Brainscape's Knowledge GenomeTM

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


See full index

(I) Symposium: Science Underpinning Practice, High Yield > Diabetes > Flashcards

Diabetes Flashcards

You may prefer our related Brainscape-certified flashcards:
Biology 101 flashcards
1
Q

SIGNS AND SYMPTOMS OF DKA

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

WHAT ARE FACTORS THAT CAN CAUSE DKA OR HHS

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

What is DKA and HHS PATHOPHYSIOLOGY

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

a) Upon waking b)Before meals c) Post prandial (TDM1)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the common symptoms seen in TDM1 (3 P’s)

A

Polydipsia
Polyphagia
Polyuria

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

For TDM1

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

WITH BASAL BOLUS INSULIN REGIME HOW MANY TIME IS SHORT ACTING INSULIN GIVEN

A

TDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment aim for patient on hypoglycaemic medication.

A

Aim for 53 mmol/mol (7%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MAO of Metformin

A

Action: Increase sensitivity to insulin
– Increase peripheral utilisation of glucose
– Reduce hepatic glucose production

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

Administration of metformin

A

With food to reduce GI related side effects

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

Which side effect of metformin is less likely to occur.
(a) hypoglycaemia
(b) lactic acidosis
(c) Vit 12 malabsorption
(d) Weight loss

A

(a) Hypoglycaemia: less likely to cause it.

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

Which side effect of metformin is less likely to occur.
(a) hypoglycaemia
(b) lactic acidosis
(c) Vit 12 malabsorption
(d) Weight loss

A

(a) Hypoglycaemia: less likely to cause it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which adverse effect occurs when ACE-I are taken with SGLT-2 inhibitors.
(a) UTI
(b) Headache
(c) Hypoglycemia
(d) Hyperkalemia

A

(d) Hyperkalemia: By SGLT-2 inhibitors blocking the entry of glucose into the proximal tubule it also inhibits sodium reabsorption leading to RAAS activation. But the blockade of Ang I being converted to Ang 2 means that aldosterone is not secreted so there is more retention of potassium and further excretion of sodium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which effects are mediated through SGLT-I.
(a) Headache
(b) Weight gain
(c) Blood pressure drop
(d) Blood pressure increase

A

(c) BP drop.

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

Which drug is associated with weight gain.
(a) Empagliflozin
(b) Metformin
(c) Exenatide
(d) Gliclizide

A

(d) Sulphonylureas: Gliclizide.

28
Q
A
29
Q

True or False: Pioglitazone worsen heart failure by fluid retention.

A

True.

30
Q
A
31
Q

What is DDP-4 mechanism of action.

A

Inhibits DPP-4 therapy by increasing GLP-1. Increasing pancreatic insulin secretion and inhibiting glucagon secretion.

32
Q

What is the treatment aim for patient on hypoglycaemic medication.

A

Aim for 53 mmol/mol (7%)

33
Q

For patient with chronic heart failure or established atherosclerotic CVD what is the first line agent.

A

Metformin as soon as tolerability is confirmed along with SGLT2 inhibitor (flozin).

34
Q

For patient who experience GI disturbances while on Metformin what is the next intervention step.

A

Metformin modified release.

35
Q

For patient who metformin is contraindicated what is the next line of therapy.

A

SGLT-2 inhibitor.

36
Q

Patient R lives on his own and has decreased mobility since his car accident. He is contraindicated for metformin and recently been struggling to maintain healthy lifestyle. What glycemic control drug would you prescribe.

A

SGLT-2 inhibitor.

37
Q

First line for patient who doesn’t have a high CVD risk.

A

Metformin literate dose to max tolerated dose 2g.

38
Q

What is the monitoring and prescribing guidance concerning metformin.

A

Titrate to the maximum tolerated dose 2g daily over weeks depending on patient symptoms.
Determine patient renal function before treatment.
Annual foot and eye checks of diabetic patients.

39
Q

For patient who HBA1c is not controlled and is currently metformin and empagliflozin what is the next step.

