Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Symptoms of hyperglycemia

A 
polyuria (excessive urination)
polydipsia (excessive thirst)
weight loss
polyphagia (increased hunger)
headache
blurred vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

diuretics in DM

A

can cause worsening of glucose control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

dosing of sulfonylureas

A

start at lowest dose and titrate up as needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Patient criteria for tx with sulfonylurea

A

disease duration <5 years
no hx of insulin or good glycemic control on <40u/d
close to normal body weight
FPG <180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

most important adverse effect of sulfonylureas

A

hypoglycemia

in younger patients hypoglycemia can be associated with alcohol abuse and overexertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sulfonylureas and nursing

A

all but glyburide (B) are pregnancy category C

do not take while nursing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

contraindications for sulfonylureas

A

sulfa allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Metformin mechanism of action

A

does not stimulate insulin secretion and is therefore not a hypoglycemic
inhibits hepatic glucose production and intestinal glucose absorption and improves peripheral sensitivity to insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dosing metformin

A

initially 500-850 1-2 times daily
can increase every 1-2 weeks to a max dose of 2550mg/d
do not increase any more frequently than weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

contraindications to metformin

A

severe renal insufficiency
alcoholics
children
dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

metformin and iodine

A

dc prior to receiving and until at least 48h after d/t impairment of renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

adverse reactions to metformin

A

GI side effects should subside with continued therapy

lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

signs of lactic acidosis

A

late-onset vomiting/diarrhea

unusual drowsiness, extreme fatigue, muscle aches, or unexplained hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

metformin and cimetidine

A

increases hypoglycemia risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

metformin and glucocorticoids or alcohol

A

increases risk for lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

thiazolidinediones (TZDs) mech of action

A

reduces resistance at sites of insulin action without directly stimulating in sulin secretion from pancreatic beta cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Administration of metformin

A

Take with meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

administration of TZDs

A

take with the main meal of the day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

TZD drugs

A

rosiglitazone (Avandia)

pioglitazone (Actos)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

unique to rosiglitazone

A

may see small increases of HDL and LDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

concern specific to pioglitazone

A

increased risk of bladder cancer

may reduce concentration of birth control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

TZD and ovulation

A

may restore menses in previously anovulatory premenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

contraindications for TZDs

A

HF

active liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

symptoms of liver failure to assess for with TZDs

A 
abdominal pain
fatigue
n/v
jaundice
dark urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

drugs to use with caution with TZDs

A 
digoxin
warfarin
fexofenadine
midazolam
nifedipine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

a-Glucosidase inhibitors mech of action

A

slows absorption of carbs from the intestines minimizing the post-prandial rise in BG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

why are a-glucosidase inhibitors not often used as monotherapy

A

limited ability to lower A1C and side effect profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

administration of a-glucosidase inhibitors

A

should be taken with the first bite of each meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

contraindications to a-glucosidase inhibitors

A

IBD, colonic ulceration, obstructive bowel disorders, chronic intestinal disorders of digestion/absorption, nursing, liver cirrhosis (Acarbose in particular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

a-glucosidase drug interactions

A

may decrease levels of propranolol and ranitidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

meglitinide analogs mech of action

A

rapid-acting

stimulate release of insulin from the pancreas in response to a meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

meglitinide analog drugs

A

repaglinide (Prandin)

nateglinide (Starlix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Administration of meglitinide analogs

A

15-30 min prior to meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

contraindications for meglitinide analogs

A 
DM1
DKA
severe infection, surgery, trauma, or other severe stressors
pregnant/nursing
children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

dipeptidyl peptidase-4 inhibitors (DPP4-i) drugs

A 
sitagliptin (Januvia)
saxagliptin (Onglyza)
linagliptin (Tradjenta)
vildagliptin (Galvus)
alogliptin (Nesina)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

contraindications for DPP4-i drugs

A

Type1 DM
pancreatitis hx (sitagliptin)
caution with renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

most common adverse effects of DPP4-i drugs

A

URI, UTI, HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

mech of action of incretins

A

stimulate glucose-dependent secretion of insulin from pancreatic beta cells while supressing the inappropriate release of glucagon from alpha cells. Slows gastric emptying and increases satiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Increntins (GLP-1R) drugs

