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NAPLEX > Diabetes > Flashcards

Diabetes Flashcards

1
Q

fasting glucose diabetic diagnosis

A

126 or greater

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2
Q

2 hour 75 gram glucose tolerance test diabetic diagnosis

A

200 or greater

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3
Q

hba1c % for diagnosis of diabetes

A

6.5% or greater

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4
Q

prediabetes diagnosis a1c

A

5.7-6.4%

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5
Q

random plasma glucose of ____ or greater can also diagnose diabetes

A

200 or greater

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6
Q

diagnosis for gestational diabetes

A 
two step strategy
screening done
1) 50 gram oral glucose (non fasting)
in 24th to 28th week of pregnancy, glucose measure after 1 hour
-if value 140 or greater proceeds to 2nd step
2) full glucose tolerance test
fasting! 100g sugar load test
must meet 2 criteria 
-fasting >95
-1hour >180
-2 hour >155
-3 hour >140
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7
Q

one step GDM diagnosis

A

75 gram OGTT at 24 - 48 weeks after an overnight FAST of at least 8 hours

diagnosis made if any of the following criteria are made

  • fasting 92 or greater
  • 1h 180 or greater
  • 2h 153 or greater
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8
Q

pre prandial goal

A

80-130

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9
Q

post prandial goal

A

<180

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10
Q

goal alc

A

less than 7

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11
Q

microalbumin in the urine

A

<30mg/24hr is what you want

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12
Q

eAG =estimated average glucose

A

6%=126

add 28.5 to get any other percent

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13
Q

ace or arb in diabetics if

A

microalbuminuria >30 mg/day or eGFR <60 ml/min

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14
Q

aspirin in diabetes in

A

history of stroke or MI

  • 10 year risk score greater than 10 percent
  • 50 or older with smoker, dyslipidemia, htn, FMH, albumineria)
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15
Q

statins in diabetes if >40

A

if >40 yes

  • no risk factors: moderate
  • risk factors: high
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16
Q

statins in diabetes less than 40

A

only if ascvd/ risk factors

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17
Q

risk factors for statins in diabetes

A 
LDL 200 or greater
 HTN,
Smoker,
albumineria, 
FMH of ascvd
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18
Q

high int. statins

A

rosuvastatin (crestor) 20-40

atorvastatin (lipitor) 40-80

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19
Q

diabetic eye exam

A

annually

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20
Q

urine exam

A

annually

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21
Q

foot exam

A

check each visit

check for pulse and infection

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22
Q

diabetic foot infections

A

mild superficial infections (strep+mssa): cephalexin, dicloxacillin

if mrsa is a concern: doxy or bactrim

deeper infections add gram negative coverage and anaerobic coverage

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23
Q

trim toenails straight

A

across and check feet everyday

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24
Q

vaccines in DM

A

flu 6 months or older
pneumococcal 2 or older then again at 65
hep b age 19-59

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25
Q

hep b age

A

19-59

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26
Q

rapid acting insulins

A

lispro (humalog)
aspart (novolg)
glulisine (apidra)

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27
Q

rapid acting discard after
humalog
novolog
apidra

A

28 days

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28
Q

fiasp

A

insulin aspart works faster than other rapids (5 min quicker) 100u/ml

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29
Q

where to inject insulin

A

2 inch away from belly buttom
back of the arm
thigh

keep it in place, dont pull it out right away

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30
Q

rapids are used to

A 
cover a meal
should be clear 
onset 5-15 min 
peak 1-2 hours 
duration 3-5 hours
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31
Q

how many units of insulin are in a 3 ml pen

A

300 units

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32
Q

how many units of insulin are in a 10 ml vial

A

1000 units

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33
Q

who do you not use afreeza in

A

asthma/copd

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34
Q

afreeza is

A

rapid

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35
Q

effect of insulin on potassium

A

hypokalemia, brings potassium into the cell and out of the blood

used as a treatment for hyperkalemia

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36
Q

afreeza room temp for

A

unopened 10 days
opened strips 3 days

bring cartridge to room temp before using (10 min)
discard inhaler after 15 days

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37
Q

humulin R u-500

A

RX only!
5x as potent
vial 40 days
pen 28 days

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38
Q

humulin R and Novolin R are

A 
regular insulins they are OTC 
onset is 30 min
duration is 6- 8 hours 
THey are CLEAR because of the R (R is for regular)
100u/ml
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39
Q

humulin R room temp discard after

A

31 days

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40
Q

novolin R room temp discard after

A

42 days

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41
Q

intermediate acting insulins are OTC

A

NPH
Humulin N
Novolin N

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42
Q

NPH=clear or cloudy

A

cloudy

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43
Q

humulin N discard after

A

31 days

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44
Q

novolin N R discard after

A

42 days (6 weeks)

