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PHM 602 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Which are the loose guidelines?

A

ADA

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2
Q

Which are the strict guidelines?

A

AACE

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3
Q

What is ADA A1C goal?

A

<7%

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4
Q

What is ADA pre-prandial goal?

A

80-130 mg/dL

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5
Q

What is ADA post prandial goal?

A

<180 mg/dL

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6
Q

What is AACE A1C goal?

A

<6.5%

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7
Q

What is AACE pre-prandial goal?

A

<110 mg/dL

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8
Q

What is AACE post-prandial goal?

A

<140 mg/dL

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9
Q

When would you use a strict goal?

A

patient <65 and without clinical ASCVD

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10
Q

When would you use a loose goal?

A

patient ≥65 OR <65 with clinical ASCVD

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11
Q

SGLT2s with ASCVD benefit

A

canagliflozin

empagliflozin

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12
Q

SGLT2s with CHF benefit

A

canagliflozin
empagliflozin
dapagliflozin

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13
Q

SGLT2s with CKD benefit

A

canagliflozin
empagliflozin
dapagliflozin

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14
Q

GLP-1 with ASCVD benefit

A

dulaglutide
liraglutide
semaglutide

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15
Q

TZDs with ASCVD benefit

A

pioglitazone

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16
Q

68 y/o with T2DM with ASCVD risk of 40% should be started on…

A

Metformin

GLP-1 or SGLT2

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17
Q

68 y/o T2DM with HF should be started on…

A

Metformin

SGLT2

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18
Q

68 y/o T2DM with CKD should be started on…

A

Metformin

SGLT2 (or GLP-1 if needed)

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19
Q

68 y/o T2DM needing to lose weight should be started on…

A

Metformin

GLP-1 or SGLT2

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20
Q

68 y/o T2DM needing to minimize hypoglycemia should be started on…

A

Metformin

DPP-4i, GLP-1, SGLT2, TZD

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21
Q

68 y/o T2DM worried about cost should be started on…

A

Metformin

SU or TZD

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22
Q

68 y/o T2DM starting on insulin should get…

A

Basal insulin

10 units or 0.1-0.2 units/kg/day

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23
Q

68 y/o T2DM started on 10 unit basal insulin and should be titrated…

A

2 units every 3 days

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24
Q

68 y/o T2DM started on 10 unit basal insulin and is now hypoglycemic, we should…

A

decrease by 10-20% (aka 1-2 units)

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25
Q

68 y/o T2DM started on basal insulin of 20 units and now needs prandial insulin, we should give…

A

4 units or 10% of basal (aka 2 units) with the largest meal

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26
Q

68 y/o T2DM started on basal insulin of 20 units and prandial insulin of 4 units and still needs additional blood glucose lowering we should…

A

stepwise addition of prandial insulin, add one meal on at a time

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27
Q

42 y/o T2DM with no clinical ASCVD with an A1C <7.5% should get…

A

Mono therapy - Metformin

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28
Q

42 y/o T2DM with no clinical ASCVD with an A1C ≥7.5-9% should get…

A

Dual or Triple Therapy

Metformin, GLP-1, SGLT2

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29
Q

42 y/o T2DM with no clinical ASCVD with an A1C >9% with no symptoms should get..

A

Dual or Triple Therapy

Metformin, GLP-1, SGLT2

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30
Q

42 y/o T2DM with no clinical ASCVD with an A1C >9% with symptoms should get…

A

Insulin and other agent

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31
Q

42 y/o T2DM with no clinical ASCVD with an A1C >8% starting basal insulin should get…

A

0.2-0.3 units/kg

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32
Q

42 y/o T2DM with no clinical ASCVD with an A1C <8% starting basal insulin should get…

A

0.1-0.2 units/kg

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33
Q

42 y/o T2DM with no clinical ASCVD already on 20 units of basal insulin needs to be started on prandial insulin, what could we give him…

A

10% of basal dose at the largest meal (aka give 2 units at lunch)

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34
Q

42 y/o T2DM with no clinical ASCVD needs to be started on basal and prandial insulin, what could we give him…