A

Consider triple therapy: adding DDP-4 inhibitor.

40
Q

Patient R have a BMI 35 kg/m2 and is a lawyer who is currently at the top of her game. She was commenced triple therapy with metformin and 2 other drugs and her HBA1c was not controlled. What do you recommend we commence.

A

GLP-1 analogue (exenatide)

41
Q

Why are Sulphonylureas falling out of favour when it comes to prescribing in practice.

A

Sulphonylureas are very good at dropping blood glucose however they are associated with increase in all cause mortality and major hypoglycaemic episodes compared with other anti diabetic medication.

42
Q

Why is DDP-4 inhibitors not recommended readily by NICE.

A

It is more expensive than common diabetes drugs like sulfonylurea and metformin. Commonly used DPP-4 drugs: Januvia (sitagliptin).

43
Q

SGLT-2 inhibitors: What are the common side effects.

A

Dehydration: glucose is hyperosmotic so it draws water in from renal tubules
Fungal genital infection: due to glycosuria.

44
Q

SGLT-2 inhibitors: What are the uncommon side effects

A

Euglycemic DKA: increase acid secretion in the blood in the absence of ABNORMAL glucose levels.
Foot disease
“Fournier’s gangrene”: Due to increase glucose in urine—> optimal place of dirty stuff to grow.

45
Q

SGLT-2 inhibitors: When patient is unwell what is the sick day rule.

A

Stop taking SGLT2 inhibitors if unwell especially with vomiting, diarrhoea or fever (high temperature). Increase the number of times blood glucose levels are checked.

46
Q

Why is Empagliflozin picked over other SGLT-2 inhibitor

A

In trials Empagliflozin has shown potent SGLT2 inhibitor activity —>effective.

47
Q

What is the peak time for Lispro
a. 2-3 hr
b. 1-1.5 hr
c. 10-16 hr
d. No peak

A

b. 1-1.5 hr

48
Q

What is the peak time of regular insulin
a. 1-1.5 hr
b.2.5 hours
c. 10-16 hr
d. No peak

A

B. 2.5 hours

49
Q

What is the peak time for NPH
a. 8 hr
b. 1-1.5 hr
c. 10-16 hr
d. No peak

A

a. 8 hr

50
Q

What is the peak time for degludec
a. 8 hr
b. 1-1.5 hr
c. 10-16 hr
d. No peak

A

d. No peak

51
Q

Duration of Aspart

a. 3-4 hr
b. 1-1.5 hr
c. 10-16 hr
d. No peak

A

a. 3-4 hr

52
Q

Duration of NPH
a. 3-4 hr
b. 1-1.5 hr
c. 10-16 hr
d. No peak

A

c.

53
Q

Type 2 diabetes as an insidious onset that results in long-term complication if not managed.
(a)True
(b) False

A

(a) True type 2 diabetes has progressive (insidious) onset.

54
Q

True or false: Insulin causes increase in hepatic gluconeogenesis

A

a. False, it decreases glucose levels

55
Q

Which side effect is caused by Gliclazide
a. Lactic acidosis
b. Hypoglycemia
c. Upper respiratory tract infection
d. Peripheral oedema
e. Glycosuria

A

(b) hypoglycaemia is pronounced with gliclazides

56
Q

Which side effect is commonly caused by metformin.
a. Vitamin B12 deficiency
b. Hypoglycaemia
c. Peripheral oedema
d. Respiratory tract infection

A

(a) Vitamin b12 deficiency

57
Q

Select the best option for each scenario provided.
a. Insulin
b. Gliclazide
c. Metformin
d. Sitagliptin
e. Pioglitazone
f. Empaglifozin

  1. A 36-year-old moderate-severe renal impairment of patient who is newly diagnosed with diabetes.
  2. A thin Afro-Carribean female, 15 years is treated for diabetic ketoacidosis and is due to be discharged.
  3. A 48 year old Caucasian woman with eGFR>90 mL/min and has a BMI 29 kg/m2 currently on low dose metformin. With QRISK score 12%
  4. A 28-year old woman currently on anti-diabetic and has experienced weight loss.
  5. A 40-year-old man currently on anti-diabetic diagnosed with macrocytic anaemia.
A
  1. (e) Pioglitazone is cheaper than DDP-4 and is likely to be selected in this instance. The rest require good renal function.
  2. (a) Basal bolus dosing schedule

3.(f) SGLT-2 indicated for cardiovascular disease and QRISK score >10%.

