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P4 year Study > Diabetes > Flashcards

Diabetes Flashcards

1
Q

T/F: The goal for types of nutrition is a balanced intake with most carbohydrates from non-starchy vegetables

A

True

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2
Q

What is the equation for net carbs

A

Take total carbohydrate grams and

SUBTRACT the grams of fiber

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3
Q

What type of weight loss goals should be determined for patients with diabetes and prediabetes

A

Diabetes: At least 5% of weight loss
Prediabetes: 7 to 10%

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4
Q

How much exercise is needed for a patient is needed per week

A

150 minutes per week (no more than two days without exercise/ 2 to 3 days of resistance training)

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5
Q

What is the drug of choice for type 2 diabetes

A

Metformin

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6
Q

What is the MOA of metformin

A

Decreases hepatic glucose production, decreases intestinal glucose absorption, increase insulin sensitivity

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7
Q

What are the clinical effects of metformin

A

A1C: decrease by 1 to 2 percent, FBG: 50-70 mg/dL

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8
Q

How is metformin excreted

A

Urine (kidneys)

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9
Q

What are the most common adverse effects of metformin

A

Diarrhea. N/V, abdominal bloating/flatulence. malabsorption, and heartburn

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10
Q

What are the rare adverse effects of metformin

A

LACTIC ACIDOSIS. headache, taste disturbances, and loss of energy

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11
Q

What is the starting dose for metformin

A

500 mg once a day with food in order to reduce gastrointestinal adverse effects

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12
Q

What is the maximum clinically effective dose

A

2000 mg per day

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13
Q

What patients are contraindicated for using metformin

A

eGFR is less than 30/ml/min/1.73m2 (if eGFR later falls below 45/ml/min/1.73m2 then asssess benefits and risks of treatment

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14
Q

What are drug interactions with metformin

A

Amiloride, digoxin, morphine, procainimide, alcohol

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15
Q

What are the thiazolidinediones (TZDs)

A

PIOGLITAZONE and Rosiglitazone

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16
Q

What is the MOA of TZDs

A

Improve insulin sensitivity, enhance glucose in muscle and adipose tissue, inhibit gluconeogenisis,

17
Q

T/F: TZDs have a delayed onset of action of 2-4 weeks with full effect not seen until 12 weeks

A

True

18
Q

What are the clinical effects of TZDs

A

A1C: 0.5-1.5%
FBG: 30 to 60%

19
Q

What are the liver enzymes used in TZDs

A

CYP2C8 and CYP3A4

20
Q

What patients cannot receive TZDs

A

Patients with congestive heart failure (Class 3 or 4)/ Monitor weight gain dyspnea (shortness of breath) and edema

21
Q

What must be monitored for using TZDs

A

Liver enzymes (Do not initiate if ALTis greater than 2.5 times the ULN

22
Q

What are the adverse effects of TZDs

A

edema, weight gain, change in lipids, upper respiratory infection

23
Q

What patients are not recommended to get TZDs

A

Patients with heart disease and liver disease

24
Q

What is the mechanism of SGLT2 inhibitors

A

Block the reabsorption of filtered glucose leading to glucosuria

25
Q

What are the sodium glucose co-transporter 2 inhibitors

A

Canagliflozin (Invonaka), Dapaglifozin (Farxiga), Empaglifozin (Jardiance), Ertuglifozin (Steglatro)

26
Q

How are the SGLT2 inhibitors excreted

A

Urine and Feces

27
Q

Which SGLT2 is known for increased of amputation

A

Canagliflozin

28
Q

Which patients are contraindicated in SGLT2 inhibitors

A

End Stage Renal disease

29
Q

What are the adverse effects of SGLT2 inhibitors

A

KETOACIDOSIS, genital mycotic infections, UTIs, dehydration and increased urination,

30
Q

Which SGLT2-inhibtor is has an additional indication to reduce Cardiovascular death

A

Empaglifozin

31
Q

What is MOA of DDP-4 inhibitors

A

increase increntin (GLP-1 and GIP) inhibiting glucagon release and increasing insulin secretion

32
Q

What are the DDP-4 inhibitors

A

Sitaglipitin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)

33
Q

What are the advantages of giving DDP-4 inhibitors

A

They can be given in patients with renal insufficiency

34
Q

Which DDP-4 inhibitors have an FDA alert, what for

A

Saxagliptin and Aloglipitin/ may increase risk of heart failure

35
Q

What are the DDP-4 side effects

A

Headache, nasopharyngitis, hypoglycemia, edema (Saxagliptin)

36
Q

What is the MOA of sulfonylurea

A

Stimulate insulin secretion from pancreatic beta cells, improves insulin sensitivity

37
Q

What are the sulfonylureas

A

Glyburide: once-twice daily with breakfast
Glipizide: once-twice daily (immediate release formulation should be taken 30 minutes before food)
Glimepride: once daily with breakfast or first main meal

38
Q

What are the adverse effects of sulfonylurea

A

Hypoglycemia, dizziness, gastrointestinal disturbances, allergic skin reactions

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