A

Begin prandial insulin before each meal
0.3 - 0.5 units/kg
50% basal / 50% prandial

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35
Q

Hypoglycemia is a glucose

A

<70 mg/dL

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36
Q

Hypoglycemia treatment

A

Check BG to confirm
Eat 15g of carb
Wait 15 minutes then re-check
Follow up with substantial snack

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37
Q

Severe Hypoglycemia treatment

A

Glucagon

AEs N/V

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38
Q

Hyperglycemia Signs

A

BG > 250

Polyuria, Nocturia, Polyphagia

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39
Q

Microvascular Diabetic Complications

A

Retinopathy, Nephropathy, Neuropathy

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40
Q

Macrovascular Diabetic Complication

A

Cerebrovascular Disease, Heart Disease, Peripheral Vascular Disease

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41
Q

ADA blood pressure treatment

A

no preference unless albuminuria is present (then ACE/ARB)

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42
Q

AAC blood pressure treatment

A

drug of choice ACE/ARB

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43
Q

ADA ASA primary prevention

A

for patients with high CVD risk

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44
Q

AACE ASA primary prevention

A

when ASCVD risk score >10%

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45
Q

ADA ASA secondary prevention

A

everyone gets it

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46
Q

AACE ASA secondary prevention

A

everyone gets it

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47
Q

AACE guidelines say you are a candidate for obesity meds at BMI of…

A

≥27

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48
Q

AACE guidelines say you are a candidate for bariatric surgery at BMI of…

A

≥35

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49
Q

Immunizations diabetics should receive

A

Influenza
Pneumococcus
Hepatitis B

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50
Q

DCCT Trial said…

A

T1DM tight glucose control = less micro and macro

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51
Q

UKPDS Trial said…

A

T2DM tight glucose control = less micro and macro

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52
Q

Advance Trial said…

A

micro and macro will be decreased in T2DM with intensive therapy

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53
Q

Accord Trial said..

A

intense glucose control with ASCVD patients already isn’t great

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54
Q

Hospital Diabetic A1C

A

> 6.5%

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55
Q

Hospital hypoglycemia

A

<70

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56
Q

Hospital hyperglycemia

A

> 140

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57
Q

Hospital severe hypoglycemia

A

<40

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58
Q

Fasting blood glucose goal in hospital

A

<140

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59
Q

Random blood glucose goal in hospital

A

<180

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60
Q

Modify therapy in hospital when blood glucose is…

A

<100

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61
Q

T1DM insulin dosing inpatient

A

0.2-0.4 units/kg/day
50% as basal
50% as nutritional (divided into 3)
Use correctional for values above goal

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62
Q

T2DM insulin dosing inpatient

A

Insulin naive - 0.3-0.5 units/kg
50% as basal
50% as nutritional (divided into 3)
Use correctional for values above goal

If take insulin at home decrease by 20-25% when inpatient

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63
Q

DKA onset

A

hours to days

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64
Q

DKA glucose

A

> 250

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65
Q

DKA acidosis

A

< 7.3

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66
Q

DKA anion gap

A

> 12

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67
Q

DKA ketones

A

positive

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68
Q

DKA serum osmolality

A

<320

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69
Q

HHS onset

A

several days to weeks

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70
Q

HHS glucose

A

> 600

71
Q

HHS acidosis

A

normal

72
Q

HHS anion gap

A

variable

73
Q

HHS ketones

A

negative

74
Q

HHS serum osmolality

A

> 320

75
Q

Main therapies in treatment of DKA and HHS

A

Fluids
Insulin
Potassium
Sodium Bicarbonate

76
Q

Sulfonylureas MOA

A

Stimulate insulin release from Beta cells

77
Q

Sulfonylurea drugs

A

Glyburide
Glipizide
Glimepiride

78
Q

Glyburide dose

A

1.25-20mg PO
Glynase or glynase prestab
Can’t use CrCl<50

79
Q

Glipizide dose

A

IR: 2.5-20 PO QD-BID
XL: 5-10 PO QD

80
Q

Glimepiride dose

A

1-4 PO

81
Q

Beer’s List Sulfonylureas

A

Glyburide and Glimepiride

82
Q

Sulfonylurea AEs

A

N/V, weight gain

83
Q

Sulfonylurea counseling points

A

Take first thing in the morning
Take with food
Avoid alcohol

Ask about hypo and weight gain

84
Q

Sulfonylurea CV effects?