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45
Q

intermediated acting onset and duration

A

onset 2 hours
peak 6 to 8 hours, consider a snack after 6 hours after the dose
duration 10-16 hours

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46
Q

in combo insulins the bigger number is the ___ acting

A

longer acting

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47
Q

glargine cannot be

A

mixed with any other insulin product

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48
Q

long acting insulins are RX

A

detemir (levemir)
glargine (lantus, toujeo, basaglar, semglee)
degludec (tresiba)

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49
Q

tresiba room temp for

A

56 days

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50
Q

detemir (levemir) room temp for

A

42 days

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51
Q

levemir/ detemir can be QD or __

A

BID

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52
Q

toujeo is U-

A

300

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53
Q

when switching from toujeo to basaglar

A

reduce dose by 20 percent

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54
Q

tresiba is only

A

once daily

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55
Q

detemir flex touch pen

A

prime 2 units insert, press, hold in for 6 sec

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56
Q

all insulin glargine are given

A

qd

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57
Q

lantus room temp

A

28 days

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58
Q

nph to detemir (levemir)

A

1:1

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59
Q

nph once daily to lantus or toujeo

A

1:1

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60
Q

nph twice daily to glargine u-100

A

decrease dose by 20 percent and give glargine once daily

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61
Q

long acting to nph

A

1:1 and give BID

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62
Q

toujeo u-300 to lantus, basaglar, or levemir(detemir)

A

decrease dose by 20 percent and give QD

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63
Q

insulin is given

A

SC

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64
Q

regular insulin can be given

A

IV IM or SQ

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65
Q

rotate injection site with insulin to avoid

A

lipohypertrophy (lump of fat under skin)

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66
Q

use shortest __mm and thinnest __-__gauge for insulin

A

4mm, 29-32

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67
Q

type 1 starting insulin

A

0.5 u /kg/day

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68
Q

type 2 starting insulin

A

0.1-2u/kg/day (start with basal)

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69
Q

check glucose if high can add 1 unit per __ mg/dl above glucose goal

A

50mg;dl

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70
Q

pramlintide(symlin)

A

both type 1 and type 2 used as an adjunct to patients who use meal time insulin

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71
Q

pramlintide (symlin) should only be used if the patient is already on

A

insulin

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72
Q

pramlintide is a ____ line measure due to risk of hypoglycemia and cost

A

3rd

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73
Q

do not give symlin to patients with

A

alc >9
hypersensitivity to metacresol preservative
gastroparesis or gi motility meds like reglan

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74
Q

pramlinitide makes you feel ___

A

full thus causes severe nausea can also cause anorexia and weight loss

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75
Q

MOA of symlin

A

a synthetic analog of human amylinm, a naturally occuring hormone made by pancreatic beta cells. amylin is secreted with insulin from beta cells and lowers post prandial blood sugars

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76
Q

other things that symlin (pramlinitide) does

A

1) delays gastric empyting
2) INHIBITS post prandial blood glucose release
3) reduces appetite/weight loss

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77
Q

pramlinitide dosing

A

t1dm: 15mcg sq tid immediately before meals
t2dm: 60 mcg sq tid immediately before meals

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78
Q

SE of pramlinitide

A

nausea, anorexia, weight loss, SEVERE hypoglycemia

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79
Q

symlin room temp

A

discard after 30 days

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80
Q

storage room temp 28 days

A 
humalog
novolog
apidra
lantus
bydureon
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81
Q

storage room temp 30 days

A

symlin
byetta
victoza

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82
Q

storage room temp 31 days

A

humulin R/N combos

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83
Q

storage room temp 42 days

A

Novolin R/N combos

Detemir (Levemir)

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84
Q

Room temp 56 days

A

glargine (toujeo)

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85
Q

10 days room temp pens

A

humalog mix

humulin mix

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86
Q

14 day pen storage

A

novolog mix

humulin N prefilled pen

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87
Q

28 day pen storage

A

novolin N flex pen
Humalog
Novolog
Lantus

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88
Q

42 day pen storage

A

Detemir (levemir)

