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Pnt Exam 1 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes is more common in which gender

A

equal in both males and females

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2
Q

type one diabetes is more common in what age

A

children and young adults

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3
Q

type 2 DM is more common in what age

A

older

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4
Q

Type 2 DM is more common in what races

A

African, Asian, Latino

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5
Q

Insulin is secreted from where

A

pancreatic beta cells

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6
Q

Insulin effects on glucose uptake into muscle

A

stimulates

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7
Q

insulin effects on gluocse uptake into adipose tissue

A

stimulates

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8
Q

insulin effects on lipolysis and FFA release from adipose tissue

A

decreases

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9
Q

Insulin effects on liver’s production of glucose

A

decrease

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10
Q

Glucagon is secreted from where

A

pancreatic alpha cells

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11
Q

glucagon’s effect on glucose levels

A

increases

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12
Q

glucagon’s effect on glycogenolysis

A

increases

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13
Q

glucagon’s effect on gluconeogenesis

A

promotes

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14
Q

glucagon purpose

A

maintain adequate fasting plasma glucose levels

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15
Q

amylin is secreted from where

A

co-secreted with insulin from beta cells

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16
Q

amylin purpose

A

decrease post meal increases in glucose

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17
Q

amylin effect on rate of gastric emptying

A

slows

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18
Q

amylin effect on satiety

A

increases

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19
Q

amylin effect on postmeal glucagon secretion

A

inhibits

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20
Q

GIP stands for

A

Gastric inhibiting polypeptide

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21
Q

GIP is secreted from

A

duodenum

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22
Q

GIP purpose

A

stimulate insulin secretion, expansion of beta cells

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23
Q

GIP effect on gastric emptying

A

minimal

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24
Q

GIP effect on satiety

A
  • no effect
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25
Q

GIP effect on glucagon secretion

A

may stimulate

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26
Q

GIP secretion in daibetes

A

normal

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27
Q

GLP-1 stands for

A

glucagon like peptide 1

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28
Q

GLP1 is released from

A

jejunum and ileum

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29
Q

GLP1 does what

A

stimulates insulin secretion, expansion of beta cells

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30
Q

GLP1 effect on gastric emptying

A

slows

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31
Q

GLP1 effect on satiety

A

increases

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32
Q

GLP1 effect on glucagon secretion

A

suppress

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33
Q

GLP1 secretion in diabetes

A

less

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34
Q

Insulin resistance i Type 1 DM

A

absent; uncommon; may be present but does not contribute

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35
Q

Insulin resistance in Type 2 DM

A

present; common, major contributing factor to development

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36
Q

Insulin secretion in Type 1 DM

A

absent

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37
Q

Insulin secretion in Type 2 DM

A

impaired but some degree of insulin secretion still remains

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38
Q

Amylin secretion in Type 1 DM

A

absent

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39
Q

Amylin secretion in Type 2 DM

A

increased during early stages, low or absent in later stages

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40
Q

GLP-1 secretion in Type 1 DM

A

intact secretion, effect may or may not be diminished

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41
Q

GLP-1 secretion in Type 2 DM

A

Secretion intact, effects are diminished

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42
Q

Medications that cause increased blood glucose

A

thiazides
beta blockers
corticosteroids
niacin

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43
Q

gestational diabetes cause

A

defects in beta-cell secretion and increased insulin demand

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44
Q

Diabetes from pancreatic damage cause

A

beta cell damage - pancreatitis, ethanol abuse, cystic fibrosis

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45
Q

diabetes from cushing syndrome cause

A

over production of catecholamines, increased hepatic production of glucose and insulin resistance

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46
Q

What is prediabetes

A

elevated glucose levels but not diagnostic of DM

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47
Q

prediabetes fasting glucose

A

100-125

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48
Q

prediabetes 2 hour post oral glucose tolerance level

A

140-199

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49
Q

prediabetes A1C

A

5.7-6.4%

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50
Q

symptoms of diabetes

A

hungry (polyphasia)
urinate a lot (polyuria)
polydypsia (increased thirst)
Weight loss