A

None

85
Q

Sulfonylurea HF effects?

A

None

86
Q

Meglitinides MOA

A

Stimulate insulin release from beta cells, short acting

87
Q

Meglitinide drugs

A

Repaglinide (Prandin)

Natglinide (Starlix)

88
Q

Repaglinide brand name

A

Prandin

89
Q

Nateglinide brand name

A

Starlix

90
Q

Nateglinide dose

A

60-120 mg PO before meals

91
Q

Repaglinide dose

A

0.5-2 mg PO before meals

92
Q

Repaglinide drug interactions

A

NPH insulin - can cause MI
Gemfibrozil
Mifepristone

93
Q

Nateglinide drug interactions

A

Mifepristone

Pazopanib

94
Q

Meglitinides precautions in

A

renal or impaired liver

95
Q

Meglitinides counseling points

A

Skip meal, skip the dose
Avoid alcohol
ask about hypo and weight gain

96
Q

Meglitinides ASCVD benefit?

A

none

97
Q

Meglitinides HF benefit?

A

none

98
Q

Meglitinides CKD benefit?

A

none

99
Q

Biguanides MOA

A

Primary: decrease glucose output from the liver (hepatic glucose production)

Secondary: increase peripheral muscle glucose sensitivity (glucose uptake and utilization)

100
Q

Target Metformin dose

A

2,000 mg QD

101
Q

Metformin renal considerations

A

d/c with eGFR≤30

102
Q

Metformin AEs

A

N/V/d

103
Q

Metformin ASCVD benefit?

A

maybe

104
Q

Metformin HF benefit?

A

none

105
Q

Metformin CKD benefit?

A

none

106
Q

Metformin monitoring

A

renal function

107
Q

Thiazolidinediones (TZDs) MOA

A

Primary: increase peripheral muscle glucose sensitivity (glucose uptake and utilization)

Secondary: decrease glucose output from the liver (hepatic glucose output)

108
Q

TZD drugs

A

Rosiglitazone (Avandia)

Pioglitazone (Actos)

109
Q

Rosiglitazone brand name

A

Avandia

110
Q

Pioglitazone brand name

A

Actos

111
Q

Rosiglitazone dose

A

4-8mg PO

112
Q

Pioglitazone dose

A

15-30mg PO

113
Q

TZD AEs

A

Edema (worsen CHF), weight gain

114
Q

Pioglitazone drug interactions

A

oral contraceptives

115
Q

Rosiglitazone drug interactions

A

insulin, nitrates

116
Q

TZD Black box warning

A

can exacerbate CHF, MI (rosiglitazone)

117
Q

TZD counseling

A

Take once a day at the same time each day

118
Q

TZD ASCVD benefit?

A

maybe (pio)

119
Q

TZD HF benefit?

A

increased RISK

120
Q

TZD CKD benefit?

A

none

121
Q

Alpha Glucosidase Inhibitors (AGI) MOA

A

decrease breakdown of sucrose and complex carbs in brush border of the small intenstine

122
Q

AGI drugs

A

Acarbose (Precose)

Miglitol (Glyset)

123
Q

Acarbose brand name

A

Precose

124
Q

Miglitol brand name

A

Glyset

125
Q

Acarbose dosing

A

25mg PO TID

126
Q

Miglitol dosing

A

25mg PO TID

127
Q

AGI Contraindications

A

bowel stuff (IBS, crohn’s, colonic ulceration)

128
Q

AGI counseling points

A

Take with the first bite of each meal

Skip meal skip dose

129
Q

AGI ASCVD benefit?

A

none

130
Q

AGI HF benefit?

A

none

131
Q

AGI CKD benefit?