  1. (c) Metformin can cause weight loss it is usually weight neutral
  2. (c) Metformin= can cause Vit B12 malabsorption.
58
Q

Select the best option for each scenario provided.
a. Insulin
b. Gliclazide
c. Metformin
d. Sitagliptin
e. Pioglitazone
f. Empaglifozin
g. Dulaglutide

  1. A 38-year female having persistent abdominal pain.
  2. A newly diagnosed type II diabetes patient with chronic kidney disease stage IV.
  3. A patient who had been admitted to hospital with ketoacidosis.
  4. A newly diagnosed obese type II patient.
  5. This is suggested by NICE as first line treatment for type II diabetes.
A
  1. (d) Sitagliptin can cause pancreatitis which manifest as persistent abdominal pain. The pancreatitis is due to increase GLP-1 acting on pancreas which leads to increased pancreatic ductal turn over, ductal metaplasia and inflammation.
  2. (e) Pioglitazone is cheaper than DPP-4 inhibitor.
  3. (a) Insulin
  4. (c) Metformin
  5. (c) Metformin
59
Q

Select the best option for each scenario provided.
a. Insulin
b. Gliclazide
c. Metformin
d. Sitagliptin
e. Pioglitazone
f. Dulaglutide.
g. Empagliflozin

  1. A 40 year old African American man with BMI 36 kg/m2 on triple anti-diabetic regime.
  2. A newly diagnosed type II diabetic who is classed as severely frail with end stage kidney disease.
A
  1. (g) GLP-1 analogues are indicated in Tx with BMI greater than 35 that are of asian or black groups.
    2.(f) Empagliflozin because Pioglitazone will worsen Tx frailty and also he has severe renal function and all the other agents are renally cleared.
60
Q

Patient is newly started on Ramipril which agent will you be concerned about if you was to prescribe it.
a. Insulin
b. Gliclazide
c. Metformin
d. Sitagliptin
e. Pioglitazone
f. Empaglifozin

A

(f) Empagliflozin, it can increase risk of hyperkalemia.

61
Q

What are the MHRA warnings with SGLT-2 inhibitors.

A

Amputation and Euglycemic Ketoacidosis.

62
Q

What side effect is associated with Sitagliptin
a. Hypoglycaemia
b. Headache
c. Euglycemic ketoacidosis
d. Nasopharyngitis

A

d. Nasopharyngitis

63
Q

Which ones are side effects of Pioglitazone and why.
(a) Heart failure
(b) Fracture risk
(c) Pancreatitis
(d) Tachycardia

A

(a) Heart failure because PPAR-gamma leads to elevated macrophage inflammation and athelescelrosis.

64
Q

Which one is side effect of Canagliflozin
(a) Respiratory tract infection
(b) hyperkalemia
(c) Peripheral oedema
(d) Dehydration

A

(b) + (d)

65
Q

Which ONE of the following best describes the usual features of Type 2 diabetes mellitus.
a. Associated with older age; accounts for approximately 10% of diabetes cases; absolute insulin deficiency; insidious onset
b. Commonly presents in children and adolescents; accounts for approximately 90% of diabetes cases; relative insulin deficiency and resistances cute onset.
c. Commonly present in children and adolescents; accounts for approximately 10% of diabetes cases; absolute deficiency; acute onset.
d. Associated with older age, accounts for approximately 90% of diabetes cases; relative insulin deficiency and resistance; insidious onset.

A

(d)

(I) Symposium: Science Underpinning Practice, High Yield (12 decks)

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