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51
Q

Fasting glucose levels for DM

A

126+

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52
Q

2 hour post oral glucose tolerance level in DM

A

200+

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53
Q

a1c in DM

A

6.5+

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54
Q

random glucose with symptoms in DM

A

200+

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55
Q

Screening for type 1 DM

A

not routine, autoimmune antibodies in high risk (transient hyperglycemia or family history of type 1)

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56
Q

Screening for Type 2 DM

A 
44+ years old
previous pre-diabetes
250
3. PCOS
4. prediabetes
5. CVD
6. baby 9+ lbs or gestational DM
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57
Q

How often to screen asymptomatic adults for Type 2 DM

A

every 3 years

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58
Q

how often to screen individuals at risk of type 2 DM (prediabetes)

A

yearly

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59
Q

Average age at diagnosis of type 1 DM

A

young

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60
Q

Average age at diagnosis of type 2 DM

A

older

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61
Q

Speed of onset of symptoms in type 1 DM

A

rapid

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62
Q

Speed of onset of symptoms in type 2 DM

A

slow

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63
Q

Presenting symptoms of Type 1 DM

A

DKA

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64
Q

Presenting symptoms of Type 2 DM

A

polydypsia
polyphagia
polyuria

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65
Q

Body habitus of type 1 DM

A

normal/underweight

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66
Q

Body habitus of type 2 DM

A

obese

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67
Q

complications of DM

A
  1. Nephropathy
  2. peripheral neuropathy
  3. poor wound healing and ulcers
  4. retinopathy
  5. atheroscleotic vascular disease
  6. risk of infection
  7. erectile dysfunction
  8. autonomic dysfunction
  9. acute complications (DKA, HHNS)
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68
Q

Consequences of nephropathy

A

end stage renal disease, dialysis, renal transplant

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69
Q

Consequences of peripheral neuropathy

A 
loss of sensation
numbness
neuropathic pain
lower extremity deformities
amputation
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70
Q

consequences of poor wound healing and ulcers

A

lower extremity amputations

loss of limb function

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71
Q

consequences of retinopathy

A

blindness

retinal hemorrhages

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72
Q

consequences of atherosclerotic vascular disease

A

ACS, MI
TIA, CVAs,
PAD

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73
Q

screening for nephropathy

A

spot urinary albumin excretion

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74
Q

screening for peripheral neuropathy

A

monofilament testing, pinprick sensation and vibration perception

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75
Q

screening for poor wound healing and ulcers

A

Comprehensive foot exam yearly

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76
Q

Screening for retinopathy

A

Dilated pupil exam at least annually

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77
Q

Screening for atherosclerotic vascular disease

A

no single screening, monitor s/s and risk

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78
Q

Intervention to reduce risk of nephropathy

A

glycemic control

HTN management

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79
Q

Intervention to reduce risk of peripheral neuropathy

A

glycemic control

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80
Q

Intervention to reduce risk of poor wound healing and ulcer

A

glycemic control, control of PAD risk factors (HTN, lipids, smoking, physical activity) podiatrist for foot care

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81
Q

Intervention to reduce risk of retinopathy

A

glycemic control
HTN
lipid control

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82
Q

Intervention to reduce risk of atherosclerotic vascular disease

A 
glycemic control
HTN management
Lipid
smoking
antiplatelet therapy
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83
Q

Goals of therapy for DM

A

reduce morbidity and mortality

  1. reduce risk for complications
  2. alleviate symptoms of complications
  3. achieving of glucose goals
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84
Q

goals of therapy for prediabetes

A

goal is to delay, slow progression of development of Type 2 DM

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85
Q

recommendations for prediabtes

A 
weight loss (7+%) 
Physical activity (150 minutes/week)
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86
Q

What study showed greater benefits in lifestyle modification than drug therapy to prevent diabetes

