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Pharmacology II > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diagnosis of:

  1. symptoms of DM plus random blood glucose concentration of?
  2. Fasting plasma glucose of?
  3. 2hr plasma glucose of what during an oral glucose tolerance test?
  4. HbA1C?
A
  1. 200
  2. 126
  3. 200
  4. > 6.5%
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2
Q

What is the HbA1C test?

A

% of Hb that is coated with glucose or glycated

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3
Q

Mortality is mostly from macro vascular complications such as what?

A

MI and CHF

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4
Q

Diabetes ketoacidosis is typically experienced by pts with what dm?

A

Type 1

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5
Q

What is DKA?

A

Lack of insulin - no carbohydrate metabolism, promotes lipgloss and metabolism of FFA to ketones

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6
Q

What can contribute to development of DKA (surgery, trauma, infection)

A

Stress

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7
Q

What is the overall deficit of DKA?

A

Water, K and phosphate, although ECF concentrations may look normal

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8
Q

Presents as severe hyperglycemia, hyperosmolarity, and dehydration that is typically seen in type 2 DM and pts over 60?

A

Hyperglycemia hyperosmolar syndrome (HHS)

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9
Q

How fast does hyperglycemia hyperosmolar syndrome evolve and what is the plasma osmolarity?

A

Days to weeks of glycosuric diuresis

Plasma osmolarity >340

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10
Q

DKA: glucose, pH, bicarb?

A

Glucose: >250
pH: 7.25-7.3 (mild), 7-7.24 (mod), <7 (severe)
Bicarb: 15-18 (mild), 10-<15 (mod), <10 (severe)

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11
Q

HHS: glucose, pH, bicarb, serum osm

A

Glucose: >600
pH: >7.3
Bicarb: >15
Serum osm: >350

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12
Q

What drug is biguanides?

A

Metformin

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13
Q

What drug is sulfonylurea?

A

Glyburide

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14
Q

What drug is meglitinides (glinides)

A

Repaglinide

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15
Q

What drug is thiazolidinediones?

A

Pioglitazone

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16
Q

What drug is alpha glucosidase inhibitor?

A

Acarbose

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17
Q

What drug is DPP4 inhibitor?

A

Sitagliptin

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18
Q

What drug is SGLT2 inhibitors?

A

Canagliflozin

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19
Q

What drug is GLP1 receptor agonist?

A

Exenatide

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20
Q

What drug is amylin mimetics?

A

Pramlintide

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21
Q

What drugs are apart of the insulin analogs rapid acting? (3)

A

Lispro
Aspart
Glulisine

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22
Q

What drug is insulin analogs short acting?

A

Human regular

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23
Q

What drug is insulin analogs intermediate acting?

A

Human NPH

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24
Q

What drugs are insulin analogs basal? (3)

A

Glargine
Detemir
Degludec

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25
Q

What drugs are insulin analogs premixed? (4)

A

NPH/Reg 70/30
Aspart 70/30
Lispro 75/25
Lispro 50/50

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26
Q

Mechanism of biguanides?

A

Activated AMP kinase

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27
Q

Mechanism of sulfonylureas?

A

Closes k-ATP channels on beta cell membrane

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28
Q

Mechanism of meglitinides (glinides)?

A

Closes k-ATP channels on beta cell membrane

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29
Q

Mechanism for thiazolidinediones?

A

Activates nuclear transcription factor PPAR-gamma

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30
Q

Mechanism for alpha glucosidase inhibitor?

A

Inhibits intestinal alpha glucosidase

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31
Q

Which classes/drugs cause hypoglycemia?

A

Sulfonylureas/glyburide

Meglitinides(glinides)/repaglinide

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32
Q

Overall what does biguanides/metformin do (3)?

A
  1. Decrease intestinal absorption of glucose
  2. Decrease hepatic glucose production
  3. Increases insulin sensitivity
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33
Q

Alpha glucosidase inhibitors competitively and reversible inhibits enzymes in the small brush border responsible for the breakdown of what 2 things?

