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NAPLEx > diabetes > Flashcards

diabetes Flashcards

1
Q

prediabetes
metformin

A

can be used to help improve BG levels especially if pt w/ a BMI of >=35, <60 years, and women with a history of gestational mellitus

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2
Q

c-peptide test

A

used to determine if the patient is still producing insulin
this is released by the pancreas only when insulin is released
type 1 diabetes is indicated by very low or absent C-peptide level

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3
Q

risk factors

A
  • physical inactivity
  • overweight >25 or >23 in Asian
  • gestational diabetes
  • > A5.7%
  • first-degree relative w/ diabetes
  • HDL <35, TG> 250
  • CVD, hypertension
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4
Q

diagnosis

A
  • hemoglobin A1C: indicates average BG over approximately the past 3 months
  • fasting blood glucose (FPG): gives BG at the moment and is taken after fasting for >=8 hrs
  • OGTT determines how well glucose is tolerated by measuring BG level 2 hrs after drinking liquid that is high in glucose
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5
Q

diabetes diagnosis

A

A1C >= 6.5%
EPG>= 126
OGTT >= 200

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6
Q

prediabetes diagnosis

A

A1C >= 5.7-6.4%
EPG>= 100-125
OGTT >= 140-199

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7
Q

glycemic targets in diabetes
not prego
prego

A

not prego: A1C <7, preprandial 80-130, after meals 2 hours <180

prego: preprandial <=95, after meals 1 hour <=140 and after 2 hours <= 120

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8
Q

testing frequency

A

quarterly if not yet at goal
and biannually every 6 months if at goal

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9
Q

physical activity

A

150 min moderate-intensity per week over at least 3 days
reduce sedentary- stand every 30ming

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10
Q

diabetes complications
microvascular

A

retinopathy, kidney disease, peripheral neuropathy, autonomic neuropathy (gastroparesis, loss of bladder control, and erectile dysfunction)

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11
Q

diabetes complications
macrovascular

A

CAD, CVA, PAD, ASCVD

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12
Q

Natural products

A

cinnamon
alpha lipoic acid
chromium

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13
Q

pt w/ ASCVD, HF or chronic kidney disease

A

regardless of A1C, w/ or w/out metformin
start a GLP-1 or SGLT 2 inhibitors

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14
Q

if baseline A1C is 8.5%-10%

A

start patient on two drugs, metformin + non-insulin drug

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15
Q

insulin can be started if

A

A1C >10% or BG>= 300mg/dL

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16
Q

if injectable medication is preferred

A

GLP1 agonist over insulin is preferred

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17
Q

metformin

A

glucophage, fortamet, glumetza
boxed warning: lactic acidosis- increased renal impairment
contra: GFR <30 and chronic metabolic acidoses don’t start if GFR <45
can cause vitamin b12 deficiency
decrease A1C by 1-2%

  • biguanide
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18
Q

metformin and topiramate

A

increase risk of metabolic acidosis

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19
Q

canagliflozin

A

Inovkana
don’t start if GFR <30 unless albuminuria
increased risk of leg and foot amputations, higher history of PAD, peripheral neuropathy,
risk of fractures and hyper K risk!!
-SGLT2

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20
Q

dapagliflozin

A

farxiga
do not start if GFR < 25, or even 24-45 rang…
-SGLT2

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21
Q

empagliflozin

A

jardiance
do not start if GFR <30
-SGLT2

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22
Q

-SGLT2 general info
safety/SE/monitoring

A

contra in dialysis
warning:
- ketoacidosis can occur so D/C prior to surgery
- genital mycotic infection, urosepsis, pyelonephritis, necrotizing fasciitis
- hypotension and AKI (due to volume depletion)

shown reduction in HF, CKD, and ASCVD

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23
Q

liraglutide

A

victoza
saxenda- for weight loss
daily dosing
- shown ASCVD benefit

  • GLP-1 agonist
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24
Q

dulaglutide

A

trulicity
weekly dosing
- shown ASCVD benefit

  • GLP-1 agonist
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25
Q

Exenatide

A

Byetta
BID dosing (give 60 min of meals)
do not start CrCl <30

  • GLP-1 agonist
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26
Q

Exenatide ER

A

bydureon
weekly dosing
do not start eGFR <45
- serious injection-site reactions (abscess, cellulitis, necrosis)!

