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NAPLEX 2021 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

how often should BG be checked in prediabetics

A

annually

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2
Q

The preferred treatment for gestational diabetes

A

insulin*

metformin and glyburide are sometimes used

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3
Q

Classic symptoms of high BG

A

polyruia
polydipsia
polyphagia

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4
Q

diagnostic criteria (A1c, FPG, 2-hr PPG)

A

a1c: >6.5 (pre: 5.7-6.4)
FPG: >126 (pre: 100-125)
2-hr PPG: >200 (pre: 140-199)

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5
Q

Treatment goals: not pregnant

A

A1c <7 or 6.5
preprandial: 80-130
2hr PPG: <180

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6
Q

Treatment goals: pregnant

A

preprandial: <95
1hr PPG: <140
2hr PPG: <120

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7
Q

what is the eAG for an A1c of 6%

A

126

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8
Q

what does 1% ^ in A1c roughly equal in eAG

A

1% increase in A1c is about 28mg/dl increase in eAG

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9
Q

statin instensity needed in diabetics

A

high if ASCVD (post-MI, PAD) or >50 with multiple risk factors
mod: no ASCVD and 40-75yo
Patients <40yo w/ ASCVD: mod
Patients <40yo w/o ASCVD: no statin

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10
Q

blood pressure goal in diabetes

A

<130/80 mmHg

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11
Q

when is an ACEi or ARB needed in diabetic patients

A

Albuminuria or HTN present

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12
Q

drugs with little/no risk of hypoglycemia

A

GLP-1
DPP4 inhibitors
SGLT2s
TZD

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13
Q

1st line in T2DM with HF

A

SGLT2: empag, canag, dapagliflozin

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14
Q

CI for SGLT2

A

eGFR <30

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15
Q

T2DM with ASCVD first line

A

GLP1: dulagluride, liraglutide, semaglutide
SGLT2: empagliflozin, canagliflozin

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16
Q

first line in diabetes

A

METFORMIN

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17
Q

cut off for metformin initiaion

A

eGFR<30

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18
Q

when can insulin be initiated initially

A

A1c>10% or BG > 300mg/dL

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19
Q

which drug classes bascially do the same thing and shouldn’t be initiated together

A

DPP4 and GLP-1s

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20
Q

What is the starting dose of basal or bedtime NPH insulin?

A

10 units daily or TDD of 0.1-0.2 units/kg/day

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21
Q

How/when to initiate prandial insulin

A

initiate if BG is not controled with basal insulin at goal. Start with once daily dose before meal with highest carb intake or highest post-prandial BG

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22
Q

What percentage of basal do we start prandial insulin at?

A

10%

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23
Q

When to pick SGLT2 over GLP-1

A

heart failure or CKD patients

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24
Q

Warnings with metformin

A

lactic acidosis with renal disease or alcohol disease
B12 deficiency
stop prior to contact media

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25
Q

What eGFR indicates to not initiate metformin

A

30-45

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26
Q

Side effects of thiazolidinediones

A

“-glitazones”
edema
weight gain
bone fractures

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27
Q

Because of certain side effects, which patients would we not want to start a thiazolidinedione on?

A

Heart failure (edema)

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28
Q

What is a unique warning with thiazolidinediones?

A

“glitazones”

can stimulate ovulation!

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29
Q

Which sglt2s provide renal benefit

A

canagliflozoin (invokanna)

empagliflozin (jardiance)

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30
Q

which sglt2s provide hf benefit

A

canagliflozoin (invokanna)
empagliflozin (jardiance)
dapagliflozin (Farxiga)

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31
Q

when do sglt2s need to be d/c acutely

A

3 days prior to surgery to decrease risk of ketoacidosis

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32
Q

Boxed warning of amputation with _____

A

canagliflozin (invokanna)

do not use in neuropathy

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33
Q

eGFR of ____ = SGLT2s CI

A

eGFR <30

34
Q

Which DPP4 does not need adjusted for renal impairment

A

linagliptin (Tradjenta)

35
Q

which DPP4 can cause hepatotoxicity?

A

Alogliptin (Nesina)

36
Q

which DPP4s should not be used in HF

A

aloglpitin (Nesina)

saxagliptin (Onglyza)

37
Q

Which drug class should not be used with insulin

A 
sulfonyureas 
(-ide) 
glipizide, glimepiride, glyburide 
AND 
meglitinides 
(glinide) 
repaglinide, nateglinide
38
Q

What is a unique thing about sulfonyureas having to do with prolonged use

A

efficacy will decrease due to decreased beta cell function

39
Q

MOA of sulfonyureas

A

increase insulin secretion by beta cells

40
Q

Which drug class has a Beers Criteria warning against use

A

sulfonyureas

41
Q

MOA of DPP4 inhibitors

A

increases incretin causing less glucagon production therefore lowering blood glucose

42
Q

thiazolidinediones MOA

A

(actos/avandia)

increase muscle uptake of blood glucose due to increased sensitivity

43
Q

Meglitinides MOA

A

-glinide

incease mealtime insulin secreation

44
Q

risk of hypoglycemia with meglitinides?

