DIABETES Flashcards
What vaccines should diabetes patients get?
What are the adult treatment goals?
What drugs raise blood sugar?
Annual influenza, both pneumococcal and hep b.
A1C <7%, Preprandial 80-130, Postprandial <180.
Beta blockers, diuretics, immunosuppresants, Niacin, Protease inhibitors, Quinolones, Second generation(atypical) antipsychotics, statins, systemic steroids.
What is metformin’s MOA and drug names?
What are metformins dosing and safety concerns?
What are the counseling points with metformin?
First line treatment, decreases hepatic glucose production. Glucophage, Fortamet, Glumetza.
Take with a meal, ER formulations will leave a ghost tablet. BBW of lactic acidosis with hypoxic states, renal impairment, IV contrast media. CI’d in eGFR <30, metabolic acidosis, Not recommended in 30-45 eGFR, Vitamin B12 deficiency. Watch for N/V/D, flatulence, abdominal cramping, renal function. Lowers A1C 1-2%.
Don’t drink alcohol due to lactic acidosis, take with food, discontinue metformin before an IV contrast media thing and restart 48 hours after.
What are the insulin secretagogues?
What to know about the meglitinides?
What to know about the sulfonylureas names?
SU’s and meglitinides. Stimulate insulin secretion to lower postprandial glucose.
Their name ends in glinide. Take 15-30 minutes before a meal for repaglinide and take 1-30 minutes before a meal for nateglinide. Watch for hypoglycemia and weight gain.
Start with G and end in ide. Glipizide is Glucotrol, Glimepiride is Amaryl, Glyburide or micronized Glyburide is Glynase.
What safety/side effect/monitoring things to know about the SU’s?
What are the counseling points of the SU’s and meglitinides?
How do the TZD’s work and what are their names?
Sulfa allergy CI, Watch for hypoglycemia and weight gain, nausea. Glipizide IR is taken 30 minutes before a meal and all other products take with breakfast, hold doses if NPO. Glucotrol XL is an OROS formulation and can leave a ghost tablet, Glyburide is renally cleared and is not a preferred drug in renal patients.
Insulin, SU’s, and Meglitinides should never be used together. Always keep a source of sugar near you. Watch for hunger, confusion, sweating, seizures.
They are PPARy agonists and increases insulin sensitivity. They end in glitazone. Pioglitazone is Actos.
What are the side effects and stuff of the TZD’s?
What are the TZD counseling points?
What are the SGLT2 inhibitors and how do they work?
Rosiglitazone has increased risk of MI, CI’d in NYHA Class 3/4 heart failure patients. Caution with hepatic failure, edema(macular edema), risk of fractures. Pioglitazone increased risk of urinary bladder tumors so don’t use in patients with bladder cancer, peripheral edema, weight gain, LFT’s, s/sx of heart failure.
Water retention, swelling, weight gain, heart failure. Watch for signs of heart failure, heart disease or liver problems, bladder cancer with pioglitazone which is Actos.
They work in the proximal renal tubules, inhibit SGLT2 and reduce reabsorption of glucose, increases urinary glucose excretion and end in gliflozin. Canagliflozin is Invokana, Empagliflozin is Jardiance.
What side effects and such to know about the SGLT2 inhibitors?
What are the SGLT2 counseling points?
What are the DPP4 inhibitors and how do they work?
BBW of Canagliflozin(Invokana) is increased risk of leg and foot amputations. Empagliflozin(Jardiance) reduces risk of CV mortality in patients with type 2 diabetes and ASCVD. CI’d in severe renal impairment (eGFR <30), Ketoacidosis, genital mycotic infections, and UTI’s. Hypotension and acute kidney injury due to volume depletion, Canagliflozin causes hyperkalemia, weight loss, increased urination and thirst, monitor Renal function.
Risk of hypotension and AKI can be increased if used with diuretics, RAAS inhibitors and NSAIDs. Monitor potassium in canagliflozin(invokana). Watch for UTI’s, ketoacidosis, N/V, stomach pain are symptoms, dehydration, Watch for leg and foot amputations in Canagliflozin(Invokana).
Break down incretin, increase insulin release and lower glucagon secretion. Sitagliptin(Januvia), Linagliptin(Tradjenta),
What special things to know about the DPP4 inhibitors?
What are less common oral medications used?
What are the GLP-1’s and how do they work?
