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naplex > diabetes > Flashcards

diabetes Flashcards

1
Q

glucagon is produced in

A

alpha cells in the pancrease

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2
Q

insulin is produced in

A

Beta cells in pancrease

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3
Q

ketones

A

glucagon signals fat cells to maek ketonees as an alternative energy source

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4
Q

DKA

A

typically in T1 Diabetes
C peptde level is very low or absent T1D is diagnosed

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5
Q

diabetes in pregnancy

A

before pregnancy
during pregnancy- gestational
- in anycase BG goals are more stringent
can cause fetus to be larger
oral glucose test OGTT at 24-28 weeks

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6
Q

symptoms

A

poly uria
polyphagia (hunger)
polydipsia (THIRST)

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7
Q

Diagnosis

A

HG A1C >6.5 A1C
fasting plasma glucose (8hours or more) >126
OGTT(2 hours after drinking glucose) >200

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8
Q

pregnant diagnosis for Diabetes

A

pre prandial>95. (80-130)
1 hr PPG 140. (-)
2 hour >120. (normal 180)

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9
Q

what are some microvascular complications of diabetes

A

retinopathy
diabetic kidney disease
peripheral neuropathy
autonomic neuropathy

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10
Q

what are some macrovascular disease

A

coronary artery disease (CAD) including MI
Cerebrovascular disease (CVA)
peripheral artery disease (PAD)

*kinda like ASCVD

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11
Q

is aspirin recomended for primary prevention

A

NOPE only secondary prevention
CAD/PAD aspirin + lowdose rivaroxaban
used in pregancy to reduce risk of preeclampsia

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12
Q

statin therapy

A

High if diabetes + ASCVD
age 50-75 with multiple ASCVD

moderate if diabetes with no ASCVD
diabetes +ASCVD

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13
Q

what are some natural products used in T2D

A

cinamon
alpha lipoic acid
chromium
magnesium
ginseng

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14
Q

treatment options

A

metformin- 1st line

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15
Q

when to use 2 drugs

A

A1c 8.5-10
when ASCVD risk

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16
Q

when to use insulin

A

A1C >10 or PPG >300

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17
Q

refer to page 616

A

for Treatment pathway

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18
Q

what is metformin

A

GLucophage
Biguanide that decrease hepatic glucose production, absorption of glucose in the intestines
increase insulin sensitivity
can lower 1-2%
can cause GI effects
should not be used in eGFR<30, metabolic acidosis
max 2000-2550

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19
Q

metformin should be stopped before

A

Dye use
topiramate use can increase risk of metabolic acidosis

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20
Q

what are some SGLT2 inhibitros

A

Canagliflozin invokana
dapagliflozin farxiga
empagliflozin jardiance

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21
Q

does SGLT2 cause weight gain

A

no weight losss

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22
Q

does metformin cause weight gain

A

no weight neutral

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23
Q

does SGLT2 cause hypoglycemia

A

YES

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24
Q

does metfomin cause hypoglycemia

A

nope
VITB12 defeciency

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25
Q

which diabetes med can be used in HF

A

SGLT2
dapagli
canagli
empagli

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26
Q

what are some risks for sglt2

A

dialysis
can cause hypo
<30 should not be used
urosepsis
hypotension aki ketoacidosis

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27
Q

how much Ac1 is reduced by SGLT2

A

0.7-1%

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28
Q

SGLT2 MOA

A

proximal renal tubules inhibits SGLT reducing reabsorption of glucose and increase urinary glucose excretion

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29
Q

GLP 1 agonist MOA

A

increase insulin secretion
decrease glucagon secretion
slows gastric emptying
improves satiety
weight loss

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30
Q

what are some GLP1

A

liraglutide or victoza, saxenda
dulaglutide or trulicity
semaglutide or OZempic or rybelsus is oral

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31
Q

how much A1c lowering by GLP

A

0.5-1.5

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32
Q

what can you not use with GLP and why

A

DPP4 uses same pathway

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33
Q

GLP can increase INR

A

true

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34
Q

weight loss is true for GLP

A

YES

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35
Q

GLP can cause hypoglycemia ?