A

YES! Especially if patient skips meals`

45
Q

Which drug class can cause weight gain?

A

meglitinides, insulin, sulfonylureas, tzds

46
Q

GLP1 that can be used in type 1 DM

A

pramlintide (symlin)

47
Q

Which GLP1s come with pen needles?

A

weekly injections: Trulicity, Bydureon, Ozempic

48
Q

which diabetic drug should be avoided in hyperkalemia?

A

canagliflozin

49
Q

____ cells produce glucagon

A

alpha

50
Q

____ cells produce insulin

A

beta

51
Q

What is the glucose reverse in the liver/muscle stored stored as?

A

glycogen

52
Q

MOA glucagon

A

pulls glucose into blood stream from glycogen stores

53
Q

When are ketones made?

A

When glycogen stores in liver are low, glucagon signals fat cells to create ketones

54
Q

List of basal insulins

A

glargine
detemir
degludec

55
Q

which basal insulin is ultra-long acting

A

degludec

56
Q

what is Regular insulin’s role

A

bolus, but is slower acting than a rapid acting insulin

57
Q

NPH facts

A

intermediate acting
p = protamine
hypoglycemia risk due to peaks that don’t coincide with food intake
variable, duration of action (14-24 hours)

58
Q

onset and duration: rapid acting

A

15 min onset

3-5 hour duration

59
Q

onset and duration: regular insulin

A

30 min onset

6-10 hours duration

60
Q

onset and duration- NPH

A

1-2 hour onset

14-24 hour duration

61
Q

onset and duration- detemir

A

3-4 hour

1 day

62
Q

pros of basal insulin

A

NO PEAKS!

63
Q

onset and duration - glargine

A

3-4 hour

1 day

64
Q

onset and duration - degludec

A

1 hour onset

42+ hour duration

65
Q

which diabetic drug should not be used with insulin due to risk of heart failure

A

rosiglitazone

66
Q

which is rapid acting, humalog or humulin?

A

humalog and novolog!

think, diabetics need to LOG their meals and these are used at meal time

67
Q

How is NPH given? `

A

twice daily before breakfaast and supper

68
Q

how to start basal/bolus regime

A

if doing TID, start with 0.5u/kg/day then split 50:50 among basal and bolus dosing. bolus dosing should be spread out tid

69
Q

how to convert between insulins

A

typically 1:1 except NPH ->lantus or Toujeo ->lantus - use 80% of current dosing

70
Q

what is the ICR

A

insulin to carb ratio - how many grams of carbs are covered by 1 unit insulin

71
Q

how to calculate icr

A

regular: rule of 450 = 450/TDD insulin
Rapid: rule of 500 = 500/TDD = g of carbs covered by 1 unit insulin

72
Q

what is the correction factor?

A

indicates how much the BG will be lowered by 1 unit of insulin

73
Q

How to calculate the correction factor

A

regular: 1500 rule
1500/TDD
rapid: 1800 rule
1800/tdd

74
Q

how to calculate correction dose

A

(BG now - target BG)/correction factor

75
Q

how to use correction dose

A

add it to the normal number of units of insulin before meals

76
Q

If a patients BG readings before dinner are consistently high and they are on basal/bolus regime, what dose needs changed?

A

increase lunch time bolus

77
Q

which insulins have a room temp stability other than 28 days?

A

10: humalog mix pen
14: humulin N and N/R pens
31: humulin R vial
40: Humulin R U-500 vial
41: Novolin N, R, N/R, 70/30 vials, levemir
56: Tresiba, Toujeo pen

78
Q

goal BG in hospitalized patients

A

140-180

79
Q

Lab values of DKA

A

bg >250
ketones in urine and serum
anion gap acidosis (pH<7.35, gap >12)

80
Q

Treating DKA and HHS

A

aggressive fluid resuscitation with NS, once BG 200 switch to D5W 1/2 NS
Watch K+ and replace as needed
insulin infusion 0.1 u/kg/hr
give sodium bicarb with pH is <6.9

81
Q

what is HHS

A 
hyperosmolar hyperglycemic state: 
confusion/delirium 
BG>600 with osmolarlity of >320 
dehydration 
pH>7.3

NAPLEX 2021 (28 decks)

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