A

DPP diabetes prevention program

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87
Q

Which study showed benefit to early aggressive attempts to control glucose to reduce risk of developing DM and that maintainance of weight is important for prolonged risk reduction

A

DPPOS diabetes prevention program outcomes study

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88
Q

What measures of glucose are used

A

plasma/blood glucose
A1C
fructosamine

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89
Q

what is fructosamine

A

glucose linked to albumin over 2-3 weeks

90
Q

ADA goal for A1c in healthy younger adults

A

<7%

91
Q

ADA goal for a1c in healthy older adults

A

7.5-8%

92
Q

ADA goal for a1c in adlts with poor health

A

8.5+%

93
Q

ACE and AACE goals for A1c

A

<6.5%

94
Q

ADA goals for fasting glucose in healthy young adults

A

70-130

95
Q

ADA goals for fasting glucose in healthy older adults

A

90-130

96
Q

ADA goals for fasting glucose in older adults with chronic illness of cognitive impairment

A

9-150

97
Q

ADA goals for fasting glucose in adults with poor health and short life expectancy

A

100-180

98
Q

ACE and AACE goals for fasting glucose

A

<110

99
Q

ADA goals for 1-2 hour post meal glucose

A

<180

100
Q

ACE and AACE goal for 1-2 hour post meal glucose

A

<140

101
Q

ADA goals for pre-prandial glucose in non critically ill hospitalized pts

A

<140

102
Q

What trial said that A1c under 7 reduced risk for complications?

A

DCCT diabetes control and complications trial

103
Q

What study said that meeting goals early in disease had long term CV outcomes

A

UKPDS

104
Q

Medical nutrition therapy can have what % decrease in a1c

A

1-2%

105
Q

EtOh intake for DM

A

women 1

men 2

106
Q

How many minutes of aerobic exercise for DM

A

150 minutes/week

107
Q

How often resistance training for DM

A

3x/week

108
Q

Weight loss of how much for DM

A

5-10%

109
Q

Type 1 DM pts exercise may effect glucose how

A

increase

110
Q

pts on agents that can cause hypoglycemia with pre-exercise BG of <100 can experience what

A

hypoglycemia

111
Q

Oral agents to treat DM

A 
metformin
sulfonylureas
meglitinides
thiazolidinesiones
dipeptidyl peptidacse IV inhibitors 
alpha glucosidase inhibitors
sodium glucose cotransporter 2 inhibitors
112
Q

what are biguanides

A

metformin

113
Q

biguanides reduce a1c how much

A

1.5-2

114
Q

biguanide MOA

A

decrease hepatic glucose production, decrease glucose absorption, increase insulin sensitivity

115
Q

sulfonylureas

A 
acetohexamide
clorpropamide
tolazamide
tolbutamide
glipizide
glyuride
glimiperide
116
Q

sulfonylureas lower a1c by how much

A

1.5-2

117
Q

sulfonylurea MOA

A

stimulates insulin release, reduce glucose output from liver, increase insulin sensitivity

118
Q

glipizide brand name

A

glucotrol

119
Q

glimiperide brand name

A

Amaryl

120
Q

Meglitinides

A

repaglinide

nateglinide

121
Q

repaglinide brand name

A

prandin

122
Q

nateglinide brand name

A

starlix

123
Q

meglitinide a1c lowering

A

0.5-1

124
Q

meglitinide MOA

A

stimulated glucose dependent insulin release (blocks ATP dependent K+ channels)

125
Q

Thiazolidinediones (TZD)

A

pioglitazone

rosiglitazone

126
Q

pioglitazone brand name

A

actos

127
Q

rosiglitazone brand name

A

avandia

128
Q

TZD a1c lowering

A

0.5-1.5

129
Q

TZD MOA

A

Improves cellular response to insulin

130
Q

Alpha glucosidase inhibtitors

A

acarbose

miglitol

131
Q

acarbose brand name

A

precose

132
Q

miglitol brand name

A

glyset

133
Q

Alpha glucosidase inhibtitors A1c lowering

A

0.3-1

134
Q

Alpha glucosidase inhibtitors MOA

A

delayed glucose absorption and lower post-prandial glucose

135
Q

GLP-1 analogs

A

Exenatide

Liraglutide

136
Q

GLP-1 analogs MOA

A

increase glucose dependent insulin secretion, decrease inappropriate glucagon, increases beta cell growth, slows gastric emptying, decreases food intake

137
Q

GLP-1 analogs A1c lowering

A

0.5-1

138
Q

Exenatide brand name/s

A

bydureon, byetta

139
Q

Liraglutide brand name

A

victoza

140
Q

DDP4 inhibitors

A

sitagliptin
saxagliptin
linagliptin
alogliptan

141
Q

DDP 4 inhibitors A1c lowering

A

0.4-0.8

142
Q

DDP 4 inhibitors MOA

A

increases incretin - regulate glucose homeostasis, increase insulin synthesis, decrease glucagon - decrease glucose production

143
Q

sitagliptin brand name

A

januvia

144
Q

saxagliptin brand name

A

onglyza

145
Q

linagliptin brand name

A

tradjenta

146
Q

alogliptan brand name

A

nesina

147
Q

Amylin analog

A

pramlintide

148
Q

pramlintide brand name

A

sumlin

149
Q

amylin analog MOA

A

reduces post prandial glucose, prolongs gastric emptying, reduction of postprandial glucagon, appetite suppression

150
Q

amylin analog a1c lowering

A

0.3-0.5

151
Q

injectable agents for DM

A

insulin
amylin analogs
GLP-1 analogs

152
Q

Bile acid sequestants

A

welchol

153
Q

bile acid sequestrants MOA

A

unknown

154
Q

bile acid sequestrants a1c lowering

A

0.3-0.5

155
Q

Bromocriptine brand name

A

cycloset

156
Q

bromocriptine A1c lowering

A

0.5-0.7

157
Q

bromocriptine MOA

A

reduce post prandial glucose - suppress hepatic glucose production; does not effect insulin

158
Q

SGLT-2 inhibitor

A

canaglifozin

159
Q

canaglifozin brand name

A

invokana

160
Q

SGLT-2 inhibitor a1c lowering

A

0.7-1

161
Q

SLGT2 inhibitor MOA

A

reduce reabsorption of glucose in kidneys

162
Q

First line agent for type 2 DM

A

metformin

163
Q

minimum metformin dose

A

1500mg

164
Q

metformin dosage forms

A

IR tablets, ER tablets, liquid

165
Q

Max effective dose metformin

A

2000mg/day

166
Q

metformin excretion

A

unchanged in urine

167
Q

CIs to metformin

A

SCr 1.4+ women, 1.5+ men, CHF requiring drug therapy; acidosis

168
Q

AEs of metformin

A 
diarrhea
dyspepsia
N/V
reduce B12 
Metallic taste
Lactic acidosis
169
Q

lactic acidosis risk factors

A 
tissue hypoperfusion
decompensated heart failure
shock 
hypoxic states
severe liver impairment
alcohol abuse
170
Q

lactic acidosis symptoms

A 
flu-like
abdominal pain
N/V
feeling cold
bradycardia
tachypnea
cardiac/respiratory compromise
171
Q

Monitoring for metformin

A

SCr, CrCl at least annually or Q3-6 motnhs
SMBG
Vitamin B12 is signs of deficiency are present

172
Q

CV effects of metformin

A

reduces risk in overweight

positive effects on lipids (decreases LDL and TG)

173
Q

Metformin risk of hypoglycemia

A

low

174
Q

glyburide 5 mg = glyburide micronized

A

3 mg

175
Q

Majority of effect with sulfonylureas seen at what dose

A

1/2 max

176
Q

SUs ineffective at what BG levels

A

300+

177
Q

SUs should be taken when

A

30 minutes before a meal

178
Q

Which su has active metabolites

A

glyburide

179
Q

SU metabolism and excretion

A

liver metabolism - renally excreted

180
Q

AEs of SUs

A

hypoglycemia
weight gain
hemolytic anemia (G6PD)

