Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pharmacology > diabetes > Flashcards

diabetes Flashcards

1
Q

most significant glucose transporters and site

A

glut 1 (CNS,BBB)
2( renal tubular cells, liver)
3( neurons and placenta)
4 (muscle and adipose)- insulin sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the significance of GLUT 4

A

its important for uptake of excess glucose from the bloodstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the purpose of basal insulin secretion

A

suppresses hepatic glucose production between meals overnight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

prospandial insulin

A

occurs in response to food intake and controls hyperglycemia after meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

glucagon function

A

stimulates glycogenolysis- break down of glycogen to glucose in the liver
stimulates gluconeogenesis by the liver and kidney
turns off glycolysis causing the intermediates to be shunted for gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe diabetes type 1

A 
occurs in younger people
the patients are lean 
autoimmune 
insulin deficiency
always need insulin
develop ketoacidosis 
c peptide disappears
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe diabetes type 2

A 
older patients 
overweight 
partil insulin deficiency 
develop HONK 
many come to need insulin when beta cells fail overtime 
c peptide persists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how to diagnose diabetes

A

impaired fasting glucose- fasting plasma glucose (6.1-6.9)
impaired glucose tolerance
FPG greater than 7
2 hour OGTT 7.8-11.0

diabetes 
FPG greater than 7
2 hr OGTT- greater than 11 
HbA1c  greater than 6.5 percent 
random plasma glucose greater than 11
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

complications of diabetes

A 
Macrovascular complications
Ischaemic Stroke
Miocardial infarction
Peripheral arterial disease
Microvascular complications 
Cataracts, Retinopathy
Nephropathy
Neuropathy (autonomic neuropathy, painful polyneuropathy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

metabolic syndrome

A 
atleast 3 out of 5 symptoms 
central obesity
hypertension
hyperglycemia 
raised serum triglycerides 
low serum HDL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment of type 1 diabetes

A

insulin therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

types of insulin therapy

A

short acting
intermediate acting
biphasic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

shorting acting

A 
3 times daily 
30 mins before meals 
peak action - 2-5 hours 
duration of action 5-8
eg actrapid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

intermediate acting

A 
once or twice daily 
usually at night before 10
onset of action 1-3 hpurs 
peak action 6-12
duration of action 16-24 hours 
e.g protophane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

biphasic

A

mixture of short and intermediate
onset of action 30
peak action 2-12 hours
duration of action 16-24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

basal bolus regimen

A

Preferred management with “basal bolus regimen”
Combined pre-meal short-acting insulin (bolus) and bedtime (not later than 22:00) intermediate-acting insulin
The initial total daily insulin dose: 0.6 units/kg body weight
The total dose is divided into: 40–50% basal insulin and rest as bolus insulin, split equally before each meal.

17
Q

dangers of not changing injection site

A

lipoatrophy (immunologic reaction to insulin)

18
Q

education related to insulin therapy

A 
Insulin storage (stock in fridge; room temp if in use)
Recognition and treatment of acute complications, e.g. hypoglycemia
19
Q

type 1 diabetes monitoring

A

HbA1c annually

one month before next appointment

20
Q

Metformin function

A

reduces gluconeogenesis and glycogen metabolism
decreases carbohydrate absorption from GIT
lowers ldl and cholesterol
phosphorylates GLUT4 increasing its sensitivity to insulin

21
Q

metformin dosing

A

contraindicated if GFR less than 30
Initially 500mg once or twice daily; or 850mg once or twice daily, with meals
After 5-7 days, up-titration, maximum 2000 mg/day (based on GIT side effects)

22
Q

Metformin side effects

A 
loss of apetite
nausea
diarrhoea
lactic acidosis- due to inhibited conversion of lactate to glucose
reduced vitamin B12 absorption
23
Q

sulphonylureas types

A

glipenclamide
glimepiride
glipizide
gliclazide- lowest risk of hypoglycemia

24
Q

mech of action of sulphonylureas

A

stimulates insulin secretion from pancreatic beta cells
enhances beta cell sensitivity to glucose
reduces glucagon release

25
Q

contraindications of sulphonylureas

A

severe hepatic impairment (hepatic metabolism py450 isoenzymes)
pregnancy
renal impairment GFR less than 60

26
Q

sulphonylureas dosing

A

Glimepiride
Initially 1mg daily, adjusted according to response in 1mg increments at 1-2 week intervals (maximum dose of 4 mg daily)
Preferred in the elderly
Glibenclamide
2.5mg daily and titrate slowly to maximum of 15mg daily
When ≥7.5mg per day is needed – 2/3 of the total dose in the morning and 1/3 at night
Avoid in the elderly

27
Q

side effects of sulphonylureas

A

hypoglycemia

weight gain

28
Q

what happens in hypoglycemia

A 
plasma glucose of less than 4mmol/l
whipple's triad
low plasma glucose
symptoms of hypoglycemia
relief of those symptoms after the plasma glucose level is raised
29
Q

clinical features of mild hypoglycemia

A 
Pallor
Sweating 
Tachycardia
Palpitations
Hunger
Paraesthesiae
Tremor
30
Q

mild hypoglycemia treatment

A

Fast acting oral carbohydrates (at least 15g)
Sources include
Three glucose tablets (5g each)
2 ½ cups of fruit juice
½ to ¾ cup regular soda
1 cup of milk
If patient is unable to take orally give IV dextrose

31
Q

clinical features of moderate hypoglycemia

A 
Inability to concentrate		
Confusion
Slurred speech			
Irrational behaviour
Slower reaction time		
Blurred vision
Somnolence			
Extreme fatigue
Weakness
32
Q

clinical features severe hypoglycemia

A 
Associated with severe impairment of neurologic function
Completely disoriented behavior
Loss of consciousness
Coma
Seizures
Can be fatal
33
Q

treatment for moderate to severe hypoglycemia

A

Dextrose - 50mL of 50% dextrose IV bolus after blood drawn, followed by 10% dextrose
Glucagon – 1mg IM or SC can be given (family or friend) – effective in treating hypoglycemia only if sufficient liver glycogen present
These measures raise blood glucose only transiently
Patient is urged to eat as soon as possible, once fully awake

34
Q

how to prevent hypoglycemia

A

Patient education
Knowing signs and symptoms of hypoglycemia
Take meals on a regular schedule
Carry a source of carbohydrate
Self monitoring of blood glucose
Take regular insulin at least 30 min before eating

35
Q

other diabetes non insulin therapy

A 
Thiazolidinediones (Glitazones) 
SGLT-2 inhibitors (Dapagliflozin) 
α-Glucosidase inhibitors
Incretin (GLP-1) based drugs
DPP-4 inhibitors
GLP-1 receptor agonists
36
Q

what monitoring do we do for type 2 diabetic patients

A

finger prick
weight
creatinine, K+, foot and eye examination, ab circumference

37
Q

outline the stepwise approach to diabetes type 2

A 
step 1
presents with typical diabetes symptoms and test results 
treatment:
lifestyle modification
metformin 
aim- reduce glucose and HbA1c
38
Q

step 2 of managing diabetes 2

A

failed step 1 (2-3 months)
life style modification
metformin
add sulphonylureas

39
Q

step 3 of managing diabetes type 2

A

insulin
lifestyle modification
stop sulphonylureas
but continue metformin

pharmacology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions