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diabetes Flashcards

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1
Q

Metformin’s effect on weight

A

weight loss 2-5kg

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2
Q

Metformin’s effect on Hgb H1ac

A

decrease 1.5 to 2.6 %

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3
Q

Metformin’s effect on women

A

pcos treatment

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4
Q

Metformin’s effect on TG

A

decrease by 16%

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5
Q

Metformins effect on lipid level

A

lower by 8%

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6
Q

Metformins effect on HDL and total cholesterol

A

increase HDL by 2% and increase total cholesterol by 5%

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7
Q

Metformins effect on fibrinolysis, inflammatory marker, endothelial function

A

improvement

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8
Q

what is metformin’s drug class?

A

biguanides

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9
Q

what is the role of metformin

A

insulin sensitizer

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10
Q

metformin peak level

A

1-3hr

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11
Q

metformin half life

A

5hrs

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12
Q

metformin metabolism site

A

liver and kidneys

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13
Q

metformin preparations

A

500, 750, 850, 1000mg

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14
Q

metformin maximum daily dosage

A

2000mg

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15
Q

metformin adverse effect:

A

GI side effect and anorexia

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16
Q

when do you eat metformin?

A

after meals

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17
Q

Clinical use of metformin

A

diet failed DM2 especially in overweight, failure to meet treatment goals in SU, IGT, PCOS.

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18
Q

how is metformin used with other drugs or solo?

A

monotherapy or combo with SU, glinides, AGIs, glitazones, and insulins

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19
Q

Metformin contraindication in women

A

pregnancy and breastfeeding

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20
Q

metformin renal dysfunction

A

creatinine >1.5mg/dl (males), >1.4mg/dl(females)

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21
Q

metformin liver dysfunction

A

hepatic dyfunction = lactate metabolism

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22
Q

metformin electrolyte problem

A

acute or chronic lactic acidosis

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23
Q

metformin lifestyle contra

A

hx of alcoholism

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24
Q

metformin no nos

A

any condition with renal dysfunction or hypoxic conditions (cvd, severe infection, use iodinated contrast, trauma, major operation)

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25
Q

metformin additional iotragenic problem

A

hold metformin: prevent contrast induced nephropathy

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26
Q

increase insulin secretion regardless of blood glucose level.

A

sulfonylureas and meglinitides

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27
Q

sulfonylurea and meglinitides side effect

A

hypoglycemia, stimulate appetite weight gain, nausea, fullness, heartburn. Rash, swelling

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28
Q

contraindication of sulfonylurea and meglinitides

A

type 1 dm, pregnancy, breast feeding

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29
Q

stimulating insulin secretion by the pancreat beta cells

A

sulfonylureas

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30
Q

A1c effect

A

reduction 1-2%

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31
Q

sulfonylurea treatment method

A

monotherapy or in combo with others

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32
Q

sulfony urea is unaffected by food except

A

glipizide

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33
Q

metabolized in urine

A

chlorpropamide

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34
Q

metabolized in biliary

A

glipzide

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35
Q

adverse effect on SU

A

hypoglycemia and weight gain

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36
Q

blood effect on Su

A

agranulocytosis, thrombocytopenia, BM aplasia, RBC aplasia, hemolytic anemia

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37
Q

skin effect on Su

A

rashes, pruritis, erythema nodosum, erythema multiforme, Steven Johnson syndrome, exfoliative dermatitis, purpura photosensitivity

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38
Q

GIT effect on Su

A

N/V, heartburn

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39
Q

Liver effect on Su

A

abnormal function test, jaundice, cholestasis, granulomatous hepatitis

40
Q

Good candidate for SU treatment

A

Recently dx DM2, mild to moderate fasting hyperglycemia (

41
Q

Bad candidate for SU treatment

A

type 1 dm, pregnancy, breast feeding, Major surgery (NPO), severe infection, stress, trauma (prone to hypoglycemia), severe adverse reaction, Liver or kidney disease (delayed clearance)

42
Q

works similar to sulfonylurea but with a more rapid onset and shorter duration of action

A

Meglitinides

43
Q

Insulin effect on Meglitinide

A

Insulin secretion is stimulated to a greater extent immediately after administration

44
Q

When is good time to take it

A

before meals

45
Q

improves insulin sensitivity in muscle, adipose tissue and liver, reduce glucose output from liver, change fat distribution by decreasing visceral fat and increasing peripheral fat

A

thiazolidinediones

46
Q

Side effects of Thiazo

A

weight gain, fluid retention, headache, decrease hemoglobin, fracture in women, bladder Ca in men

47
Q

contraindication of thiazo

A

liver disease, heart failure or history of heart disease, pregnancy and breast feeding

48
Q

when is it not contraindicated

A

renal insufficiency

49
Q

possible advantage of thiazo

A

potential benefits of pioglitazone, reduce levels of LDL-C, increase levels of HDL-C

50
Q

Thiazo actions depends on?

A

presence of endogenous or exogenous insulin and insulin resistance

51
Q

Thiazo effect on HbA1c

A

decrease 0.5 to 1.3%

52
Q

dosing frequency of Thiazo

A

once or twice daily

53
Q

metabolism site of TZD-Pio

A

liver and kidneys

54
Q

adverse effect of TZD

A

weight gain, edema, dilutional anemia

55
Q

contraindicated of TZD

A

congenital heart failure

56
Q

adverse effect on plasma

A

plasma volume expansion: reduction in hemoglobin, hematocrit, neutrophil count

57
Q

what NYHA class to be avoided by tzd

A

class 3 and class 4

58
Q

Pioglitazone names

A

actos, prialta, piozone, glucozone, glitaz, PPAR, zolid

59
Q

slow digestion of sucrose and starch and delays absorption. Slow post meal rise of blood glucose

A

alpha glucosidase inhibitor

60
Q

must to do list for alpha glucosidase inhibitor

A

must be taken just before a meal or within first bite wtf

61
Q

what other drugs will cause hypoglycemia if alpha glucosidase inhibitor is used

A

sulphonylurea- so as remedy use glucose

62
Q

contraindication of alpha glucosidase inhibitor

A

intestinal disease -Crohn’s, autonomic neuropathy affecting the gastrointestinal tract

63
Q

side effect of alpha glucosidase inhibitor

A

flatulence, ab discomfort, diarrhea, NO hypoglycemia used as monotherapy

64
Q

inhibits pancreatic alpha amylases that hydrolyzes complex starches to oligosaccharides in the lumen of small intestines, reduces the rate of digestion and subsequent delayed intestinal absorption glucose

A

alpha glucosidase inhibitor

65
Q

Starch blocker

A

alpha glucosidase inhibitor

66
Q

another name for alpha glucosidase inhibitor

A

acarbose

67
Q

GI absorption of acarbose is

A

very minimal and metabolism happens in intestinal bacteria and digestive enzymes

68
Q

maximum dose of alpha glucosidase inhibitor or acarbose

A

100mg TID

69
Q

GLP 1 another name is

A

Incretin Mimetic Agent

70
Q

action of GLP 1

A

improve responsiveness of beta cell to increase glucose levels, decrease glucagon secretion, slow gastric emptying

71
Q

side effect of GLP 1

A

nausea, weight loss, diahrrea, risk of hypoglycemia when used with sulphonylurea

72
Q

contraindication of GLP1

A

end stage kidney disease or renal impairment, pregnancy, severe GI disease

73
Q

how is GLP1 administered

A

must be injected subcutaneously once or twice a day depending on medication before meals. Results in a feeling of fullness before a meal

74
Q

GUT derived factor that increase glucose stimulating insulin secretion

A

Incretin Mimetic Agent

75
Q

2 incretin molecules

A

glucagon like peptide 1(GLP 1) and Gastric Inhibitory Peptide or glucose dependent insulinotropic peptide (GIP)

76
Q

increatin molecule is inactivated y

A

both molecule rapidly inactivated by enzyme Dipeptidyl Peptidase 4 (DDP 4)

77
Q

what lymphocyte cell surface protein of DDP 4

A

CD 26

78
Q

DDP4 role on GLP1

A

DPP4 rapidly inactivates GLP1

79
Q

Inhibition of DPP4 enhances what

A

activity of GLP 1 and other bioactive peptides (GIP, GRP)

80
Q

This inibition of DPP4 creates what

A

Stimulates release of insulin, reduces secretion of glucagon

81
Q

two types of incretin modulator

A

incretin mimetics (GLP 1 analogs) and incretin enhancers (DPP 4 inhibitors)

82
Q

GLP1 actions and location

A

stimulates insulin release from beta cells and may increase beta cells mass/regeneration in ileum and colon

83
Q

GIP action

A

releases from K cells in duodenum

84
Q

medication in combo examples

A

Su + metformin, pioglitazone + metformin, DPP 4 inhibitor + metformin, SU + pioglitazone

85
Q

examples of sodium glucose transport (SGLT 2) inhibitors

A

Canagliflozin (Invokana), Sergliflozin, Remogliflozin, Dapagliflozin (Forxica)

86
Q

Insulin secretagogues MOA and location

A

increase insulin production in pancreas

87
Q

biguanides MOA and location

A

reduce glucose production in liver and cell evel

88
Q

thiazolidinediones MOA and location

A

reduce insulin resistance in cell level and liver

89
Q

alpha glucosidase inhibitor MOA and location

A

slow absorption of sucrose and starch in GIT

90
Q

GLP 1 (incretin) MOA and location

A

increase response of beta cells to circulating glucose levels in pancrease and brain

91
Q

DPP4 inhibitors MOA

A

increase effects of incretin

92
Q

action of Colesevelam

A

bile acid sequestrant

93
Q

indication of colesevelam

A

adjunt to diet and exercise to reduce elevated low density lipoprotein cholesterol (LDL-C) in patient with primary hyperlipidemia and to improve glycemic control in adults with T2DM

94
Q

action of pramlintide

A

analogue of amylin, small peptide hormones that is released into bloodstream by beta cells of pancreas along with insulin. Like insulin, amylin is completely absent in individuals with type 1 dm

95
Q

effect of pramilintide

A

by augmenting endogenous amylin, pramlintide aids in the absorption of glucose by slowing gastric emptying, promoting satiety via hypothalamic receptors (different receptors than GLP 1) and inhibiting inappropriate secretion of glucagon, a catabolic hormone that opposes the effects of insulin and amylin. Also has effects in raising the acute first phase insulin response threshold following a meal

Dermatology pearls (4 decks)

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