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SYSTEMIC PHARMACOLOGY > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes is the leading cause of

A

renal failure
Adult-onset blindness
lower limb amputation

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2
Q

In the pancreas, beta cells do what

A

produce & secrete insulin

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3
Q

In the pancreas, alpha cells do what

A

produce & secrete glucagon

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4
Q

Insulin does what to blood glucose?

A

lowers

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5
Q

Glucagon does what to blood glucose

A

increase

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6
Q

Stressful conditions lead to (inc/dec) in productional cortisol by adrenal gland which stimulates liver to put out more ____?

A

increase, glucose

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7
Q

In Type 1 Diabetes, what cells are being destroyed

A

Beta cells - these cells produce insulin

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8
Q

Type 1 Diabetic patients have a severe or absolute deficiency of what

A

Insulin

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9
Q

T1 DM is diagnosed around what age

A

30

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10
Q

Mainstay of T1 DM therapy is _____ and prevention of ____

A 
Insulin replacement
Diabetic ketoacidosis (DKA)
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11
Q

Pre-diabetic patients are prone to getting

A

Type 2 DM

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12
Q

T2 DM suffer from insulin ____ or _____

A

Resistance or relative insulin deficiency

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13
Q

Impaired fat metabolism is a sign of which DM?

A

T2 DM
Increased free fatty acid and triglyceride
Decreased HDL (good cholesterol)

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14
Q

Uncontrolled blood glucose in T2 DM can lead to

A

Hyperosmolar Hyperglycemic Syndrome

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15
Q

Insulin resistance is common in what type of DM

A

Type II

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16
Q

Insulin resistance results in:

___ insulin levels
___ receptor affinity
___ plasma insulin levels
___ insulin to blood glucose ratio

A

high insulin levels
Low receptor affinity
High plasma insulin levels
High insulin to blood glucose levels

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17
Q

How do you get Gestational Diabetes Mellitus (GDM)

A

Glucose intolerance during pregnancy

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18
Q

What ethnicity is most likely to get GDM

A

Asian, native american, Pacific islander, Black, hispanic

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19
Q

What are the adverse outcomes of GDM maternally?

A

Development of T2DM
C-Section
Pre-eclampsiav - protein in urine & high BP
Gestational HTN

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20
Q

What are the adverse outcomes of GDM Fetaly

A 
Shoulder dystocia/birth trauma
Macrosomia
Adolescent/ childhood obesity
Birth defects
Hypoglycemia
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21
Q

These medications cause ____

Quinolone antibiotics 
Atypical antipsychotics 
Beta blockers
Corticosteroids
Calcinurin inhibitors
Protease Inhibitors
Thiazide & thiazide-like diuretics
A

Hyperglycemia

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22
Q

These medications cause ____

Insulin
Insulin secretagogues 
GLP-1 Receptor agnostis and DDP-4 Inhibitors 
Anti-diabetic meds
Pentamidine antibiotic
Anti-hypertensive (ACEi, Beta blockers)
Clofibrate
Disopyramide
Ethanol
Salicylates
A

Hypoglycemia

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23
Q

Blood glucose and insulin release is stimulated by what foods?

A

Carbs and proteins

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24
Q

After a meal, glucose levels should be below

A

140 mg/dL

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25
Q

For diabetics, night, morning and after a meal glucose levels can be elevated to

A

200 mg/dL

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26
Q

Normal blood glucose levels for overnight are

A

60-140 mg/dL

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27
Q

Normal blood glucose levels for after meals are

A

<140 mg/dL

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28
Q

Endogenous insulin is mainly cleared by

A

liver

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29
Q

Exogenous insulin is mainly cleared by

A

renal

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30
Q

Avoid giving ____ insulin to patients with renal dysfunction

A

exogenous insulin

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31
Q

How do you administer Rapid-acting insulin?