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89
Q

hypoglycemia

A

blood sugar 70 or less

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90
Q

examples of fast sugar for hypoglycemia

A 
5-6 life savers
2 cubes sugar
4 oz orange juice
6 jelly beans 
3-4 glucose tablets
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91
Q

hypoglycemia and patient is unconcious

A

glucagon 1 mg sc/im/iv

or glucose (iv dextrose) if glucagon is unavailable

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92
Q

sick day management

A

insulin requirements increase with illness and infection

patient must inject insulin and check glucose every 3-4 hours

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93
Q

DKA

A

usually insulin dependent
caused by illness or noncompliance

ask if insulin has been ski[[ed look for signs of infection

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94
Q

signs and symptoms of DKA

A

FRUITY BREATH!

N/V, abdominal pain

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95
Q

how to treat DKA

A

hydrate: w/ 0/9% nacl
give insulin
give dextrose when glucose drops below 200 or 250

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96
Q

DKA tx

DIABETES

A

D dehydrated- hydrate w NS
I insulin (regular insulin, IV 0.1 u/kg/hr)
A acidosis
B bicarbonate
E electrolytes (monitor k, mg, po4, hco3)
T Time
E Electrolytes
S Sugar (when glucose drops below 200 or 250)

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97
Q

if hypoglycemic at 3am how to fix

A

symogi effect

decrease bedtime NPH

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98
Q

if hyperglycemic at 3am how to fix

A

dawn phen.

not decreasing insulin

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99
Q

hypoglycemia causes an increase in

A

NE and EPI
side effects make sense
sweating tachycardia

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100
Q

biguanide

A

metoformin

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101
Q

sulfonylureas

A

glimepiride
glipizide
glyburide

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102
Q

meglinitides

A

“glinides”
repaglinide (prandin)
nateglinide (starlix)

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103
Q

thiazolidinedones

A

“glitizones”
rosiglitizone
pioglitizone

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104
Q

GLP1 agonists

A 
"tides"
liraglutide
lixisenatide
exenatide
semaglutide
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105
Q

dpp4 inhibitors

A 
"gliptins"
sitagliptin
alogliptin
linagliptin
saxagliptin
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106
Q

SGLT2 inhibitors

A

“gliflozoins”

  • canagliflozin
  • dapaglifolzin
  • empagliflozin
  • ertugliflozin
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107
Q

alpha glucosidase inhibitors

A

acarbose

miglitol

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108
Q

dopamine agonist

A

bromocriptine (cycloset)

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109
Q

Metformin (biguanide) names

A 
glucophage
glucophage XR
fortamet
glumetza
riomet
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110
Q

metformin MOA

A

decrease hepatic glucose production
decreases intestinal absorption of glucose
improves insulin sensitivity

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111
Q

metformin does not cause

A
  • hypoglycemia
  • weight gain

it causes weight loss and favorable lipid effects

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112
Q

glucophage max dose

A

2550 mg.day

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113
Q

fortamet max

A

2500 mg.day

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114
Q

glucophage XR max dose

A

2000 mg/day

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115
Q

glumetza max dose

A

2000 mg/ day

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116
Q

metformin SE

A 
nausea
low appetite---weight loss
diarrhea--take w food to decrease upset stomach
decrease vit b12
lactic acidosis
metallic taste
PREG CAT B
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117
Q

metformin CI in eGFR

A

30, initiation not rec. w eGFR 30-45

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118
Q

D/C metformin before an iodinated contrast imaging procedure in patients with egfr <60 or history of

A

liver disease
alcoholism
HF

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119
Q

sulfonylureas MOA

A

increase insulin secretion from pancreatic beta cells

120
Q

sulfonylureas SE

A

weight gain due to increase insulin
hypo glycemia due to increase insulin

take with first meal of the day

121
Q

metformin does not

A

secrete insulin

122
Q

metformin/pioglitazone

A

actoplus met

123
Q

metformin/sitagliptin

A

janumet

124
Q

metformin/canagliflozin

A

invokanamet

125
Q

ER formulations of metformin leave a

A

ghost tablet

126
Q

lactic acidosis risk increases with

A

renal disease

127
Q

1st line in pregnancy

A

insulin

128
Q

glimepiride brand

A

amaryl max 8 mg

129
Q

glipizide brand

A

glucotrol/ glucotrol xl use if renal impaired

130
Q

glyburide brand

A

glynase (do not use in renal or hepatic impairment)

