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Pharmacology - Final Exam > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the cause of type 1 DM?

A
  • absolute deficiency of insulin secretion*

- autoimmune destruction of beta cells d/t viruses

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2
Q

What is the cause of type 2 DM?

A

combination of:

  • insulin resistance
  • decline in beta cell secretion of insulin
  • increase of glucose levels regardless of stimuli
  • other hormonal deficiencies
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3
Q

What are the S&S of hyperglycemia?

A
  • 3 P’s (polyuria, polydipsia, polyphagia)

- fatigue

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4
Q

define polyuria

A
  • frequent urination
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5
Q

define polydipsia

A
  • inability to quench thirst
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6
Q

define polyphagia

A
  • loosing weight while eating a lot
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7
Q

What are the main risk factors of DM type 2?

A
  • overweight/obese

- sedentary lifestyle

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8
Q

How often can you test HbA1C?

A
  • q3mo
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9
Q

What are the tx goals for type 2 DM?

A
  • A1C less than 7
  • before meals 70-130mg/dL
  • after meals less than 180mg/dL
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10
Q

What patient population are the tx goals more strict for?

A
  • young
  • active
  • motivated
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11
Q

What is the tx for pre-diabetes?

A
  • metformin
  • diet
  • exercise
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12
Q

What are the microvascular complications of diabetes?

A
  • retinopathy
  • neuropathy
  • nephropathy
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13
Q

What are the macrovascular complications of diabetes?

A
  • CAD
  • HTN
  • dyslipidemia
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14
Q

How is CAD, as a complication of DM, tx’d?

A
  • ASA 81mg/d (baby aspirin)
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15
Q

What is the goal for HTN in DM?

A
  • 140/90
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16
Q

What is the tx for dyslipidemia 2ndary to DM?

A
  • statin
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17
Q

How are retinopathy & neuropathy, as complications of DM, tx’d?

A
  • manage HTN & glucose
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18
Q

What is the tx for peripheral diabetic neuropathy?

A
  • Gabapentin
  • Lyrica
  • Cymbalta
    (all are symptomatic tx, not DM txs)
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19
Q

What is the tx for autonomic diabetic neuropathy?

A
  • Reglan
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20
Q

What is the tx for diabetic nephropathy?

A
  • ACE-I or ARB

- manage HTN & glucose

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21
Q

What is the tx protocol for DM?

A
  1. metformin
  2. ADD sulfonylurea, TZD, DPP4 inhib, GLP1 ag, OR basal insulin
  3. ADD another 1 of the above
  4. ADD multiple doses of insulin
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22
Q

What are the oral diabetic agents?

A
  • biguanides
  • sulfonylureas
  • meglitinides
  • TZD
  • alpha glucosidase inhibitors
  • incretin mimetics (DPP4 inhib, GLP1 ag)
  • sodium glucose co-transporter (SGLT)
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23
Q

What is an example of biguanides?

A
  • Glucophage, Riomet, Glumetza (metformin)
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24
Q

What is metformin’s MOA?

A
  • inhibits hepatic glucose production

- increases insulin sensitivity to peripheral tissues

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25
Q

What is metformin’s place in therapy?

A
  • 1st line tx of DM
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26
Q

What is metformin’s A1C% reduction?

A
  • > 2%
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27
Q

What is the dose of metformin?

A
  • 1000mg BID
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28
Q

What are the side effects of metformin?

A
  • GI (diarrhea) so take with meals
  • lactic acidosis
  • Vit B12 deficiency after tx for 2-3yrs
  • wt loss
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29
Q

What is an absolute CI of metformin?

A
  • creatinine levels (>1.4w, >1.5m)
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30
Q

What is an example of sulfonylureas?

A

2nd gen

  • Amaryl (glimepiride)
  • Glucotrol (glipizide)
  • Micronase (glyburide)
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31
Q

What is the MOA of sulfonylureas?

A
  • increases insulin production from pancreatic beta cells
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32
Q

How are sulfonylureas used in DM therapy?

A
  • monotherapy
    OR
  • conjunction with basal insulin or other oral agents
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33
Q

T/F: Over time, patients on sulfonylureas & meglitindes will loose beta cel function and become DM type I.

A
  • True, after ~3-5y
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34
Q

What is the A1C % reduction of sulfonylureas?

A
  • 1-2%
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35
Q

Patient has renal insufficiency, what sulfonylurea will you use?

A
  • glipizide

no Renal, no R

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36
Q

What are the side effects of sulfonylureas?

A
  • hypoglycemia

- wt gain

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37
Q

What is a precaution for sulfonylureas?

A
  • sulfa allergy
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38
Q

What are examples of meglitinides?

A
  • Starlix (nateglinide)

- Prandin (repaglinide)

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39
Q

What is the MOA of meglitinides?

A
  • increases insulin production from pancreatic beta cells

similar to sulfonylureas

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40
Q

What is the use of meglitinides in therapy?

A
  • monotherapy
    OR
  • conjunction with oral agents
    (similar to sulfonylureas
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41
Q

What is the A1C% reduction or meglitinides?

A
  • 0.5-2%
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42
Q

T/F: Meglitinides have a longer half life than sulfonylureas?

A
  • false
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43
Q

What are the benefits of meglitinides?

A
  • side effects = less hypoglycemia & less wt gain than sulfonylureas
  • works closer to the meal
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44
Q

What are examples of TZDs?

A
  • Avandia (rosiglitizone)

- Actos (pioglitizone)

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45
Q

What is the MOA of TZDs?

A
  • potent peroxisome proliferator-activated receptor-gamma (PPAR) agonist
  • increases insulin-dependent glucose disposal & decreases hepatic glucose output by decreasing insulin resistance in the periphery and liver
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46
Q

What is the use of TZDs in therapy?

A
  • monotherapy
    OR
  • conjunction with other oral agents or insulin
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47
Q

What is a TZDs A1C% reduction?

A
  • 0.5-1%
48
Q

What are the side effects of TZDs?

A
  • MAJOR DROWSINESS
  • wt gain
  • edema
  • increased ovulation
  • hepatic dysfxn
49
Q

What is a contraindication of TZD?

A
  • stage 3 or 4 heart failure (increases edema, side effect)
50
Q

What are precautions of TZDs?

A
  • active liver disease with ALT >2.5x normal

- monitor LFTs

51
Q

What are examples of alpha glucosidase inhibitors?

A
  • Glyset (miglitol)

- Precose (acarbose)

52
Q

What is the MOA of alpha glucosidase inhibitors?

A
  • inhibits the enzyme that hydrolyzes complex carbs
53
Q

What is the place of alpha glucosidase inhibitors in therapy?

A
  • monotherapy
    OR
  • conjunction with other oral agents
    (especially high postprandial glucose values)
54
Q

What is the A1C% reduction of alpha glucosidase inhibitors?

A
  • 0.5-1%
55
Q

What are the SE of alpha glucosidase inhibitors?

A
  • GI!!! (flatulence, diarrhea)

- tx hypoglycemia with simple sugars

56
Q

What are examples of DPP4 inhibitors?

A
  • Januvia (sitagliptin)
  • Onglyza (saxaglibtin)
  • Tradjenta (linagliptin)
  • Nesina (alogliptin)
57
Q

What is the MOA of DPP4 inhibitors?

A
  • block DPP4

stops inactivation of GLP1 which allows lowering of blood glucose

58
Q

What is DPP4’s normal action?

A
  • inactivates GLP1, prevents lowering of blood glucose
59
Q

What is DPP4 inhibitors place in therapy?

A
  • type 2 DM

- in addition with other oral agents

60
Q

What is the A1C% reduction of DPP4 inhibitors?

A

-0.4-0.85%

61
Q

T/F: All DPP4 inhibitors need renal dose adjustments.

A
  • False, all EXCEPT LINAGLIPTIN
62
Q

What are the SE of DPP4 inhibitors?

A
  • H/A
  • URI
  • wt loss/neutral
63
Q

What are examples of GLP1 analogs?

A
  • Byetta (exenatide)
  • Victoza (liraglutide)
  • Tanzeum (albiglutide)
  • Trulicity (dulaglutide)
64
Q

What is the MOA of GLP1 analogs?

A
  • just different enough that DPP4 cannot break it down
65
Q

What is the use of GLP1 analogs in therapy?

A
  • 2nd line behind metformin

- good for patients that need to loose wt

66
Q

What is the A1C% reduction of GLP1 analogs?

A
  • 1-1.6%
67
Q

Which GLP1s need and do not need renal dose adjustments?

A
  • liraglutide = not studied
  • exenatide = needs renal dose adjustment
  • albiglutide, dulaglutide = does not need renal dose adjustment
68
Q

What are the SE of GLP1 analogs?

A
  • feeling full, nauseas, bloated
  • no hypoglycemia
  • wt loss
69
Q

What are the black box warnings for GLP1 analogs?

A
  • thyroid CA

- pancreatitis

70
Q

What are the examples of SGLTs?

A
  • Invokana (canagliflozin)
  • Farxigan (dapagliflozin)
  • Jardiance (empagliflozin)
71
Q

What is the A1C% reduction of SGLT?

A
  • 1%
72
Q

T/F: SGLTs require renal dose adjustments

A
  • true
73
Q

What are the SEs of SGLTs?

A
  • wt loss
  • modestly lowers BP
  • polyuria
  • thirst
  • nasopharengitis
  • UTIs
  • genital infx
74
Q

Describe insulin

A
  • regulator of glucose metabolism
  • released from pancreatic beta cells in response to hyperglycemia
  • inhibits hepatic glucose production
  • facilitates glucose transport into cells
  • stimulates glucose storage
75
Q

What are the two categories of insulin on the market?

A
  • prandial (with meals)

- basal (continued longer acting insulin)

76
Q

What are the rapid acting insulins?

A

no LAG time

  • Humalog (lispro)
  • Novolog (aspart)
  • Apidra (glulisine)
77
Q

What are the long acting insulins?

A
  • Lantus (glargine)

- Levamir (dentimir)

78
Q

What type of insulin is used as bolus?

