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Pharmacy > Diabetes > Flashcards

Diabetes Flashcards

0
Q

Sulfonylureas (secretagogues)

A

Increase insulin production by pancreas. Bind to Katp channel, Inhibit K efflux, depolarize, increase Ca, increase insulin release

glipizide (take on empty stomach), glimepiride, glyburide (not recommended cardio MI)

Contraindicated in liver/renal impairment

Weight gain, hypoglycemia

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1
Q

Alpha glucosidase (amylase) inhibitors

A

Slow starch and disaccharide absorption in the gut
Lower post-prandial peak

Acarbose, Glyset

If hypoglycemic give simple sugar (glucose/galactose)

Adverse: flatulence

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2
Q

Meglitinides

A

Bind to SUR1.More potent release of insulin from pancreas. Insulin suppresses hepatic glucose production

Nateglinide, repaglinide

May cause weight gain, hypoglycemia

Flexible, skip dose if skipped meal

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3
Q

Biguanide

Decrease all cause mortality, MI

A

Decrease glucose production in liver
Increase peripheral glucose uptake (Glut4) and activate AMPK (inhibit PEPCK glucose formation) decrease conversion of lactate to pyruvate

Increase fatty acid oxidation, less fatty liver, increase hepatic insulin sensitivity

Decrease intestinal glucose absorption

Metformin, take with largest meal
Weight loss, improves lipid profile
Adverse: diarrhea, VitB12 deficiency, lactic acidosis avoid: SCr >1.5
Cleared renally

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4
Q

Thiazolidinediones (TZD)

A

Increase uptake of sugar by muscle and fat cells (adipocytes)

PPARy ligands, increase adiponectin (good for insulin sensitivity)

Pioglitazone, rosiglitazone (more toxic on lipid profile)

Cause weight gain (adipose PPARy triglyceride synthesis from glucose)
And fluid retention (kidney PPARy), edema CHF, bone fracture

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5
Q

Proinsulin

A

Endogenous

Has C-peptide

T1DM lacks proinsulin

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6
Q

Type 1 DM

A

No insulin to bind to receptor and stimulate glucose uptake or conversion into fatty acids

Goal preprandial 110
2 hour post prandial 140

Requires multiple insulin injections and

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7
Q

Type 2 DM

Risk >45 African Latino Asian

A

Skeletal muscle and adipose tissue become insulin resistant

Decreased signaling capacity for the insulin receptor. Glut transporter 4 levels decrease

Not a CHD risk equivalent

Can have single insulin injection w/oral

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8
Q

Insulin

Benefit of early addition

A

Inhibit PEPCK (rate limiting enzyme)

Bind to insulin receptor, glut4 transporter, glucose into glycogen, pyruvate, fatty acid

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9
Q

Humalog

A

Reverses Lys and Pro (lispro)
Rapid acting

15 min before or at meal

Use rapid acting in insulin pump

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10
Q

Novolog

A

Insulin aspart

Proline to aspartic acid

Rapid acting

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11
Q

Apidra

A

insulin glulisine

Glutamic acid to lysine

Rapid acting

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12
Q

Short acting insulin

A

Novolin R, Humulin R

IV insulin Recombinant direct hexamer to monomer (no dimer) faster absorption

Effect appears in 30 min
More weight gain, more glycemic highs and lows

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13
Q

Intermediate acting

A

NPH Novolin N
NPH Humulin N

Effect appears in 2 hours

Less doses BID

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14
Q

Long acting

A

Insulin glargine (lantus) - precipitates at neutral pH. Glycine to asparagine

Insulin detemir (Levemir)

Long duration, designed to be peakless
Less weight gain

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15
Q

Incretins/GLP-1

Pen formulations

A

Stimulate release of insulin during a meal before glucose levels rise

Exanatide (Byetta)

Potentiate glucose-mediated insulin secretion
Suppress postprandial glucagon release
Slow gastric emptying

Cause weight loss

Avoid if CrCl <30

16
Q

DPP4 inhibitor

A

DPP4 enzyme inactivates GLP-1

Inhibit DPP4

Sitagliptan (Januvia)

No weight gain
May increase heart failure

Do not combo w/ GLP

17
Q

HgbA1C < 9%

A

Metformin & lifestyle

Metformin lowers 2% A1C at best

Caution alcohol lowers blood sugar

18
Q

HgbA1C 9-10%

A

Metformin + 2nd agent

Sulphonylurea, TZD, DPP4inhibitor, GLP-1

19
Q

HgbA1C >10%

A

Metformin & insulin

Scr > 1.5 give insulin

20
Q

Sodium glucose transporter 2 inhibitor

A

Inhibit glucose reabsorption in proximal tubule and let glucose be released in the urine

Canigliflozin, dapagliflozin

Weight loss, lowers BP

Need GFR>60

Chronic urinary glucose excretion is benign

21
Q

Statin

A

Proves beneficial, regardless of LDL goal target, 30% change is ideal

High Beneficial if prior stroke (ASCVD)
40-75 w/diabetes
LDL >190
40-75 w/ASCVD risk >7.5%

High intensity: ator 80, rosu 20 for overt CVD

Caution myopathy in elderly >75
Can supplement VitD

22
Q

Blood pressure

A

Target is < 140/80

Target 120/80 long term renal disease

23
Q

Persistent albuminuria >30mg/day

Protein spills in urine

A

Initiate thiazides, ACE, ARB, or CCB

Thiazides, CCBs first line in blacks

Don’t combine ACE and ARB

Beta blockers are not first line anti hypertensive therapy

24
Q

Weight loss

A

Decrease adipocytes, increase adiponectin, increase insulin sensitivity

25
Q

Brain function

A

Blood glucose >40mg/dL

26
Q

Blood glucose monitoring

A

Check glucose 2 hours after injecting

27
Q

Insulin injections

Use within 28 days

Syringe requires dexterity
Pens are easier, more expensive

A

Rotate injection site
Inject to fat vs. muscle (faster uptake)
Abdomen>arm>thigh>

0.5 U/kg/day
1/2 basal (glargine)
1/2 / 3 at each meal (lispro)

28
Q

A1C to mg/dL

A

130mg/dL=6%
30mg/dL=1%

Goal <8% if vascular complications
General 7%, recently diagnosed

Reduce microvascular, MI
Every 1% increase increases CVD 18%

29
Q

Mixed insulin

A

Higher % is NPH
Lower % is short-acting

Clear before cloudy (NPH)
Never mix long acting

30
Q

SMBG

A

Rapid: 2hours post prandial
Short: before next meal or bed snack
NPH: 12 hours after
Long acting: before breakfast

31
Q

Insulin pump

A

Good for those with dawn rise BG
Recurrent hypoglycemia
Lifestyle, busy

Needs to monitor BG QID

32
Q

Hypoglycemia

A

BG <70mg/dL

Shaky, sweating, hunger

15g carb, 15 min check

Glucagon if patient uncooperative or unconscious

33
Q

Diabetic Keto Acidosis

T1 and T2DM

A

INSULIN constant infusion
Potassium supplement
IV fluids

34
Q

Hyperosmolar hyperglycemic state

HHS or HONK no ketones

A

Mostly older T2DM

Hypotonic fluids and low-dose insulin

35
Q

Somogyi

A

Rebound hyperglycemia at night

Decrease NPH dose at bedtime

36
Q

ISensitivityF ICarbRatio

A

ISF = 1700/ total daily insulin doses

1 unit / mg/dL

ICR= ISFx0.33

Pharmacy (63 decks)

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