131
Q

___ and ___ sulfonylureas are on the beers criteria for patients that are >65

A

glyburide and glimepiride, use glipizide (glucotrol) for patients greater than 65

132
Q

Amaryl (glimepiride)

A

1-2 mg QD max 8 mg
metabolized 100 percent by the liver
safe in renal failure , dose must be reduced- glipizide is first choice

133
Q

Glucotrol (glipizide)

A 
max dose 20 mg BID (40 mg QD)
glipizide ER (glucotrol xl): max 20 mg qd - oros ghost tablet

DOC in RENAL and elderly if using a sulfonylurea
IR- TAKE 30 min before first meal of day

134
Q

Glynase (glyburide)

A

high risk with elderly becuase it is sooo long acting avoid in patients 65 or older

do not use in renal or hepatic failure

135
Q

repaglinide brand

A

prandin

136
Q

nateglinide

A

starlix

137
Q

meglinide MOA

A

stimulate insulin secretion from beta cells

mostly affect postprandial glucose

138
Q

meglinides SE

A

weight gain
hypoglycemia
dose adjust in renal impairment

139
Q

most important thing with meglinides (prandin, starlix) (repaglinide, nateglinide)

A

if a meal is missed or added omit or add a dose accordingly, give before meals :)

140
Q

pioglitazone

A

actos ( i p when i act)

141
Q

rosiglitazone

A

avandia

142
Q

tzds MOA

A

insulin sensitizers

increase skeletal muscle cell sensitivity to insulin

143
Q

TZDs boxed warning

A

avoid with heart failure

144
Q

TZDs warnings

A

hepatic failure
edema
can cause or worsen heart failure
bone fractures
can stimulate ovulation (may need contraception)
avoid with history of bladder cancer (pioglitazone)

145
Q

which TZD increases lipids

A

rosiglitazone (avandia)

146
Q

which tzd decreases TGs

A

pioglitazone (actos)

147
Q

dont give TZDs with

A

insulin

148
Q

liraglutide brand

A

victoza QD

149
Q

lixisenatide

A

adlyxin QD

150
Q

exenatide

A

byetta BID

151
Q

exenatide ER

A

bydureon once weekly

152
Q

dulaglutide

A

trulicity once weekly

153
Q

semaglutide

A

ozempic once weekly

154
Q

semaglutide

A

rybelsus tabs PO QD

155
Q

GLP1 agonists “tides” MOA

A
  1. slows down gi motility
  2. decrease appetite- weight loss
  3. decrease glucagon
  4. increase insulin
156
Q

GLP 1 agonist SE

A 
G- gi symptoms, gall bladder disease
L-weight Loss
P-pancreatitis
1- thyroid tumors- boxed warning
A- acute renal failure and chronic renal failure exacerbation
157
Q

do not use GLP1 with

A

DPP4, so no tides with gliptins

158
Q

boxed warnings for GLP1s “tides”

A

do not use if personal family hx of medullary thyroid cancer (MTC)

do not use if hx of multiple endocrine neoplasia (MEN2)

159
Q

saxenda max

victoza max

A

saxenda weight loss 3 mg

victoza DM 1.8 mg

160
Q

must dispense needles with

A

byetta, victoza, adlyxin

161
Q

needles are provided with

A

weekly insulin

162
Q

dulaglutide is given

A

once weekly

163
Q

bydureon, trulicity, ozempic come with or without needles

A

with

164
Q

do you give GLP 1s in end stage renal disease

A

no

165
Q

exenatide (byetta) is given

A

BID (6 hours apart) 60 min before meals

166
Q

exenatide CI in crcl

A

<30

167
Q

exenatide ER (bydureon, bydureon BCise) given

A

weekly must mix either 15 sec or 80 sec

168
Q

trulicity (dulaglutide) given

A

once weekly

room temp 14 days

169
Q

semaglutide (ozempic and rybelsus)

A

ozempic (SQ once weekly)

rybelsus (tabs) 3mg then up to 7-14 mg after 30 days

170
Q

rybelsus special things

A

take on empty stomach

store in original pack

171
Q

byetta/bydureon CI

A

GFR <30

172
Q

victoza avoid in (liraglutide)