A

Oligosaccharides and disaccharides

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34
Q

Drugs with mechanism of inhibits DDP4 activity, increasing postprandial in region (GLP-1,GIP) concentrations

A

DPP4 inhibitors/sitagliptin

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35
Q

Drug with mechanism of activates GLP-1 receptors?

A

GLP1 receptor agonist (incretin mimetic)/exentide

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36
Q

Drug with mechanism of inhibits sodium glucose transport in the proximal tubule?

A

SGLT2 inhibitors/canagliflozin

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37
Q

Drug with mechanism of activates amylin receptors?

A

Amylin mimetics/pramlintide

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38
Q

Which drug has adverse effects of GI, lactic acidosis?

A

Biguanide/metformin

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39
Q

Which drug has adverse effects of hypoglycemia, wt gain?

A

sulfonylurea/glyburide

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40
Q

Which drug has adverse effects of edema?

A

Thiazolidinediones/pioglitazone

41
Q

Which drugs has adverse effects of pancreatitis?

A

DPP4I/sitagliptin

Glucagon like particle receptor agonist/exenatide

42
Q

Which drug has adverse effects of glucosuria, UTI, hyponatremia, dehydration?

A

SGLT2 inhibitors/canagliflozin

43
Q

Effect of surgery on glucose control all potentially leads to?

A

Hyperglycemia or even ketosis

44
Q

Preop glucose >200 mg/dL associated with what?

A

Deep wound infections

45
Q

What is severe hypoglycemia?

A

<40

46
Q

Symptoms of hypoglycemia <70? (4)

A

Tremor, palpitation, anxiety, sweating

47
Q

Symptoms of hypoglycemia <60? (1)

A

Cognitive dysfunction

48
Q

What is the number one thing NOT to do when managing type 1 pts rather than a type 2 pt?

A

Hold long-acting insulin

49
Q

Meds to hold or stop prior to surgery if fasting prior to surgery?

A

Hold morning oral meds

50
Q

Meds to hold or stope prior to surgery: metformin?

A

Hold 1 day before prolonged surgeries

51
Q

Meds to hold or stop prior to surgery: sulfonylureas?

A

Discontinue 1-2 days prior to surgery; long half-lives and risk for hypoglycemia

52
Q

Meds to hold or stop prior to surgery: SGLT2 inhibitors?

A

Hold 3 days prior; risk of hypovolemia, AKI, DKA

53
Q

Meds to hold or stop prior to surgery: thiazolidinediones?

A

Worsen fluid retention and peripheral edema; problematic for systolic HF pts

54
Q

Managing insulin prior to surgery: short acting?

A

Omit morning of surgery

55
Q

Managing insulin prior to surgery: NPH?

A

Intermediate acting at half dose

56
Q

Managing insulin prior to surgery: basal (glargine, detimer)?

A

Give regular dose or half dose

57
Q

Goal BG prior to surgery?

A

80-180, but stay away from 80

58
Q

What reduces risk for hypoglycemia without increased risk?

A

Less tight control

59
Q

What has more hypoglycemia without benefits (reducing risk for infection)

A

Tighter control (closer to low end of normal)

60
Q

How often do you check BG?

A

Every hr, more frequently if less than 100 or falling rapidly

61
Q

For pts not treated with insulin (type 2), how often do you check BG?

A

Every 2 hrs

62
Q

Pts critically ill, on vasopressors, or hypotensive, should have BG checked how?

A

Venous or arterial blood samples instead of finger stick samples

63
Q

Starting 5% dextrose containing IV at 75-125 provides about what?

A

4-6 glucose/hr to avoid starvation (ketosis)

64
Q

For insulin treated pts, if hyperglycemia then what administration is appropriate?

A

Short or rapid acting insulin

65
Q

IV route of insulin administration requires more or less BG monitoring?

A

More

66
Q

In DMT1 pts, if hypoglycemic then how should you handle insulin infusion?