181
Q

SU monitoring

A

SCr, CrCl
SMBG
hypoglycemia
weight

182
Q

Max dose of glyburide

A

20 mg/day

183
Q

Max dose of glipizdide

A

40 mg/day

184
Q

max dose glyburide micronized

A

12 mg/day

185
Q

max dose glimiperide

A

8 mg/day

186
Q

repaglinide metabolism

A

3a4, 2c8 , oatp1b1

187
Q

nateglinide metabolism

A

2c9, 3a4

188
Q

which meglitinides have active metabolites

A

nateglinide

189
Q

CIs to repaglinide

A

gemfibrozil, trimethoprim

190
Q

AEs of meglitinides

A

hypoglycemia, weight gain

191
Q

drug interactions with repaglinide

A

gemfibrozil, ketoconazole, cyclosporine

192
Q

drug interactions with nateglinide

A

amiodarone, fluconazole

193
Q

monitoring for meglitinides

A

SMBG,
hypoglycemia
weight

194
Q

Do not use meglitinides with what other class

A

SUs

195
Q

Pioglitazone dosing

A

15-30 mg QD. max 45 mg QD

196
Q

Pioglitazone dosing in NYHA I or II heart failure

A

15 mg QD

197
Q

Pioglitazone max dose when taking gemfibrozil

A

15 mg QD

198
Q

CIs to pioglitazone

A

NYHA III or IV heart failure

199
Q

AEs to TZDs

A 
weight gain/fluid retention
HF exacerbations
risk of bladder cancer
risk of fracture in post menopausal women
Liver injury
Reduction in hgb/hct
Low risk of hypoglycemia
200
Q

monitoring for TZDs

A 
Liver function - baseline and periodically 
SMBG
Weight
s/s of heart failure
Bone health screening
201
Q

CV effects of TZDs

A

increased risk possible

202
Q

CIs for Alpha glucosidase inhibtitors

A

DKA, cirrhosis, intestinal diseases

203
Q

AEs for Alpha glucosidase inhibtitors

A

flatulence, bloating

low risk for hypoglycemia

204
Q

Monitoring for Alpha glucosidase inhibtitors

A

Liver function - baseline + periodically

SMBG

205
Q

When not to give acrabose

A

SCr 2+

206
Q

Which DPP4 inhibitor has active metabolites

A

saxagliptin

207
Q

sitagliptin dosing

A

100 mg QD

208
Q

dose adjustment for sitagliptin CrCl 30-50

A

50 mg QD

209
Q

dose adjustment for sitagliptin CrCl < 30

A

25 mg QD

210
Q

AEs of DPP4 inhibitors

A

weight neutral / possible loss
low risk hypoglycemia (except with SUs)
more peripheral edema with TZDs

211
Q

Monitoring for DPP4 inhibitors

A

renal function Q6-12 months

SMBG

212
Q

CV effects of DPP4 inhibitors

A

CV benefits

213
Q

AES of canaglifozin

A

volume depletion

vaginal fungal infections

214
Q

Dosing of canaglifozin

A

100 mg QD max 300 mg QD

215
Q

Exenatide dosing

A

5- 10 mcg subQ BID or 2 m SubQ QW

216
Q

Do not use Exenatide in what CrCl

A

< 30

217
Q

AEs of exenatide

A

weight loss,
hypoglycemia w/SUs
N/V
pancreatitis

218
Q

Monitoring for exenatide

A

Renal function Q6-12 months

SMBG

219
Q

Exenatide CV effects

A

may be favorable

220
Q

Bromocriptine dosing

A

0.8 mg within 2 hours of waking for 1 week, titrate to 1.6-4.8 mg QD

221
Q

CIs of bromocriptine

A

syncopal migraines

nursing women

222
Q

AEs of bromocriptine

A 
hypotension
syncope
somnolence
N/V
dyspepsia

Pnt Exam 1 (6 decks)

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