A

none

132
Q

Gliptins/DPP4-i MOA

A

potentiate the effects of incretin hormones (which are involved inn physiologic regulation of glucose homeostasis)

suppresses glucagon secrertion, slow gastric emptying , reduces food intake, promotes beta cell proliferation

133
Q

DPP4-i drugs

A

Januvia (Sitagliptin)
Tradjenta (Linagliptin)
Onglyza (Saxagliptin)
Nesin (Alogliptin)

134
Q

Sitagliptin dose

A

100mg QD

use less with worsening renal function

135
Q

Saxagliptin dose

A

5mg QD

use less with worsening renal function

136
Q

Alogliptin dose

A

25mg Qd

use less with worsening renal function

137
Q

Linagliptin dose

A

5mg QD

no renal adjustment

138
Q

Gliptins AEs

A

nasopharyngitis, URI

139
Q

Gliptins precautionns

A

impaired renal. hx of pancreatitis, heart failure, use with GLP-1

140
Q

Gliptins ASCVD benefit?

A

none

141
Q

Gliptins HF benefit?

A

potential RISK (sax & alo)

142
Q

Gliptins CKD benefit?

A

nonne

143
Q

SGLT-2i MOA

A

inhibit SGLT2, reabsorption of filtered glucose is reduced and the renal threshold for glucose is lowered –> increase sugar in pee

144
Q

SGLT2-i drugs

A

Invokana (canagliflozin)
Farxiga (dapagliflozin)
Jardiance (emagliflozin)
Steglatro (ertugliflozinn)

145
Q

SGLT2-i renal consideration

A

contraindicated in eGFR<30

146
Q

Canagliflozin dose

A

100-300 QD

147
Q

Dapagliflozin dose

A

5-10 QD

148
Q

Empagliflozin dose

A

10-25 QD

149
Q

Ertugliflozin dose

A

5-15 QD

150
Q

SGLT2-i AEs

A

UTIs, mycotic infections

151
Q

SGLT2-i counseling points

A

take in the morning

wipe good

152
Q

SGLT2i ASCVD benefit?

A

yes

153
Q

SGLT2i HF benefit?

A

yes

154
Q

SGLT2i CKD benefit?

A

yes

155
Q

bone fractures seen in

A

TZD and SGLT2i

156
Q

GLP-1 MOA

A

slows gastric emptying, promotes beta cell proliferation

157
Q

GLP-1 Contraindications

A

Thyroid C-cell tumor
Severe GI disease
Pancreatitis
CrCl < 30

158
Q

GLP-1 counseling points

A

avoid large meals
store in fridge
timing of doses (30 mins before first meal)
take with little water

159
Q

GLP-1 drugs

A 
liraglutide
semaglutide
dulaglutide
exenatide
lixisenatide
160
Q

GLP-1 ASCCVD benefit?

A

yes

161
Q

GLP-1 HF benefit?

A

none

162
Q

GLP-1 CKD benefit?

A

yes (lira, dula)

163
Q

Ultra rapid acting insulins

A 
insulin aspart (Fiasp)
insulin lispro-aabc (Lyumjev)
164
Q

rapid acting insulins

A

insulin lispro, aspart, glulisine (humalog, novolog, apidra)

165
Q

short acting insulins

A

regular insulin (humulin, novolin)

166
Q

intermediate acting insulin

A

nph (humulin-nph, novolin-nph)

167
Q

long acting insulins

A

insulin glargine, detemir, degludec (Lantus, Toujeo, Basaglar, Levemir, Tresiba)

168
Q

Ultra rapid insulin info

A

can be used in SQ pumps
do not give IV
can be mixed with NPH

169
Q

rapid acting insulin info

A

can be used in SQ pumps
do not give IV
can be mixed with NPH

eat within 15 min of injection

170
Q

regular insulin info

A

can be given in SQ pumps

can be given IV

171
Q

NPH insulin info

A

frosting = loss of potency

can mix with regular, aspart, lispro, glulisine

172
Q

Long acting insulin info

A

do not dilute

do not mix

173
Q

Fast insulin absorption when you are

A

hot and hydrated

PHM 602 (3 decks)

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