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PharmD > Diabetes > Flashcards

Diabetes Flashcards

Antiglycemic agents, diagnostic and treatment guidelines, diabetes-related emergencies

1
Q

Metformin MOA

A
  • Decreases hepatic glucose production
  • Improves insulin sensitivity
  • Delays glucose absorption in gut

Biguanide

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2
Q

GLP1/GIP agonist MOA

A
  • Increases glucose-dependent insulin secretion
  • Decreases glucagon secretion
  • Slows gastric emptying and increases satiety

Tirzepatide

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3
Q

GLP-1 agonist MOA

A
  • Increases glucose-dependent insulin secretion
  • Decreases glucagon secretion
  • Slows gastric emptying and increases satiety
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4
Q

GLP-1 agonists

A

Liraglutide
Semaglutide
Dulaglutide
Exanatide

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5
Q

DPP-4s MOA

A
  • Inhibt breakdown of incretin hormones (GLP-1 and GIP)
  • Increases glucose-dependent insulin secretion
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6
Q

SGLT2i MOA

A

Increase urinary glucose excretion

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7
Q

DPP4s

A

Sitagliptin
Linagliptin
Saxagliptin

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8
Q

SGLT2 inhibitors

A

Canagliflozin
Dapagliflozin
Empagliflozin

“flows”

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9
Q

Sulfonylureas MOA

A

Stimulates pancreatic beta cells to release insulin

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10
Q

Sulfonylureas

A

Glipizide
Glyburide
Glimepiride

ride out

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11
Q

Thiazolidinediones MOA

A

Directly increase insulin sensitivity in muscle

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12
Q

Thiazolidinediones

A

Pioglitazone
Rosiglitazone

“azo”

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13
Q

Antiglycemic agents that cause weight loss

In order from greatest to least

A

Tirzepatide
GLP1s
SGLT2s
Metformin

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14
Q

Antiglycemic agents that cause weight gain

In order from greatest to least

A

Insulin
SUs
TZDs

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15
Q

Antigylcemic agents with very high A1c lowering power

Rough range

A

Tirzepatide
Semaglutide, dulaglutide
Insulin

1.5 to 2.5%

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16
Q

Antigylcemic agents with high A1c lowering power

Rough range

A

Metformin
Exenatide, liraglutide
SGLT2s
SUs
TZDs

0.5 to 1.5%

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17
Q

Antigylcemic agents with moderate A1c lowering power

Rough range

A

DPP4s

0.5 to 1%

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18
Q

Antiglycemic agents with ASCVD benefits

A

Liraglutide
Semaglutide (SQ)
Dulaglutide
Canagliflozin
Empagliflozin

“LSD” GLPs, “CE” SGLT2s

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19
Q

Antiglycemic agents with benefits in heart failure

A

Empagliflozin
Dapagliflozin

“ED” SGLT2s - canagliflozin has moderate benefits too

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20
Q

Antiglycemic agents contraindicated/cautioned in heart failure

A

TZDs
Saxagliptin

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21
Q

Antiglycemic agents with renal protective effects

A

Liraglutide
Semaglutide (SQ)
Dulaglutide
Canagliflozin
Dapagliflozin

“LSD” GLPs, “CkD” SGLT2s - empag has moderate benefits too

22
Q

Metformin ADEs and CIs

A

GI effects - diarrhea, flatulence (titrate or ER)
Risk of lactic acidosis

CI: CKD, liver disease, heavy alcohol consumption

23
Q

GLP1s (GLP1/GIPs) ADEs and CIs

A

N/V/D
Stomach pain

CI: Personal or family hx of medullary thyroid cancer or pancreatitis

24
Q

DPP4s ADEs and CIs

A

Flu-like symptoms
Risk of pancreatitis

25
Q

SGLT2s ADEs and CIs

A

UTIs, genital mycotic infections
Polyuria

CI: Hx of UTIs, bone fractures (cana)

26
Q

Sulfonylureas ADEs and CIs

A

Hypoglycemia
Weight gain

CI: high-risk hypoglycemia, CKD or elderly (glyburide)

27
Q

TZDs ADEs and CIs

A

Weight gain
Edema
Anemia

CI: Class 3-4 CHF

28
Q

What is C-peptide measured for?