A

ESRD

173
Q

adlyxin avoid in

A

crcl <15 ESRD

174
Q

ozempic (semaglutide) no dosage adj nes. in

A

renal impairment

175
Q

trulicity avoid in

A

ESRD

176
Q

DPP 4 Inhibitors (gliptins) are usually

A

add on therapy

177
Q

dpp 4 Is

A 
SALSa:JNTO
Sitagliptin: januvia
Alogliptin: Nesina
Linagliptin: tradjenta
Saxagliptin: onglyza
178
Q

sitagliptin brand

A

januvia

179
Q

alogliptin brand

A

nesina

180
Q

linagliptin brand

A

tradjenta

181
Q

saxagliptin brand

A

onglyza

182
Q

SE with DPP ivs gliptins

A 
joint Pain (arthralgia)
Pancreatitis
183
Q

how to take DPPIVs

A

with or without food

184
Q

brands together DPPIVs (4)

A

januvia
nesina
tradjenta
onglyza

all are oral!

185
Q

DPP4 MOA

A
  1. Pancreas: GLP1 and GIP cause increase insulin release and decrease glucagon release both leading to decrease blood glucose
    (inhibit you from metabolizing GLP 1, so you have more of it)
  2. liver: decrease release of glucose
  3. feeling of fullness: reduce food intake
  4. slow down the absorption of glucose from the GI
186
Q

DPP4 on weight

A

neutral

187
Q

dose adjust all dpp 4s except

A

linagliptin (tradjenta)

188
Q

avoid saxagliptin (onglyza) and alogliptin (nesina) in

A

HF

189
Q

linagliptin (tradjenta) can be given in

A

RENAL

190
Q

4 drugs to not given in HF

A

saxagliptin, alogliptin, rosiglitazone, pioglitazone

191
Q

which two DPP 4s are cyp 3a4 substrates

A

linagliptin (tradjenta)

saxagliptin (onglyza)

192
Q

janumet, janumet XR

A

sitagliptin+metformin

193
Q

all SGLT2s are

A

QD in the morning! or will be peeing all night

194
Q

canagliflozin

A

invokana

195
Q

empagliflozin

A

jardiance

196
Q

dapaglifozin

A

farxiga

197
Q

ertugliflozin

A

steglatro

198
Q

sglt2 brands together

A

invokana
jardiance
farxiga
steglatro

199
Q

SGLT2 side effects

A

S
G- genital yeast infections
L-increase Ldl, Lower weight, Lower BP, Labs: increase K, mg, po4
T-bone fracTures

Once daily in the morning

  • KETOACIDOSIS (peeing out sugar)
  • Necrotizing Fascitits

-diuretic effect (weight, bp)

200
Q

SGLT2s work on the

A

proximal renal tubule to increase glucose excretion

201
Q

benefits of canagliflozin

A

reduces cv events, ckd progression, HF
(good for kidneys and heart)

black box warning for increase risk of lower limb amputations

202
Q

flozins are CI if crcl is less than what

A

30

203
Q

invokana (canagliflozin) do not use if CRCL less than

A

30

204
Q

canagliflozin dose (invokana)

A

100 mg QD before first meal

can increase to 300 mg qd before first meal

205
Q

invokamet

A

canagliflozin/metformin

206
Q

canagliflozin (invokana) cautions

A 
increase scr
genital yeast infections
weight loss
hypotension
increase LDL
increase potassium
bone fracTures 
hypoglycemia - not alone but when combined with insulin or secretagoues
ketoacidosis
necrotizing fascitits 
increase risk of lower limb amputations
207
Q

flozins protect the ___ like aces

A

kidneys

it has renal protection!

208
Q

watch sglt2s with other meds that increase

A

potasssium

209
Q

stop sglt2s 3 days before

A

surgery, to decrease risk of ketoacidosis

210
Q

dapagliflozin not recommend in crcl less than

A

45

211
Q

xigduo

A

dapagliflozin/metformin

212
Q

dapagliflozin is FDA approved for ___ as an adjunctive agent for patient with reduced ejection fraction with or without diabetes

A

HF

can use this for heart failure they dont have to have diabetes to use it

213
Q

ertuglaflozin do not use if egfr is less than

A

60

214
Q

empagliflozin (jardiance) reduces what

A

major cv events and progression of HF and CKD

215
Q

alpha glucosidase inhibitors
1
2

A

acarbose (precose)

migitol (glyset)