A

DO NOT STOP, only reduce rate and address hypoglycemia with dextrose

67
Q

For long and complex procedure, what type of administration of insulin is preferred?

A

IV

68
Q

For long and complex procedure, what electrolytes should be monitored?

A

K and HCO3 for acidosis (DKA)

69
Q

For long and complex procedure, DMT1 pts require what kind of IV insulin rates?

A

1-2 units/hr

70
Q

For long and complex procedure, DMT2 pts require what kind of IV insulin rates?

A

> than 2unites/hr

71
Q

If glucose is 210, then what should rate be?

A

210/100 = 2.1 units/hr

72
Q

Increase rate by what when BG is 120-160?

A

.5 units/hr

73
Q

Increase rate by what when BG is 160-200?

A

1 units/hr

74
Q

Increase rate by what when BG is >200?

A

2 units/hr

75
Q

If you give dextrose 50%-50ml =25 grams then what should BG increase by?

A

100

76
Q

What should you not restart if significant renal insufficiency, hepatic impairment, or CHF?

A

Metformin

77
Q

What should you not restart until eating is established?

A

Sulfonylurea

78
Q

What should not be restarted if CHF or compromised liver function?

A

Thiazolidinediones

79
Q

If IV infusion used periop, then what should you do post surgery?

A

Continue until resume eatin

80
Q

Once tolerating solid food, what can you do?

A

Switch to SQ but give SQ first dose before stopping IV due to short half life

81
Q

When does first physiological response occur for hypoglycemia?

A

Around 70

82
Q

When plasma glucose gets to 70, what counter regulatory hormones are released? (5)

A

Epi, NorE, glucagon, growth hormone, cortisol

83
Q

Anesthesia will mask hypoglycemic symptoms, but what other drugs will as well (3)?

A
  1. BB
  2. Dexmedetomidine
  3. Clonidine
84
Q

Sedated anesthetize pt with <70 BG, then how to treat? (3)

A
  1. IV dextrose 25 grams
  2. Repeat BG in 5-10 min
  3. If continuous dextrose infusion needed, then insulin adjustment needed
85
Q

What can treatment of glucagon do?

A

Recombinant DNA; interacting with glucagon receptor on plasma membrane of hepatocytes

86
Q

How much is glucagon given to treat hypoglycemia?

A

1 mg IV

87
Q

How long does glucagon last?

A

Short lived, so need to implement IV dextrose

88
Q

What is key to what stops production of ketones?

A

Insulin

89
Q

If DKA, then what is treatment? (3)

A
  1. Large volume IV NS
  2. IV of 0.1 unit/kg of regular insulin or .1 unit/kg/hr infusion
  3. Monitor K and Phosphate
90
Q

What will start to improve first during treatment of DKA?

A

Glucose

91
Q

During treatment for DKA, if K is low <3.3 then what?

A

Hold insulin until give 20-40 mEq/h

92
Q

During treatment for DKA, once K is 3.3-5.3 then what?

A

Give 20-30 mEq/h

93
Q

During treatment for DKA, if K is >5.5?

A

Do not give KCl in fluids and monitor every 2 hrs

94
Q

During treatment for DKA, if phosphate is <1?

A

Initiate replacement at 20-30 mEq/l of fluid

95
Q

When is ketosis resolved? (3)

A
  1. Bicarb is at least 15
  2. Venous pH >7.3
  3. Anion gap 12 or less
96
Q

When can you convert to long acting SQ regimen during DKA treatment?

A

When 2 of 3 ketosis resolutions are true

97
Q

Treatment of HHS?

A

Fluid resuscitation (severe hyperglycemia leading to hypovolemia)

98
Q

Treatment steps with insulin of HHS? (3)

A
  1. Regular insulin 15 units then .1 unit/kg/hr
  2. Plasma near 250-300 then decrease to 2-3 units/hr
  3. Add glucose if needed to avoid hypoglycemia

Pharmacology II (8 decks)

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