  • GLP-1 agonist
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27
Q

lixisenatide

A

adlyxin
daily dosing
not recommended if eGFR< 15

  • GLP-1 agonist
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28
Q

semaglutide

A

ozempic- sc - weekly
rybelsus- oral - daily
wegovy- for weight loss
- increased complications w/ diabetic retinopathy
- shown ASCVD benefit

  • GLP-1 agonist
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29
Q
  • GLP-1 agonist
    general info
    Safety/ SE/ monitoring
A
  • all (except Byetta and Adlyxin): risk of thyroid C-cell carcinomas
  • warning: pancreatitis, not recommended in pt w/ severe GI disease
  • SE: weight loss, nausea
    Notes
  • DO NOT use w/ DPP-4 inhibitors
  • byetta and adlyxin within 60 min of meal
  • pen needles are not provided with byetta, victoza, or adlyxin- provided with all other which are the weekly dose
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30
Q

Glipizide

A

Glucotrol
Glucotrol XL- OROS formulation can leave ghost tablets
glipizide IR: take 30 min before meals

  • SU and meglitinides
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31
Q

glimepiride

A

Amaryl
not preferred in elderly on beer’s criteria

  • SU and meglitinides
32
Q

glyburide
micronized

A

Glynase
not preferred in elderly on beer’s criteria

  • SU and meglitinides
33
Q
  • SU
    Safety/ SE/ monitoring
A

contra: sulfa allergy
warning: hypoglycemia
SE: weight gain, nausea
decrease A1C by 1-2%
pt w/ G6PD deficiency can be increased risk of hemolytic anemia

34
Q

repaglinide

A

contra w/ gemfibrozil
contra: type 1 diabetes, DKA
SE: hypo and weight gain, and upper respiratory tract infections
- SU and meglitinides

35
Q

nateglinide

A

contra: type 1 diabetes, DKA
SE: hypo and weight gain, and upper respiratory tract infections
- SU and meglitinides

36
Q

sitagliptin

A

Januvia
warning: pancreatitis, severe arthralgia (join pain), acute renal failure
do not use w/ glp-1 agonsts

  • DPP4-inhibitor
37
Q

linagliptin

A

Tradjenta
warning: pancreatitis, severe arthralgia (join pain), acute renal failure
do not use w/ glp-1 agonsts

  • DPP4-inhibitor
38
Q

pioglitazone

A

actos
boxed warning: can exacerbate HF, do not use w/ NYHA class III/IV HF

warning: edema, risk of fractures hepatic failure, can stimulate ovulation so unpregnant prego
SE- weight gain

  • thiazolidinedione
39
Q

Rosiglitazone

A

Avandia
boxed warning: can exacerbate HF, do not use w/ NYHA class III/IV HF
INCREASED RISK OF MI w/ this med!!
warning: edema, risk of fractures hepatic failure, can stimulate ovulation so unpregnant prego
SE- weight gain

  • thiazolidinedione
40
Q
  • thiazolidinediones
  • DPP4-Inhibitors
  • sulfonylureas and meglitinides
  • GLP1- agonist
  • SGLT-2 inhibitors
  • biguanide

MOA

A
  • peroxisome proliferator-activated receptor gamma agonists that increase peripheral insulting sensitivity
  • prevent the enzyme DDP-4 from breaking down incretin hormones
  • stimulating insulin secretion for pancreatic beta-cells to decrease postprandial BG (meglitinides have faster onset and shorter duration)
  • analogs of incretin hormone GLP-1, which increase glucose-dependent insulin secretion, decrease glucagon secretion, slows gastric emptying
  • proximal renal tubules, prevents reabsorption of glucose
  • decrease hepatic glucose production, increase insulin sensitivity, and decrease intestinal absorption of glucose
40
Q

alpha-glucosidase inhibitors
acarbose
miglitol

A

acarbose (precose)
miglitol (Glyset)
- MOA: inhibit the metabolism of intestinal sucrose, which delays glucose absorption
does not cause hypo alone but if it does, sucrose food won’t work, use glucose tablets or gel
- each dose w/ first bite of meal

41
Q

bile acid binding resin
colesevelam

A

Welchol
also indicated for dyslipidemia
constipation most common SE

42
Q

dopamine agonist
bromocriptine

A

cycloset
contra in pt w/ syncopal migraines
should not be used w/ metoclopramide or other dopamine agonists

43
Q

amylin analog
pramlintide

A

Symlin (SC injection)
MOA: control post-prandial glucose by slowing gastric emptying
admin SC before each big meal
contra: in gastroparesis

44
Q

unopen insulin

A

refrigerate

45
Q

rapid-acting (bolus) insulin
injection

A

aspart (Novolog)
lispro (Humalog) lispro U-200 (Humalog U-200)
glulisine (Apidra)
clear and colorless

46
Q

rapid-acting (bolus) insulin
inhaled

A

afrezza!
clear colorless
contra in lung disease and smokers
replace inhaler ever 15 days
requires FEV1 monitoring

47
Q

short-acting (bolus) insulin

A

regular (Humulin R, Novolin R)
prefered for IV infusion

concentrated regular (Humulin R U-500)
fives times as concentrated- recommend in pt w/ required >200 units per day
need to be prescribed U-500 syringes
admin SC!!!! not IV, IM or insulin pump!!!

