Diabetes Flashcards
What is the blood sugar goal for fasting in pregnancy for diabetes?
What should be started in Urinary albumin excretion >30mg/24 hours or urine albumin to creatinine ratio >30.
What drugs raised blood glucose?
<95.
ACEI or ARB.
Beta blockers, Diuretics(thiazides/loop), immunosuppresants, niacin, protease inhibitors, quinolones, second-generation antipsychotics, statins, systemic steroids.
Which drugs increase or replace insulin secretion?
Which drugs decrease glucose output?
Which drugs decrease glucagon which decreases glucose production?
Insulin, SUs, Meglitinides
Metformin
GLP-1 agonists, DPP-4 inhibitors, Pramlinitide
Which drugs slow gastric emptying(increase satiety)?
Which drugs increase glucose excretion?
Which drugs increases insulin sensitivity?
GLP-1 agonists, Pramlinitide
SGLT2 inhibitors
TZDs and metformin
What is glucovance?
What is Janumet?
What is Metformins brand names and BBW and can the ER formulation leave a ghost tablet?
Metformin/Glyburide
Metformin/sitagliptin
Glucophage, Fortamet, Glumetza. Give with a meal. ER formulations can leave a ghost tablet. BBW of lactic acidosis(increased with hypoxic states), renal impairment, intravascular iodinated contrast
What are metformin’s CI, warning, side effects, notes, monitoring?
What are metformins drug interactions?
What to know about the meglitinides?
CI’d in eGFR <30 or chronic metabolic acidosis. Not recommended to initiate in 30-45 and vitamin B 12 deficiency. N/V/D, flatulence, abdominal cramping, renal function monitoring, Drops A1C 1-2%.
increase lactic acidosis, iodinated contrast can increase lactic, restart 48 hours after procedure if eGFR stable. Take with food, might see ghost shell.
ends in glinide. Take Repaglinide 15-30 minutes before a meal and Nateglinide 1-30 minutes before a meal. Hypoglycemia and weight gain warning.
What are the sulfonylureas and brand names?
What are the CI’s and warnings and notes for the sulfonylureas?
What is your TZD and how does it work?
Glipizide(Glucotrol), Glimepiride(Amaryl), Glyburide(micronized is Glynase).
CI’d in sulfa allergy, Hypoglycemia, Weight gain, nausea, Glipizide IR taken 30 minutes before a meal all other products take with breakfast, hold doses if NPO. Glucotrol is an OROS formulation and can leave a ghost tablet, Glyburide renally cleared, not a preferred drug in renal insufficiency. Drops A1C 2%. Never use Sulfonylureas and meglitinides together. Sulfonylureas begin with G and end in Ide.
Pioglitazone(Actos), PPARy agonist increase peripheral insulin sensitivity. Names end in glitazone.
What are the TZD’s BBW, side effects, warnings, etc.?
What are your SGLT2’s and how do you remember them and how do they work?
What are your SGLT2’s BBW, side effects, warnings, etc?
Rosiglitazone BBW increased risk of MI. All CI’d in NYHA class 3/4 HF, watch for hepatic failure, edema(including macular edema), risk of fractures, urinary bladder tumors; do not use in patients with active bladder cancer, peripheral edema, weight gain, LFT’s , s/sx of heart failure.
reduce absorption of glucose and increase urinary glucose excretion. Canagliflozin(Invokana), Empagliflozin(Jardiance). Jardiance also approved to reduce risk of cardiovascular mortality in type 2 diabetes and ASCVD. All end in flozin.
BBW for canagliflozin(invokana) is increased risk of leg and foot amputation. CI’d in <30 eGFR. Watch for Ketoacidosis, genital mycotic infections, urinary tract infections, hypotension and acute kidney injury due to volume depletion, Canagliflorzin(hyperkalemia), weight loss, increased urination and thirst, monitor renal function
What to know about DPP-4 inhibitors and names?
What to know about Alpha-glucosidase inhibitors?