A
  • rapid & short
79
Q

What type of insulin is used as basal?

A
  • intermediate & long
80
Q

What are the pros of rapid acting insulin?

A
  • better glucose control
  • less frequent hypoglycemia
  • convenient (can injx postprandial)
81
Q

What are the pros of short acting insulin?

A
  • no Rx needed
  • inexpensive
  • can tx DKA
  • provides some basal activity
82
Q

What are the cons of rapid acting insulin?

A
  • $$$$$

- given prior to high fat meal, increases risk of early post-prandial hypoglycemia

83
Q

What are the cons of short acting insulin?

A
  • absorbed too slowly
  • injx 30-45min prior to eating
  • prolonged duration of action = late postprandial hypoglycemia
84
Q

Discuss NPH

A
  • causes peaks therefore must eat consistently

- can be mixed with other insulins to decrease # of injxs

85
Q

Discuss glargine

A
  • most used
  • no peak = less hypoglycemia
  • CANNOT be mixed with other insulins
86
Q

Compare duration of action of detemir with NPH and glargine

A
  • longer than NPH but shorter than glargine
87
Q

Who should be on combination insulin injections?

A
  • noncompliant pts

- pts that have fixed dosing schedules

88
Q

What is U-500?

A
  • 5x strength of all other insulins
89
Q

Who should use U-500?

A
  • type II DM whose total daily dose of insulin > 200units
90
Q

What is the inhaled insulin?

A
  • Afrezza (rapid acting)
91
Q

What is the CI of inhaled insulin?

A
  • pts w/ chronic lung dz or smoker in last 6mo
92
Q

When is inhaled insulin dosed?

A
  • beginning of meal
93
Q

What is the starting dose of insulin for DM type 1?

A
  • (0.3 to) 0.5 units/kg/d
  • divide dose by 2 to determine prandial & basal doses
  • tirate PRN
94
Q

Discuss insulin schedule for type 2 DM

A
  • consider when HbA1c >8%

- start with basal, titrate, add prandial PRN

95
Q

What is the starting dose of insulin for DM type 2?

A
  • 10 units intermediate/long

- increase by 1 unit per day until preprandial goal = 80-130mg/dL

96
Q

What is the dose of starting prandial insulin for type 2 DM?

A
  • 4 units w/ largest meal & add insulin to other 2 meals PRN
97
Q

What is the 1700 Rule?

A
  • general starting point for someone new to insulin

- 1 unit for every 50 units above goal

98
Q

What is the calculation for the 1700 Rule?

A
  • (1700/total daily dose) = amt of glucose that will be reduced by 1 unit of insulin
  • 1 unit of insulin will lower the glucose level by (1700/total daily dose)
99
Q

What is the 450 Rule?

A
  • (450/total daily dose) = grams CHO covered by 1 unit insulin
  • 1 unit of insulin will cover (450/total daily dose) grams of CHO
100
Q

If the patient is on insulin, they should still be on ______ unless ????

A
  • metformin

- metformin was contraindicated or not tolerated

101
Q

If a pt is taking _____ they can continue this while on _____ _____ howerver, ?????

A
  • sulfonylurea
  • basal insulin
  • it might be stopped if prandial insulin is started
102
Q

Why would a patient on only basal insulin also be given GLP1s?

A
  • especially if they need to loose weight
103
Q

What else can be added to insulin regimen?-

A
  • DPP4 inhibitor

- SGLTs

104
Q

Why might a type 2 DM require higher doses of insulin than a type 1?

A
  • insulin resistance
105
Q

What is the tx for Somogi effect?

A
  • reduce night insulin
106
Q

What is the Somogyi effect?

A
  • early am hypoglycemia followed by rebound hyperglycemia
107
Q

What is the Dawn phenomenon?

A
  • relative resistance to insulin in early am
108
Q

What are diabetics supposed to do on sick days?

A
  • continue insulin

- may require more since body is so stressed

109
Q

How is hypoglycemia tx’d?

A
  • Rule of 15
110
Q

What is the Rule of 15?

A
  • 15g sugar will raise your blood sugar by 15 points in 15 mins
111
Q

What are the side effects of insulin?

A
  • hypoglycemia
  • wt gain
  • injx site rxns
112
Q

How do you store insulin?

A
  • refrigerate unopened pens or vials

- room temp opened pens or vials

113
Q

How do you mix insulin?

A
  • clear before cloudy
114
Q

What insulin cannot be mixed with anything?

A
  • glargine
115
Q

Diagnostic criteria of HbA1C

A
  • normal: less than 5.7
  • prediabetes: 5.7-6.4
  • diabetes: over 6.5
116
Q

Diagnostic criteria of FPG

A
  • normal: less than 100mg/dL
  • prediabetes: 100-125mg/dL
  • diabetes: over 126mg/dL
117
Q

Diagnostic criteria of OGTT

A
  • normal: less than 140mg/dL
  • prediabetes: 140-199mg/dL
  • diabetes: over 200mg/dL

Pharmacology - Final Exam (4 decks)

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