A

inject immediately before meals

Low risk of post-meal hypoglycemia (make sure pt eats)

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32
Q

How do you administer Short-acting insulin

A

Inject 30-45 min before a meal, only one available in IV (make sure pt eats)

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33
Q

How do you administer Intermediate acting insulin

A

mixed with rapid and short acting insulin due to its unpredictability

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34
Q

How do you administer Long Acting Insulin

A

Detemir - BID
Glargine - daily
Degludec - daily

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35
Q

What are factors affecting insulin levels

A

Sit of injection
Massage of injection site
Depth of injection
Exercise

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36
Q

These symptoms suggest that a patient is experiencing ______

Tachycardia
Sweating
Nausea

A

Hypoglycemia effect

Patient should drink juice or eat carbs

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37
Q

Hypoglycemia can cause ___ (usually happens in the morning)

Treat it by giving less insulin

A

post-hypoglycemia hyperglycemia
(Somogyi Effect)

Adrenal gland notices that patient is low on insulin and will produce excessive insulin. Ask pt if they had a vivid dream

38
Q

Diabetic patients should never be given this drug

A

beta blockers

39
Q

Technosphere Insulin (Afrezza) is also known as

A

inhaled insulin

40
Q

Afrezza Technosphere insulin should not be given to patients with this disease

A

COPD & smokers

Common side effect is cough

41
Q

15-15-15 rule

A

amount of carb, protein, and fat given to diabetic patients to reverse hypoglycemia

42
Q

Lipodystrophy is an adverse effect of what drug?

A

insulin - injection sites become lumpy

43
Q

Insulin is used in what DM

A

Type 1 and 2 but mainly 1

44
Q

Hb A1C should be around what range for diabetics

A

6-7

in double digits when uncontrolled

45
Q

Insulin used for intensive insulin therapy is usually

A

basal insulin = 1/2 daily insulin requirement (long acting)

46
Q

Insulin used for intensive insulin therapy is usually used in what DM

A

1 & 2

47
Q

Conventional Insulin therapy is usually used in what type of DM

A

T2 DM

48
Q

What type of insulin is used for conventional insulin therapy of T2 DM?

A

Fixed dose of long acting insulin

49
Q

Sulfonylureas (SFUs) MOA

A

insulin secreatagogues
Stimulate insulin release
Decrease glucose output from liver

50
Q

Name that the class

Glyburide
Glipizide
Glimepiride
Gliclazide

A

SFUs

51
Q

What are adverse effects of SFUs

A

Hypoglycemia
Weight gain
Blurry vision

52
Q

What is the first line agent for T2 DM

A

SFUs

53
Q

SFU should only be used on patient who have a working…

A

pancreas

54
Q

SFU and Meglitinide are known as

A

Insulin secretagogues

55
Q

MOA: Meglitinide

A

Stimulate release of insulin by closing ATP-sensitive K+ channels

56
Q

What class of drugs are these?

Repaglinide
Nateglinide

A

Meglitinide

57
Q

Almost all anti-diabetic medications cause these adverse effects

A

Hypoglycemia

Weight gain

58
Q

T/F Meglitinide, TZD & metformin (biguanides), GLP-1can be used as monotherapy or add-on to metformin in T2 DM

A

true

59
Q

What drug can be used to lower postprandial blood glucose?

A

Meglitidine, Alpha-glucosidase inhibitor

GLP-1

60
Q

Metformin fits under what class of drugs?

A

Biguanides

61
Q

For a patient who is experiencing abdominal pain you would give them metformin _____

A

extended release daily

62
Q

Vitamin B12 should be prescribed to patients who are also taking

A

metformin/ biguanides

63
Q

Lactic acid risk in patients with renal, cardio, or hepatic disease can be increased with

A

metformin, biguanides

64
Q

When should you take metformin?