48
Q

intermediate-acting (basal) insulin

A

NPH (Humulin N, Novolin N)
cloudy!
given BID generally,
if Hypo at night, do 2/3 am and 1/3 pm

49
Q

long-acting (basal) insulin

A

detemir (Levemir)
glargine (Lantus, Toujeo)
lantus is 100units/ml toujeo is 300 units/ml

semglee is a biosimilar interchanged w/ glargine without separate prescription but biosimilar Rezoglar to glargine can not! NEED NEW prescription

50
Q

ultra-long acting (basal) insulin

A

degludec (Tresiba)
vial is 100units/ml but pen comes 100units/ml and 200units/ml

51
Q

starting basal in type 1 and type 2

A

0.5 units/kg/day type 1 then divided by 2 to get basal and other is bolus

type 2 is 0.1 to 0.2 units/kg/day

52
Q

insulin room temp stability
1-2 weeks

A

Humalog Mix 50/50 and 75/25 pens
Humlin 70/30 pen

53
Q

insulin room temp stability
2 weeks

A

Humulin N pen
Novolog Mix 70/30 pen

54
Q

insulin room temp stability
about 4 weeks

A

Apidra, Humalog, Novolog- vial and pen= 28 days
Humalog Mix 50/50 and 75/25 vials = 28 days
Novolog Mix 70/30 vials = 28 days
Novolin R U-100, N and 70/30 pen = 28days
Humulin R U-500 pen= 28 days
Lantus, Basaglar, Semglee vials and pen= 28 days

Humulin R U-100, N and 70/30 vials= 31 days

55
Q

insulin room temp stability
about 6 weeks

A

Humulin R U-500 vial= 40 days
Novolin R U-100, N, and 70/30 vials= 42 days
Levemir vial and pen= 42 days

56
Q

insulin room temp stability
about 8 weeks

A

tresiba pen = 56 days
toujeo pen = 56 days

57
Q

insulin best absorbed

A

abdomen!
alternative sites: posterior upper arm, superior buttocks, and lateral thigh area

58
Q

drugs that increase BG

A

beta-blockers (they can lower too)
thiazide & loop diuretics
tacrolimus
cyclosporines
PI
quinolones (can lower too)
antipsych
statins
steroids
cough syrups
niacin

59
Q

drugs that lower BG hypoglycemia risk

A

beta blockers
quinolones
tramadol

60
Q

DKA

A

BG >250
Ketones in urine etc.
anion gap (arterial pH <7.35, anion gap >12)

61
Q

hyperosmolar hyperglycemic state (HHS)

A

confusion, delirium
BG >600mg/dL
extreme dehydration
pH > 7.3, bicarb 15 mEq/L

62
Q

DKA and HHS tx

A
  • fluids first for all pts (start NS, and when BG 200mg/dl switch to dex/NS)
  • regular insulin infusion
  • prevent hypokalemia
  • tx acidosis of pH <6.9
63
Q

cancer

A

avoid GLP-1 agonists

64
Q

GI disorders, gastroparesis

A

avoid GLP-1 agonists, pramlintide

65
Q

genital infection/UTI

A

avoid SGLT2

66
Q

HF

A

avoid TZDs, alogliptin, saxagliptin

67
Q

Hypoglycemia risk

A

avoid insulin, sulfonylureas, meglitinides and pramlintide

68
Q

hypotension/dehydration

A

avoid SGLT2

69
Q

ketoacidosis

A

avoid SGLT2 and remember D/C SGLT2 prior to surgery to avoid ketoacidosis

70
Q

lactic acidosis

A

avoid metformin w/ renal impairment, alcoholism

71
Q

osteopenia/osteoporosis

A

avoid canagloflozin, TZDs

72
Q

pancreatitis

A

avoid DPP-4 inhibitors, GLP-1 agonists

73
Q

peripheral neuropathy, PAD, foot ulcers

A

avoid canagliflozin

74
Q

sulfa allergy, severe

A

avoid sulfonylureas

75
Q

renal insufficiency

A

avoid metformin, SGLT2, exenatide, glyburide

76
Q

weight gain/ obesity

A

avoid sulfonylureas, meglitinides, TZDs, insulin

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