A

exenatide (Byetta, Bydureon)
liraglutide (Victoza)
albiglutide (Tanzeum)
dulaglutide (Trulicity)

40
Q

exentaide (Byetta) missed dose

A

restart treatment at next scheduled dose time

injection administered 60 minutes prior to morning and evening meal and spaced more than 6 hours apart

41
Q

Liraglutide (Victoza) dosing

A

initial dose 0.6mg not effective for glycmic control but must be administered for 1 week to lessen GI symptoms. Once tolerated, increase dose to 1.2mg. Max is 1.8mg

42
Q

Administration of Exenatide ER (Bydureon)

A

dosed once weekly with no adjustment for renal impairment

43
Q

contraindications to Incretins (GLP-1R)

A

Type1 DM, DKA, allergy, severe GI disorders including gastroparesis, pregnancy/nursing
Liraglutide should not be taken if there is a personal/family hx of medullary thyroid cancer or mutliple endocrine neoplasia syndrome type 2
exenatide is associated with pancreatitis (fatal and nonfatal)

44
Q

Incretins drug interactions

A

do not administer close to drugs with narrow therapeutic window due to decrease in gastric emptying
close monitoring of INR when on warfarin
exenatide can reduce effectiveness of birth control if administered within 1 hour of each other.

45
Q

dopamine receptor agonist drug

A

bromocriptine mesylate (Cycloset)

46
Q

What should you notify your provider about in relation to bromocriptine mesylate (Cycloset)

A

symptoms of orthostatic hypotension

47
Q

contraindications of bromocriptine mesylate (Cycloset)

A

nursing women

48
Q

bromocriptine mesylate (Cycloset) interactions

A

can exacerbate psychotic disorders or decrease effectiveness of meds
not recommended for use with other dopamine receptor agonists fo tx of:
Parkinson’s, restless leg, acromegaly, etc.

49
Q

amylin analog

Pramlintide (Symlin)

A

synthetic of pancreatic hormone amylin that is cosecreted with insulin in response to food
injectable medication

50
Q

mech of action of Pramlintide (Symlin)

A
  1. delays gastric emptying wich delays rise in postprandial glucose release
  2. then alters the release of additional inappropriate glucagon by pancreatic alpha cells
  3. increases satiety wich decreases overall caloric intake and promotes weight loss
51
Q

Pramlintide (Symlin) can treat type1 or type 2 DM

A
52
Q

dosage of Pramlintide (Symlin) in Type1 DM

A

15mcg prior to any major meal

titrated up in 15mcg increments to a max dosee of 30-60mcg

53
Q

dosage of Pramlintide (Symlin) in Type2 DM

A

60mcg just prior to any major meal

dose is increased to 120mcg in 3-7 days if there is no nausea

54
Q

Pramlintide (Symlin) and insulin

A

Insulin has to be reduced by 50% in both Type1 and Type2

55
Q

contraindications to Pramlintide (Symlin)

A

poor compliance to diabetic regimens
HgbA1C>9%
taking meds that increase gastric motility
pediatrics

56
Q

Pramlintide (Symlin) interactions

A

cannot mix with insulin

other interactions on p.797

57
Q

SGLT2 inhibitors drugs

A

empagliflozin (Jatdiance)
canagliflozin (Invokana)
dapagliflozin (Farxiga)

58
Q

SGLT2 inhibitors mech of action

A

causes more glucose to be secreted into urine rather than be reabsorbed in the kidney

59
Q

SGLT2 inhibitor contraindications

A

Type1 DM
DKA
severe kidney disease
hemodialysis

60
Q

adverse event of SGLT2 inhibitors

A 
hyperkalemia
mycotic infections
UTI
renal insufficiency
can cause increased urinary frequency
61
Q

hypotension with SGLT2 inhibitors

A

may be increased with low volume status (diuretics, ACEIs, ARBs)

62
Q

very rapid-acting insulin

A

Humalog (lispro)
Novolog (aspart)
Glulisine

63
Q

short-acting insulins

A

Humulin R

Novolin R

64
Q

intermediate-acting insulin

A

NPH

65
Q

long-acting insulin

A

lantus (glargine)
Levemir (detemir)
Toujeo
Humulin U

66
Q

basal insulins

A

NPH
glargine
detemir

67
Q

bolus insulin

A

regular
lispr
aspart

68
Q

general calculation for starting insulin therapy

A

0.55 x Total weight in kg = total units of insulin per day

69
Q

two ways to start insulin

A

may be supplemental or in addition to oral agents (typically singel daily injections started between 10-20u)
may be sole therapy in at least 2 injections daily usually before breakfast and dinner or bedtime

