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NAPLEX (Cardio & Diabetes) > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Which medication is FDA approved for the prevention of T1D in those with high-risk?

A

Teplizumab

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2
Q

Which test is used to determine if a patient is still producing insulin?

A

C-peptide (C-peptide is released by the pancreas only when insulin is released)

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3
Q

What is the preferred treatment of Gestational DM?

A

Insulin, then Metformin or Glyburide

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4
Q

Diagnostic results for diabetes

A

1) A1C: >= 6.5%
2) FBG (>8hr): >= 126 g/dL
3) OGTT (2 hr BG): >= 200 mg/dL

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5
Q

Diagnostic results for Pre-diabetes

A

1) A1C: 5.7-6.4%
2) FBG (>8hr): 100-125 g/dL
3) OGTT (2 hr BG): 140-199 mg/dL

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6
Q

What are the glycemic targets in Diabetes?

A

A1C: <7%
Pre-prandial: 80-130 mg/dL
2-hr postprandial: <200 mg/dL

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7
Q

What is the eAG equivalent of an A1c of 6%?

A

126 mg/dL
*Each additional 1% increase by ~28 mg/dL

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8
Q

What is the drug of choice for Diabetes + HF or CKD?

A

SGLT2i

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9
Q

What is the drug of choice for Diabetes + ASCVD or high risk?

A

SGLT2i or GLP-1

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10
Q

What combinations of medications to avoid for Diabetes?

A

SU + Insulin [Increases hypoglycemia]
DPP4i + GLP1a [Overlapping mechanisms]

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11
Q

What is the role of the incretin-hormone GLP-1?

A

1) Increases insulin secretion
2) Decreases glucagon secretion
3) Slows gastric emptying and improves satiety

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12
Q

What are the GLP1 agonist drugs?

A

1) Semaglutide (Ozempic, Wegovy for weight-loss)
2) Liraglutide (Victoza, Saxenda for weight-loss)
3) Dulaglutide (Trulicity)
4) Exenatide (Byetta)
5) Tirzepatide (Mounjaro)

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13
Q

Which GLP1 is not weekly dosing?

A

1) Liraglutide subQ (Daily)
2) Exenatide subQ (ER version is once weekly) (BID dosing)

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14
Q

Which GLP1 is available as oral?

A

Semaglutide (PO daily) - Rybelsus

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15
Q

What is the role of SGLT2 in the body?

A

1) Found in the proximal renal tubule
2) Allows the reabsorption of glucose

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16
Q

What are the SGLT2i medications?

A

1) Empagliflozin (Jardiance)
2) Dapagliflozin (Farxiga)
3) Canagliflozin (Invokana)

Once daily medication PO - Take in AM

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17
Q

What is the renal limitations of SGLT2i?

A

Use eGFR >= 20
-Contra in dialysis

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18
Q

How does Metformin work?

A

[BIGUANIDE]

1) Lowers hepatic glucose production
2) Increase insulin sensitivity
3) Lowers intestinal absorption of glucose

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19
Q

What are the brand names of Metformin?

A

Glucophage, Glumetza, Fortamet

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20
Q

Contraindication of Metformin?

A

eGFR < 30
Metabolic Acidosis

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21
Q

Metformin drug interactions?

A

1) Metformin + Contrast media (Lactic Acidosis)
2) Metformin + Alcohol (Lactic Acidosis)
3) Metformin + Topiramate (Metabolic acidosis)

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22
Q

How do sulfonylureas work?

A

The stimulate insulin secretion

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23
Q

Sulfonylurea Medication?

A

1) Glyburide (Glynase)
2) Glipizide (Glucotrol)
3) Glimepiride (Amaryl)

24
Q

Contraindication of Sulfonylureas?

A

Sulfa allergy

25
Q

What is the role of the enzyme DPP4 in the body?

A

1) Breaks down the incretin hormones (GLP and GIP)

These hormones help to regulate BG levels by increasing insulin release and decreasing glucagon secretion.

26
Q

What are the DPP-4i drugs?

A

1) Sitagliptin (Januvia)
2) Linagliptin (Tradjenta)
3) Saxagliptin (Onglyza)

27
Q

DPP4-i Warnings

A

1) Pancreatitis
2) Arthralgia (joint pain)
3) Renal Failure

28
Q

DPP4-i Side Effects

A

1) Nasopharyngitis
2) UTI
3) Peripheral edema

29
Q

How do Thiazolidinediones (TZD) work in the body?

A

TZD are PPAR-gamma agonists. They increase insulin sensitivity (increase uptake of glucose)

-Pioglitazone is the only TZD available in the US.

30
Q

What is the boxed warning for Pioglitazone?