What to know about Bromocriptine?
end in gliptin. Sitagliptin(Januvia), Linagliptin(Tradjenta). Increase insulin release by breaking down incretin hormones and decrease glucagon secretion. No renal dose adjustment in Tradjenta. Watch for acute pancreatitis, arthralgia, risk of heart failure, saxagliptin and alogliptin.
Acarbose and Miglitol. Hypoglycemia, need to purchase actual glucose tablets or gel if hypoglycemia caused by combination product because of sucrose blockage. Each dose should be taken with the first bite of each meal, watch for flatulence, diarrhea, abdominal pain.
Don’t use with other dopamine agonists.
What to know about GLP-1 inhibitors, names, BBW?
What to know about GLP-1’s?
What pen do you start in with Adlyxin?
Increase glucose secretion(look like incretin), decrease glucagon secretion,End in tide. All except byetta and adlyxin have BBW of risk of thyroid c-cell carcinomas. Byetta and Bydureon not recommended in CrCl <30 mL/min. Byetta is BID and Bydureon is weekly.Liraglutide(Victoza), Saxenda(for weight loss), Dulaglutide(trulicity)
Liraglutide is daily, dulaglutide, lixisenatide(weekly), semaglutide is weekly. Pancreatitis, not recommended in patients with severe GI disease, including gastroparesis. Nausea(primary side effect), weight loss, Byetta and Adlyxin(within 60 minutes of meal), Pen needles are not provided. Liraglutide has cardiac benefits.
Green pen, starter pack has 2 different colored pens.
What to know about Pramlinitide?
What are your rapid acting insulins?
What is Afrezza?
analog of amylin, slowing gastric emptying and suppressing glucagon. BBW of severe hypoglycemia, watch for gastroparesis, hypoglycemia(reduce mealtime insulin by 50%), N/V, anorexia, headache, weight loss. Administered prior to each major meal and can use in type 1 and 2.
Aspart(novolog), lispro(humalog). Give up to 15 minutes before meals. CI’d for use in acute hypoglycemia, watch for hypoglycemia and hypokalemia,shifts K, weight gain and lipodystrophy. HumaLOG kwikpen also comes in 200 units/mL.
Oral inhalation powder, replace inhaler every 15 days, inhale at the beginning of meals, BBW of acute bronchospasm, asthma or COPD plus other meal time insulin stuff, CI’d in asthma and COPD, FEV1 monitor and not recommended in people who smoke.
What are your regular insulins?
What’s your intermediate-acting insulin?
What are your long acting insulins?
Humulin R. Insulin of choice for IV including TPN, available without a prescription. Humulin-r 500 5 times as concentrated(when you need >200 units per day its good), do not mix with other insulins, no doses conversions. Do not use any other type of syringe besides a U-500 insulin syringe.
NPH insulin(Humulin N). Cloudy, without prescription, can mix with rapid or short-acting insulins, CLEAR before CLOUDY.
Determir(levemir), Glargine(Lantus, Toujeo). Do not mix with other insulins. Toujeo comes in 300 units/mL.
What are your premixed insulins?
What’s your TDD of insulin equation?
What is your rule of 500 for rapid and rule of 450 for regular?
NPH and protamine insulins are cloudy, without a prescription, percentage of each component with basal first.
0.6 units/kg/day based on total body weight. Divided in half basal half bolus.
Carb ratio, 500/TDD = grams of carb covered by 1 unit of rapid. 400/TDD is grams of carb covered by 1 regular.
What’s your normal gauge size?
What drugs can lower blood glucose?
Which diabetic drugs have the biggest drop in A1C?
28-32G with the higher the thinner. Common brands are BD.
Linezolid, Lorcaserin(Belviq), Pentamidine, Beta blockers, quinolones.
Insulin, metformin, sulfonylureas, TZD’s, GLP-1 agonists.
Which drugs have the greatest hypoglycemia risk?
Which drugs cause weight gain?
Which cause weight loss?
Insulin, sulfonylureas, pramlinitide
Insulin, sulfonylureas, meglitnides, TZD’s.
SGLT2 inhibitors, GLP-1 agonists