A

With meals

65
Q

A patient with reduced renal function should not take? (eGFR <30 mL/min/1.73 m^2)

A

METFORMIN, biguanides

66
Q

Off-label use of this drug can be used to treat
Gestational Diabetes
Polycystic Ovary Syndrome
Pre-Diabetes (A1C 5.7-6.4% or impaired fasting glucose)

A

Metformin, biguanides

67
Q

What is the method of action for Thiazolidinediones (TZD)

A

ligands of the peroxisome proliferator-activated receptor (PPAR receptors)
Decrease insulin resistance in muscles and fat
Increase HDL & decrease triglycerides

68
Q

What class do these drugs belong to?

Pioglitazone
Rosiglitazone

A

Thiazolidinediones

69
Q

This class of drugs is contraindicated for NYHA Class III/IV heart failure

A

Thiazolidinediones (TZD)
Pioglitazone
Rosiglitazone

70
Q

Name the adverse effects of Thiazolidinediones
Pioglitazone
Rosiglitazone

A 
Weight gain
Volume retention: CHF
Increases fracture risks
Increases LDL (rosi)
Increases risks for bladded cancer (pio)
71
Q

MOA of Alpha-Glucosidase Inhibitors

A

Competitively inhibit alpha glucosidase enzymes –> slows intestinal carbohydrate digestion/absorption

72
Q

Do not give this medication to patients who have renal failure

A

Miglitol (Apha-glucosidase inhibitor)
Metformin/biguanides
Exogenous insulin

73
Q

Flatulence is an adverse effect of which drug?

A

Alpha-glucosidase inhibitor

74
Q

Alpha-glucosidase should not be used on patients with

A

GI disorders, and renal dysfunction

75
Q

Glucagon-Like Peptide-1 (GLP-1) Receptor agonist MOA

A

stimulates GLP-1 receptor –> increased insulin release, decreased glucagon secretion, slowed gastric emptying, and increased satiety

76
Q

This drug lowers the risk for hypoglycemia

A

Glucose-like Peptide-1 receptor agonists

77
Q

Glucode-like Peptide-1 receptor agonists are administered in what fashion

A

injectable

78
Q

Name the class of drugs

Albiglutide
Dulaglutide
Exenatide
Liraglutide

A

Glucose-like Peptide-1 receptor agonists

79
Q

Increased risk for pancreatitis can be induced by

A

GLP-1

80
Q

Gallbladder diseased patients should not take

A

GLP-1

81
Q

Liraglutide has been approved to be used off label as - GLP1

A

Chronic weight gain

82
Q

Severe joint pain, renal impairment, new or worsening heart failure are symptoms of

A

DPP-4 gliptins

83
Q

MOA DPP-4

A

Inhibits degradation if incretins –> increased insulin secretion, decreased glucagon secretion, slowed gastric emptying, and increased satiety

84
Q

Anxiety can be caused by

A

GLP-1

85
Q

MOA of Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor (“Flozin”)

A

Blocks reabsorption in kidneys –> increase glucosuria secretion, slowed gastric emptying and increased satiety

86
Q

What class do these drugs belong to?

Alogliptin
Linagliptin
Saxogliptin
Sitagliptin

A

DPP-4

87
Q

The dosing of these gliptins (DPP-4) should be reduced in order to prevent renal impairment and new/worsening heart failure

A

Saxogliptin & alogliptin

88
Q

MOA of Sodium-Glucose Co-Transporter 2 (AGLT2) Inhibitors (Flozins)

A

Blocks glucose reabsorption in kidneys –> increases glucosuria

89
Q

What class do these drugs belong to?

Canagliflozin
Dapaglifliozin
Empagliflozin * Jardiance

A

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors (“Flozin”)

90
Q

What class of drugs do these adverse effects belong to

Genital fungal infection, urinary tract infection, Hypotension, increased LDL

A

SGLT2 Flozins

91
Q

What are the warning and precautions of Flozins

A

Renal impairment
Bladder Cancer (dapagliflozin)
Fractures & decreased bone mineral density (Canagliflozin)

SYSTEMIC PHARMACOLOGY (3 decks)

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