet and exercise

42
Q

High risk pt population for Glinides

A

use with caution with patients in liver impairment and those taking gemfibrozil

43
Q

Therapeutic goal for Sulfonylureas

A

Maintain glycemic control in patients with Type 2 dm in conjunction with diet and exercise

44
Q

High risk pt population for Sulfonylureas

A

Do not use in pregnancy or breastfeeding

Use with caution in patients with renal or hepatic dysfunction

45
Q

what medications can raise glucose

A

sympathomimetics

glucocorticoids

46
Q

What medications can lower glucose

A

sulfonylureas

47
Q

for a fasting blood glucose, how many hours do you fast

A

8

48
Q

Name the short duration: Rapid acting insulin

A 
Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glulisine (Apidra)
49
Q

Name the Short Duration: Short Acting insulin

A

Regular Insulin (Humulin R, Novolin R)

50
Q

Name the Intermediate duration insulin

A

Humulin N, Novolin N

51
Q

Name the long duration inuslins

A 
Insulin glargine (U-100) - lantus
Insulin detemir -Levemir
52
Q

Name the Ultralong Duration inusulins

A 
Insulin Glargine (U-300) - Toujeo
Insulin degludec - Tresiba
53
Q

what insulin can be inhaled at mealtime for type 1 or type 2

A

Afrezza

54
Q

Insulin lispro Humalog onset

A

15-30 min

55
Q

Insulin aspart Novolog onset

A

10-20 min

56
Q

Insulin glulisine (Apidra) onset

A

10-15 min

57
Q

Regular Insulin (Humulin R, Novolin R) onset

A

30-60 min

58
Q

Humulin N, Novolin N onset

A

60-120 min

59
Q

Lantus onset

A

70 min

60
Q

Levemir onset

A

60-120 min

61
Q

INsulin glargine (U-300) onset

A

360 min

62
Q

Insulin degludec onset

A

30-90 min

63
Q

postprandial insulin control

A

humalog
novolog
apidra

64
Q

How often is NPH given (humulin N, Novolin N)

A

2-3 times/day

65
Q

how often is lantus given

A

1-2 /day

66
Q

How often is U-300 given

A

once per day in place of lantus

67
Q

what do you give if hypoglycemia develops while taking Acarbose

A

IM or IV glucose

You cannot use oral glucose bc receptors are blocked. It will not work

68
Q

Acarbose
Miglitol
Which is associated with hepatic dysfunction

A

Acarbose

69
Q

Which antidiabetic is more effective in African American population

A

Miglitol

70
Q

What common Side Effects does Miglitol and Acarbose have

alpha -glucosidase inhibitors

A

GI (slows motility) - delays absorption of dietary carbs and thereby reduces the rise in blood glucose after a meal

71
Q

Acarbose increases the risk for

A

anemia (can decrease the absorption of iron)

72
Q

what drug class
Glucotrol
Glucotrol XL

A

Sulfonylureas

73
Q

what dietary item must be avoided when taking a sulfonylurea

A

Alcohol will cause a disulfiram like reaction

74
Q

How is Glucotrol taken

A

once daily with breakfast

75
Q

what is a glycosylated hemoglobin level

A

HA1C

76
Q

what anti-hypertensives can you give a diabetic

A

Aces

Arbs

77
Q

what patient population can you not use metformin

A

Heart failure
liver impairment
renal impairment

due to being at high risk for lactic acidosis

liver and renal - build up
heart failure - when not pumping efficiently, anaroebic byproduct is lactic acid

78
Q

Glipizide (Glucotrol)

Glyburide (Diabeta)

A

Sulfonylureas

79
Q

when are glinides taken

A

with every meal

80
Q

When are sulfonylureas taken

A

Daily or BID

81
Q

which antidiabetic will you have weight loss

A

metformin

82
Q

Which antidiabetic will you have weight gain

A

sulfonylureas and glinides

83
Q

sitagliptin

is what class

A

Gliptins

84
Q

adverse effects of sitagliptin

A

stevens-johnson
anaphylaxis
angioedema
pancreatitis

85
Q

pt with severe hypoglycemia with limited life expectancy or advanced macro microvascular complications where should your target A1C sit

A

below 8

86
Q

when is insulin glargine given (lantus)

A

once daily at bedtime

Pharm exam 5 chapters (15 decks)

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