Acute pancreatitis, arthralgia, risk of HF, seen with saxagliptin and allogliptin. Linagliptin(Tradjenta) is NOT renally adjusted.
Alpha-glucosidase(if hypoglycemia occurs can’t be treated with sucrose), glucose tablets or gel work, each dose should be taken with first bite of meal, GI side effects common. Bile acid binding resins, Constipation. Dopamine agonist(Bromocriptine) should not be used with other dopamine agonists.
analogs of GLP-1, increase insulin secretion and decrease glucagon secretion. End in TIDE. Liraglutide(Victoza or Saxenda), Dulaglutide(Trulicity).
What to know about the dosing of these GLP-1’s?
What are the safety warnings of the GLP-1’s?
What patient counseling points for the GLP-1s?
Exenatide(Byetta) is BID and not for CrCl <30, Exenatide ER(Bydureon) is once weekly and same kidney thing. Liraglutide is daily, Dulaglutide is weekly, Lixisenatide is daily, Semaglutide is weekly.
All except Byetta and Adlyxin have risk of thyroid c-cell carcinomas. Pancreatitis, not recommended in patients with severe GI disease. Watch for nausea(primary side effect), weight loss, Give Byetta and Adlyxin within 60 minutes of a meal. Pen needles are not provided with Byetta, Victoza, or Adlyxin.
N/V/D, headache, watch for pancreatitis and rotate injection sites, do NOT store with needle attached, use Byetta 60 minutes before meals(morning and evening),Never inject after a meal.Each pen can do BID for 30 days, after 30 days throw byetta away, once bydureon mixed use immediately, Each bydureon and trulicity pack is 1 dose. Adlyxin is a starter pack and y ou must start with the green pen.
What is the amylin analog and what to know about it?
What are your rapid acting insulins?
What is Afrezza?
Slows gastric emptying, suppressing glucagon. Pramlintide (SymlinPen), Administer prior to each major meal in abdomen or thigh. Severe hypoglycemia when used with insulin is BBW, Watch for gastroparesis, hypoglycemia(reduce mealtime insulin by 50%), N/V, anorexia, headache, weight loss.
Prandial or Mealtime. Aspart(Novolog, Flexpen), Lispro(Humalog). Give up to 15 minutes before meals, acute hypoglycemia, hypokalemia(K shift), weight gain, lipodystrophy.
Oral inhalation insulin powder that’s rapid acting, Inhale at the beginning of meals, Replace inhaler every 15 days, BBW of acute bronchospasm in asthma or COPD. CI’d in asthma or COPd, monitor FEV1, not recommended in smokers.
What are your short acting insulins?
What is your intermediate insulin?
What to know about Long-acting insulins?
Humulin R, Humulin R U-500. Insulin of choice for TPN, available without a prescription(R, not R-500)., 5 times as concentrated and indicated in patients needing >200 units/day. Do not used any other syringe in 500 than provided and no dose conversion. Do not mix with other insulins in 500.
Basal, NPH(Humulin N), available without a prescription, cloudy, can mix with rapid or short-acting insulins, CLEAR BEFORE CLOUDY
Detemir (Levemir), Glargine(Lantus, Toujeo). Do NOT mix with other insulins. Toujeo only comes in 300 units/mL. Pre mixed insulins are NPH and protamine,available without a prescription, all are named as basal first and percentage of each component.
How to initiate basal bolus regimen?
What is he rule of 500 for rapid acting and 450 for regular?
What is the correction factor rule?
TDD of 0.6 units/kg/day of TBW. Divide in half and do half basal, Bolus 50 and divide the bolus among the 3 meals.
500/TDD is grams of carb covered by 1 units, same with 450.
1800 with rapid acting and 1500 with regular. 1800/TDD is 1 unit of rapid acting, 1500 is same.
How do you convert form twice daily NPH to once daily glargine(lantus, toujeo)?
What drugs can lower blood glucose?
How do you treat hypoglycemia?
Use 80% of the NPH total daily dose. Do not shake, invert pen 4-5 times.
Linezolid, Lorcaserin(Belviq), Pentamidine, Beta blockers, Quinolones.
15-20 grams of glucose or simple carbs, recheck after 15 minutes.
How do you recognize DKA?
Ketones are present or fruity breath, BG >250, Anion gap metabolic acidosis arterial PH <7.35, anion gap >12.