A

true

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36
Q

sulfonylurea MOA

A

stimulate insulin secretion

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37
Q

what are some clinical pearls of sulfonul ureas

A

can cause weight gain
sulfa allergy
take 30 mins before meal

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38
Q

what are some sulfonulureas

A

glipizide or glucotrol
glimeperide or amaryl
glyburide or glynase

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39
Q

how much A1c can be reduced by sulfonulureas

A

1-2%

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40
Q

what is the MOA of meglinitides

A

same as sulfonylurea

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41
Q

what are some meglinitides

A

repaglinide
nateglinide

42
Q

is there weight gain or hypoglycemia risk with meglinitide

A

YES same as sulfonyl urea

43
Q

what is the MOA of DPP4

A

prevents enzyme DPP4 from breaking down incretin hormones, GLP1 and GIP
indirectly these hormones help to regulate GB levels by increasing insulin release and decreasing glucagon secretion

44
Q

what are some DPP4

A

sitagliptin januvia
linagliptin trajenta
saxagliptin Onglyza
alogliptin nesina

45
Q

which Dpp 4 does not require renal dose adjustment

A

Trajenta

46
Q

how much A1c can be lowered by DPP4

A

0.5-0.8%

47
Q

what are the side effects of DPP4

A

pancreatitis, severe joint pain, AKI
** do not use with GLP

48
Q

moa of thiazolidinediones

A

PPARy agonist- peroxisome proliferator-activated receptor gamma agonist
increases insulin sensitivity

49
Q

what are some thiazolidinediones

A

pioglitazone (actos)
rosiglitazone -avandia

50
Q

what are some side effects of thiazolidinediones

A

can cause HF
Hepatic failure, edema fractures

51
Q

can thizolidine cause weight gain or hypo glycemia

A

YES, low risk of hypoglycemia

52
Q

what are some drug classess/ drugs used for T2DM

A

alpha glucosidae inhibitors
bile acid binding resins
dopamine agonist
amylin analog

53
Q

what are alpha glucosidase and what is the MOA

A

acarbose, miglitol
inhibits the metabolism of intestinal sucrose which delays glucose absorption

54
Q

Bile acid binding resins and what is the MOA

A

Colesevelam, Welchol
can bind and decrease absorption of other drugs

55
Q

Dopamine agonist

A

Bromocriptine (Cycloset)

56
Q

amylin analog and MOA

A

Pramlintide- Symlin

helps control PPG by slowing gastric emptying which suppresses glucagon secretion and increase satiety

57
Q

what are basal insulin with examples

A

for fasting glucose with 3-4 hours onset and lasts 24 hours- peakless
glargine
detemir
degludec

58
Q

What are NPH with examples

A

intermediate with 1-2 hours onset peaks 4-12 hours with unpredictable duration of action
Humulin novolin N

59
Q

what is the work of protamine

A

delay absorption and duration of effects

60
Q

what are rapid acting insulins and examples

A

bolus insulins with fast onset 15 mins ish aand peaks 1-2 hours with a duration of 3-5 hours

61
Q

regular insulins

A

onset 30 mins with peak 2 hours and lasts 6-10 hours

62
Q

what are the most important warnings for insulin

A

hypoglycemia and hypokalemia
weight gain
lipoatrophy

63
Q

what time should rapid acting injected

A

5-15 mins before meals

64
Q

how long before a meal should short acting be administered

A

30 mins before meals

65
Q

which insulin can be found in RX and OTC

A

short acting regular insulin- humulin R and novolin R
NPH- Humulin N and Novolin N
pre mixed insulin- humulin 70/30 novolin 70/30

66
Q

what is a long acting insulin

A

basal- detemir (levemir), glargine (lantus, toujeo, basaglar, senglee)

67
Q

what are some ulta long acting basal insulin

A

degludec - tresiba

68
Q

why should you not combine thiazolidinediones with insulin

A

Heart failure risk

69
Q

why should insulin with sulfonylurea or meglinitide be avoided

A

hypoglycemia also monitor with GLP, DPP4 SGLT2

70
Q

how to initiate insulin in T2DM

A

A1C >10% or PPBG>300 sign of DKA
add basal 10 units/ 0.1-0.2 units /kg/ day \

add 4 units or 10% of basal dose

71
Q

how to initaite insulin in T1DM

A

rapid and long acting are preferred
0.5units/kg/day use TBW
50% basal 50% PPG (this divided by 3 since with meal