216
Q

alpha glucosidase inhibitor MOA

A

inhibit alpha glucosidase enzymes of the proximal SMALL INTESTINE BRUSH BORDERS

prevent the breakdown of polysaccarhides (sucrose) to monosaccharides (glucose and fructose)

do not prevent but delay absorption

  • BIND TO SUCROSE*
  • if you skip a meal skip this
217
Q

acarbose brand

A

precose

218
Q

migitol brand

A

glyset

219
Q

alpha glucosidase inhibitor if hypoglycemic on these take ___ or ___ not ___

A

fructose or lactose

not sucrose
the sucrose will just bind and not get absorbed
so no table sugar!
orange juice and milk okay

220
Q

bromocriptine (cycloset) increases what

A

dopamine, it’s also used in parkinsons

221
Q

wouldnt give bromocriptine or cycloset in ___

A

schizoprenia

222
Q

bromocriptine inhibits the production of

A

MILK

avoid in lactating mothers

223
Q

increasing dopamine decreases

A

prolactin

224
Q

cinnamon helps with

A

type 2 diabetes

not for long term only short term 4 months

225
Q

decrease in b12 gives what type of anemia

A

macrocytic anemia

226
Q

2nd line therapies after metformin for diabetes

A

sulfonylureas: hypoglycemia and weight gain
glitazones: actos and avandia (weight gain, fluid retention, HF, liver failure, decrease bone density)
insulin: recommended for initial therapy when fasting glucose if over 250 or a1c is 9-10 can also be an add on

227
Q

when to initiate insulin first

A

fasting glucose over 250

OR

a1c 9-10

228
Q

For patients who are close to their a1c gaol but have high post prandial glucose:

A 
meglitinides: do not use with sulfonylureas
glp 1 agonists: lose weight
dpp4 inhibitors: weight neutral
sglt2: weight loss
alpha glucosidase inhibitors: GI SE
229
Q

TZDs are through the

A

LIVER

230
Q

diabetes in pregnancy gold standard

A

insulin

231
Q

collagenase:santyl

A

topical ointment that uses enyzmes to remove dead skin and necrotic tisse from wounds and does not harm healthy tissue

232
Q

rayos generic

A

prednisone

233
Q

parlodel generic

A

bromocriptine for parkinsons and diabetes

234
Q

dexilant generic

A

dexlansoprazole

235
Q

can steroids and ppis increase the risk of bone fractures

A

yes

236
Q

vials have how many units of insulin

A

1000 u

237
Q

pens how many units of insulin

A

300 u

238
Q

DM meds with CV benefit

A

liraglutide
canagliflozin
empagliflozin

239
Q

DM meds with HF benefit

A

canagliflozin
empagliflozin
dapagliflozin

240
Q

niacin (vitamin b3) can cause

A

hypergylcemia increase blood glucose

241
Q

which meds can reduce insulin sensitivity in women with pcos

A

tzds and metformin

242
Q

do not mix symlin (pramlinitide) with any

A

insulin

243
Q

metformin is CI with active ___ disease and __ is checked at baseline

A

liver disease

LFT

244
Q

exenatide er can cause severe

A

skin lesions (nodules) injection site reaction

245
Q

beta blockers block signs of hypoglycemia (shaking, anxiety, palpitations) but which two can still be present

A

sweating and hunger

246
Q

DKA signs

A

fruit breath, N/V, BG greater than 250, ketones in the urine or blood, anion gap acidosis

247
Q

what medication is CI in patients with gastroparesis

A

pramlinitde

248
Q

type 1 diabetes has __ c peptide levels

A

low

249
Q

quinolones can increase

A

blood glucose

250
Q

target BG in the hospital

A

140-180

251
Q

HHS causes severe

A

dehydration, most common in type 2, ketones not usually present in urine

252
Q

hpyoglycemia what to treat

A 
8 oz milk
3-4 glucose tabs
4 oz soda
4 oz oj
1 tbsp honey
1 serving glucose gel

15-20 grams of carbs

253
Q

insulin available as 200u/ml

A

insulin lispro and degludec

254
Q

medications that can cause drug induced diabetes

A

systemic steroids
protease inhibitors
antipsychotics

255
Q

fat into ketones is

A

DKA

256
Q

what test is used in pregnancy for testing for GDM

A

oral glucose tolerance testr

257
Q

hypergylcemia can cuase

A

Microvascular:
retinopathy-vision loss
nephropathy- kidney impairment/failure
neuropathy- loss of feeling—amputations
autonomic neuropathy- erectile dysfxn, gastroparesis, UTIS