A

Produced 1:1 during insulin synthesis
Marker of insulin production

29
Q

Rapid acting insulins

A

Lispro (Humalog)
Aspart (Novolog)

30
Q

Short acting insulins

A

Humulin R
Novolin R

31
Q

Intermediate acting insulins

A

Humulin N
Novolin N

32
Q

Long acting insulins

A

Glargine (Lantus, Basaglar, Toujeo)
Degludec (Tresiba)

33
Q

When to initiate insulin for T2DM

A
  • A1C > 10%
  • Active hyperglycemia symptoms
  • Emergent symptoms of hyperglycemia
  • Unable to meet A1c goals after 3 months of treatment
34
Q

Initial insulin doses

T1 and T2

A

T1DM: 0.5 u/kg/day divided 50/50 basal/bolus

T2DM:
* Basal: 10 u/day OR 0.1-0.2 u/kg/day
* Bolus: 4 u/day or 10% of basal insulin dose

Use weight based dosing for T2 if FBG is really high

35
Q

Insulin titration strategy

A

Bolus: adjust by 1-2 u/dose q3d
Basal: adjust by 2 u q3d
Hypoglycemic: decrease TDD by 10-20%

36
Q

Signs of overbasalization and what to do

A
  • Dose > 0.5 u/kg/day
  • Elevated bedtime-morning and/or post-preprandial differential
  • High variability in BG readings
  • Frequent episodes of hypoglycemia

Add bolus insulin and/or switch to BID basal dosing

37
Q

I:C ratio

A

insulin:carbs
500/TDD = carbs

38
Q

ISF

A

Insulin sensitivity factor, add on to I:C calculation
Sensitive or rapid: 1800/TDD
Resistant or short: 1500/TDD

39
Q

Symptoms of hyperglycemia

A
  • Polyuria
  • Polyphagia
  • Polydipsia
  • Fatigue
  • Weight loss

phagia = hunger, dipsia = thirst

40
Q

Complications of uncontrolled diabetes

A
  • Peripheral neuropathy
  • Hypertension
  • Nephropathy
  • Retinopathy
  • Cardiovascular disease, stroke
  • Cerebrovascular disease, cognitive impairment
  • Periodontal disease
  • Foot ulceration
41
Q

Mechanism of diabetic ketoacidosis

A

Lack of insulin causes overproduction of ketones - glucagon has free reign to breakdown free fatty acids as energy sources

42
Q

Mechanism of hyperosmolar hyperglycemic state

A

Severe dehydration due to high blood glucose levels and low fluid status, commonly triggered by illness

Kidneys cannot keep up to maintain fluid status

43
Q

Symptoms of DKA vs HHS

A

Both: polyuria, polydipsia, weakness, lethargy, weight loss
DKA:
* Abdominal pain
* “fruity” breath - smell of ketones
* BG 250 - 600
HHS:
* Delirium
* BG > 600
* Dehydration

44
Q

Likely patients DKA vs. HHS

A

DKA: T1DM, young
HHS: T2DM, elderly

45
Q

Lab findings DKA vs HHS

A

DKA
* Acidotic pH (7-7.25)
* Urine or serum ketones
* Anion gap > 10
HHS:
* pH > 7.3
* No ketones
* serum osmolality > 320 mOsm/kg

46
Q

Treatment of DKA and HHS

A

Fluid replacement:
1. NS for 1-2 hrs
2. If corrected Na level is normal/high, switch to 1/2 NS
3. Once BG < 200 (DKA) or < 300 (HHS), switch to D5W+1/2NS
IV Insulin: do not initiate if K < 3.3
* Give 0.1u/kg bolus, then 0.1 u/kg/hr
* Only decrease gluc by 50-75 mg/dL/hr, risk of cerebral edema
* Maintain BG 150-200 (DKA) or 250-300 (HHS)

DKA only: if pH < 7, give bicarb

47
Q

Diagnostic criteria for T2DM

A

A1C ≥ 6.5%
FBG ≥ 126

48
Q

Criteria for pre-diabetes

A

A1c: 5.7-6.4%
FBG: 100-125

49
Q

Treatment goals

A

A1c < 7%
FBG 80-130
2hr pp < 180

50
Q

Comprehensive care considerations for diabetes

A
  • Statin for 1º prevention
  • ASA for 2º prevention
  • Annual eye, foot, and kidney exam
  • Immunizations: HepB, PPSV23, flu, COVID
51
Q

Treatment of prediabetes

A

Lifestyle mod
Metformin if BMI ≥ 35, age 25 - 59, or hx of gestational diabetes
Monitor annually

PharmD (3 decks)

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