if NPH then 2/3 NPH and 1/3 regular

72
Q

how to use insulin pumps

A

continuous dose
bolus dose- insulin to carbohydrate ratio

73
Q

what is the insulin to carbohydrate ratio

A

grams of carbohydrate covered by 1 unit of insulin

74
Q

what rule is used for regular insulin

A

rule of 450

75
Q

what rule is used for rapid acting insulin

A

rule of 500

76
Q

what is the ICR formula

A

grams of carbs covered by 1 unit of insulin =450 or 500/ TDD

77
Q

correction dose

A
  1. calculate correction factor to find out how much BG will be lowered by 1 unit of insulin
  2. total insulin needed to return the BG to target.

BG now - target BG / Correction factor

78
Q

correction factor for regular

A

1500/TDD= correction factor for 1 unit of insulin

79
Q

correction factor for Rapid acting

A

1800/ TDD = correction factor for 1 unit of Rapid acting insulin

80
Q

NPH to basal conversion

A

use 80% of NPH

81
Q

toujeo to glargine

A

80% of toujeo

82
Q

which insulins are good for 10 days

A

humalog 50/50 and 75/25 pens
humulin 70/30

83
Q

which insulins are good for 14 days or 2 weeks

A

humulin N pen
novolog mix 70/30 pen

84
Q

which insulin is good for 31 days

A

Humulin R vials
humulin N 70/30 vials

85
Q

which insulin good for 40 days

A

Humulin R 500 vial

86
Q

which humulin good for 42 days

A

levemir vial and pen
Novolin R and N 70/30 vials

87
Q

which insulin good for 56 days

A

Tresiba
Toujeo

88
Q

the higher the gauge the ___ the needle

A

thinner

89
Q

thinnest gauge size

A

32G 28 is thickest

90
Q

which size syringe requires pinching

A

4mm and 5mm do not require pinching

91
Q

insulin injection counselling

A

get supplies
wash hands
NPH or protamine suspensions need to swirled or rolled
if pens invert up and down 4-5 times
clean injection site
use new needle for every application
prime the needle 2 units
turn the dosing to the required dosing
use clear insulin first if mixing NPH in a vial
best application site is the abdomen
needles more than 5mm gently pinch a 2 inch
insert needle straight down at 90 degrees or 45 if thin pt
press injection down and count 5-10 seconds
rotate injections ite
properly dispose needles

92
Q

what is hypoglycemia

A

<70

93
Q

symptoms of hypo

A

dizziness, sweating hunger confusion nausia

94
Q

severe hypo symptoms

A

seizure coma death

95
Q

how to tx hypo

A

rule of 15
15-20g of glucose
recheck after 15 mins
repeat

4oz of juice
8oz milk
4oz soda
1 tbsp sugar
3-4 glucose tabs

96
Q

if unconscious how to tx hypo

A

IV dextrose or glucagon SC
nasal glucagon

97
Q

what drugs cause Hypo

A

insulin
sulfonylurea and meglinitide
GLP, DPP4 TZD SGLT2 low risk alone
BB quinolones can cause both
tramadol

98
Q

what drugs can cause Hyperglycemia

A

BB Quinolones can cause both
diuretic
tacrolimus, cyclosporine
protease inhibitor
antipsych
statins
steroids
cough syrups
niacin

99
Q

what is diabetic ketoacidosis

A

DKA- high BG , ketoacidosis and ketonuria
BG>250
ketones
anion gap acidosis Arterial pH<7.35 anion gap>12

100
Q

hyperosmolar hyperglycemic state HHS

A

higher mortality rate than DKA
primary cause is illness that leads to less fluid intake
leads dehydration with altered consciousness
confusion, delirium
BG>600 high osm >320
extreme dehydration
pH>7.3 bicarbonate >15

101
Q

what is the tx for HHS and DKA

A

fluids first- start with NS, when blood glucose reaches 200mg/dL change to D5W1/2NS
regular insulin- 0.1/unit/kg bolus and then 0.1 units/kg/hr or 0.14 units/kg/hr
prevent hypokalemia- insulin shifts K into the cells
treat acidosis pH <6.9 - give sodium bicarb

102
Q

what is Tx for DKA

A

fluids start with NS, when blood blucose 200 change to D5W1/2 NS

naplex (78 decks)

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