Macrovascular:
Atherosclerosis-ASCVD
CAD: including MI
CVA: including Stroke
PAD: amputations

*depression and DKA,HHS

258
Q

3 Ps for hyperglycemia

other symptoms also

A

polyuria( increase urination)
polydypsia (increase thirst)
polyphagia (increae hunger)

fatigue, blurry vision, ED, vaginal fungal yeast infections

259
Q

when to test for diabetes what age

A

45

also test if one risk factor and bmi 25 or greater (physical inactivity is a risk factor lol)

260
Q

a1c is measured every __ months if not at goal

A

3 months

and 6 months if at goal

261
Q

pre meal pregnant goal

A

95 or less

262
Q

1 hour
2 hour
post meal pregnant goal

A

1 hour 140 or less

2 hour 120 or less

263
Q

aspirin dose for DM

A

75-162mg usually 81mg

264
Q

natural products for DM

A

cinnamon
alpha lipoic acid
chromium

265
Q

If CVD major issue use:

A

dulaglutide, liraglutide, semaglutide

If renal allows can use: empagliflozin, canagliflozin

266
Q

HF or CKD major issue use:

A

empagliflozin, canagliflozin, dapagliflozin
if renal doesnt allow for that use
dulaglutide, liraglutide, semaglutide

267
Q

never use what two together

A

glp 1 (tide) and dpp 4 (gliptin)

268
Q

do not use ___ with heart failure

A

alogliptin (nesina) or saxagliptin (onglza)

269
Q

how many units a day when starting a type 2 on it

A

10 units or 0.1 to 0.2 u/kg/dau at bedtime of basal

270
Q

2 common things with metformin, GLP1s, and SGLt2s

A

weight loss and no hypoglycemia

271
Q

byetta and adlyxin give within

A

60 min of meals other give anytim

272
Q

symlin (pramlinitide) has a boxed warning for

and its CI in

A

severe hypoglycemia

gastroparesis

decrease meal time insulin dose by 50%
used with meals

273
Q

insulin does what to potassium

A

hypokalemia

274
Q

hyperkalemia with

A

canagliflozin

275
Q

renal insuffiency avoid (CRCL <30)

A

metformin, SGLT2I, exenatide, glyburide

276
Q

can you use afrezza in smokers

A

no

277
Q

increase risk of heart failure when taking rosiglitazone with ____ do not use together

A

insulin

278
Q

inject rapids how many minutes before eating

A

5-15 min before

279
Q

regular is injection how soon before meals

A

30 minutes

280
Q

iv regular insulin should be given in what type of container

A

non pvc container

281
Q

nph is

A

humulin N, novolin N

282
Q

do not mix long actings with

A

any other insulin

283
Q

toujeo has how many units per ml in the pen and comes in what pen sizes

A

300 u/ml

comes in 1.5 ml- 450 u/ml
comes in 3 ml- 900 u/ ml

284
Q

insulin that comes concentrated

A

humalog kwikpen (lispro)- 200u/ml
humulin r u-500 kwik pen and vial- 500 u/ml
tresiba flex touch pen (degludec) 200 u/ml
toujeo solostar, max star pens (glargine) 300 u/ml

285
Q

humulin r u-500 comes in a __ ml

A

20 ml and has 10,00 u of insulin

286
Q

use 0.3 ml syringe for

A

up tp 30 units

287
Q

use 0.5 ml syringe for

A

30-50 units

288
Q

use 1ml syringe for

A

51- 100 units

289
Q

beta blockers can cause

A

hypo or hyper glycemia

290
Q

drugs that can cause hyperglycemia

A 
thiazides and loops
tacrolimus, cyclosporine
protease inhbitors
quinolones
antipsychotics
statins
steroids
cough syrups
niacin
291
Q

quinolones can cause

A

hypo or hyperglycemia

292
Q

drugs that can cause hypoglycemia

A 
linezolid
lorcaserin (belviq)
pentamidine
beta blockers
quinoloines
tramadol
293
Q

tramadol and linezolid can decrease

A

blood glucose

294
Q

hypoglycemia symptoms

A 
dizziness
anxiety
irritability
shakiness
headache
diaphoresis (sweating)
hunger
confusion
nausea
ataxia
tremors
tachycardia
palpitations
blurred vision
295
Q

severe hypoglycemia can cause

A

seizures coma and death

NAPLEX (24 decks)

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