A

Can cause or exacerbate HF.

31
Q

What are the rapid acting insulins?

A

Insulin Aspart (Novolog)
Insulin lispro (Humalog)
Insulin glulisine

Onset: 15 mins
Peak: 1-2 hours
Duration: 3-5 hours

31
Q

What are the intermediate acting insulin?

A

NPH (Humulin N, Novolin N)

Onset: 1-2 hours
Peak: 4-12 hours
Duration: 14-24 hours

  • Used as a basal insulin
  • Only insulin that is cloudy, due to protamine
32
Q

What are the short acting insulin?

A

Regular Insulin (Novolin, Humulin)

Onset: 30 mins
Peak: 2 hours
Duration: 6-10 hours

*Usually does BID

33
Q

What are the basal insulin?

A

Insulin glargine (Lantus, Toujeo)
Insulin detemir (Levemir)
Insulin degludec

Onset: 3-4 hours
Peak: No Peak!
Duration: >= 24 hours

*These impact fasting glucose

34
Q

How is insulin and potassium related?

A

Insulin facilitate the entry of potassium into the cell. Therefore, insulin causes hypokalemia.

35
Q

What is the standard concentration of insulin?

A

U-100
100 units/mL

36
Q

What are the brand names of insulins?

A

Rapid Acting:
- Insulin Aspart (Novolog)
- Insulin Lispro (Humalog)
Short Acting:
- Regular Insulin (Humulin, Novolin)
Intermediate:
- NPH (Humulin N, Novolin N)
Long Acting:
- Insulin glargine (Toujeo, Lantus)
- Insulin detemir (Levemir)

37
Q

What do the numbers in this formulation mean: Novolin 70/30?

A

70%NPH, 30%Regular

38
Q

Premixed Insulin: What does the numbers mean in Novolog Mix 70/30?

A

70% aspart protamine/ 30% aspart

39
Q

When to start insulin in T2D?

A

Usually A1c >10% or BG >300 mg/dL
-It is usually added on to GLP1

40
Q

What is the starting dose of insulin in T2D?

A

10 units/day or 0.1-0.2 units/kg/day, then titrate

41
Q

When to start Prandial insulin in T2D, and how much?

A

Start when fasting glucose not at goal.

Start 4 units or 10% of basal dose before largest meal. Add doses before other meals PRN

42
Q

What is the insulin starting dose in T1D?

A

0.5 units/kg/day

50% is basal; 50% is prandial

-Long and rapid acting insulins are preferred. NPH can be used if cost is an issue.

43
Q

What is ICR?

A

Insulin to Carbohydrate Ratio

It is the grams of Carbs covered by 1 unit of insulin

44
Q

ICR: Rule of 450

A

For Regular Insulin

450/TTD of Insulin

45
Q

ICR: Rule of 500

A

For Rapid Acting

500/TDD of Insulin

46
Q

What are the hyperglycemic crises?

A

1- Diabetic ketoacidosis (DKA)
2- Hyperosmolar hyperglycemic state (HHS)

47
Q

What are the criteria for DKA?

A

Usually T1D patients
BG > 250 mg/dL
ketones (Blood or urine)
Anion gap acidosis

48
Q

What are the criteria for HHS?

A

Usually T2D
Caused by an illness which leads to less fluid intake and extreme dehydration
BG >600 mg/dL
pH > 7.3

49
Q

What is the treatment of HHS and DKA?

A

1) Aggressive fluids (Start with NS until BG ~200 mg/dL, then change to D5W1/2NS
2) Regular insulin (0.1 units/kg bolus, then 0.1 units/kg/hr cont. inf. OR 0.14 units/kg/hr cont. inf.)
3) Prevent hypokalemia
4) Treat acidosis if pH < 6.9 with NaHCO3.

50
Q

Which T2D medication to avoid with eGFR < 45?

A

1) Metformin
2) Exenatide ER
3) Glyburide

51
Q

Which T2D medication should be avoided in HF?

A

1) Pioglitazone
2) Saxagliptin

52
Q

Which medication should be avoided in patients with T2D and pancreatitis?

A

1) GLP-1’s
2) DPP4-i ‘gliptins’

52
Q

Which T2D medication can cause weight gain?

A

1) Insulin
2) Sulfonylureas
3) Meglitinides
4) TZD

53
Q

What is the conversion of regular insulin to rapid acting insulin?

A

1:1

54
Q

What is the treatment for gestational diabetes?

A

1st line: Insulin
2nd line: Metformin or glyburide

55
Q

What is the conversion of NPH to insulin glargine?

A

Reduce dose by 20%

NAPLEX (Cardio & Diabetes) (9 decks)

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