70
Q

dosing insulins mixed with long-acting, intermediate-acting, or premixed formulations

A

dosed twice daily prior to breakfast and dinner

71
Q

combination insulins

A

70/30 (NPH/regular)
50/50 (NPH/regular)
75/25 (NPL/lispro)
70/30 (NPA/aspart)

72
Q

guidelines for insulin daily doses in lieu of empiric estimations

A

children/adults: 0.5-0.6u/kg/day
adults during illness or adolescents: 0.5-0.75u/kg/day
adolescents during growth spurt: 1.25-1.5u/kg/day
pregnancy: 0.7u/kg/day

73
Q

Recommendations for dosing twice daily insulin

A

2/3 in am with a 2:1 ratio of intermediate- to short-acting insulin
1/3 with dinner with a 1:1 ratio of short acting and intermediate acting insulin

74
Q

adjusting insulin doses based on clinical response

A

table 46.5 on p. 801

75
Q

insulin sensitivity factor calculation

A

ISF = 1500/TDD
if you take 50u insulin in 24 then: 1500/50=30
Each unit of insulin lowers BG by 30mg/dL

76
Q

what is the insulin sensitivity factor used for

A

To help you decide how many units of insulin to adjust

77
Q

dawn phenonmenom

A

worsening hyperglycemia in the early morning hours caused by growth hormone surges while sleeping

78
Q

somogyi effect

A

rebound hyperglycemia that occurs after an early morning episode of insulin-induced hypoglycemia

79
Q

symptoms of hypoglycemia while sleeping

A

night sweats, nightmares, sleep disturbances, early morning headaches

80
Q

most common drugs that potentiate insulin effects

A 
salicylates
beta-blockers
MAOIs
alcohol
sulfa drugs
81
Q

most common drugs that antagonize insulin

A 
corticosteroids
isoniazid
niacin
estrogens
thyroid hormones
thiazides
phenothiazines
sympathomimetics
82
Q

indications for continuous glucose monitoring (CGM)

A

frequent hypoglycemia
hypoglycemia unawareness
elevated HgbA1C despite multiple treatment plan adjustments

83
Q

red flag for Type2 DM in adolenscents

A 
acanthosis nigricans (dark pigmentation in skin creases and flexural area)
this is a sign of insulin resistance
84
Q

presentation of children with Type1 DM

A

inapropriate polyuria, dehydration, poor wight gain, ketonuria

85
Q

insulin therapy dosages for children

A
  1. 7mg/kg before puberty
  2. 0mg/kg midpuberty
  3. 2mg/kg after puberty
86
Q

only DM drugs approved for children

A

insulin

metformin

87
Q

potential neonatal complications of gestational DM

A

shoulder dystocia, hypoglycemia, polycythemia, respiratory distress

88
Q

first-line insulin therapy for Type1 DM

A

basal at night with rapid prior to meals

89
Q

1st line insulin dosing for type1 DM

A

0.5-0.6u/kg/d
25-50% given as basal insulin once daily
prandial insulin distribution: 40% before brakfast, 30% prior to lunch, 30% prior to dinner

90
Q

1st line therapy for DM 2 with HgbA1C <7.5

A

monotherapy with an oral agent

Biguanide, GLP1, DPP4i or AGi

91
Q

when are biguanides the agent of choice for monotherapy

A

Type2DM with HgbA1C<7.5
patients with metabolic syndrome
BG levels are <250

92
Q

When are AGi (a-glucosidase inhibitor) used as monotherapy

A

Type2 DM with HgbA1C<7.5

postprandial hyperglycemia but only mild fasting glucose elevations

93
Q

combo therapy recommended for HgbA1C >8

A

sulfonylurea and biguanide

94
Q

what must be monitored in combo treatment with a biguanide and TZD

A

liver and renal function

95
Q

Look at tables 46.6-46.10 on pages 803-805
and
figure 46.2 on p. 804

A

Pharmacology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions