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Summer pharm exam 2 > Diabetes intro/Meds > Flashcards

Diabetes intro/Meds Flashcards

1
Q

What is diabetes mellitus

A

hyperglycemia with abnormal fat, carb, and protein metabolism
Caused by abnormal insulin and glucagon secretion, and/or insulin sensitivity

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2
Q

What do pancreatic cells produce

A

Alpha: Glucagon
Beta: Insulin, amylin, C-peptide

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3
Q

How is insulin release controlled

A

If glucose concentration rises, ATP production increases= Potassium channels close= cells repolarize
Calcium channels in muscle and nerve open up
More IC calcium= increased insulin secretion

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4
Q

What are the types of diabetes

A

T1: AI beta cell destruction
T2: progressive loss of B cell fxn, insulin resistance
Gestational: second or third trimester, not present prior
Other: neonatal diabetes, CF, pancreatitis, etc.

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5
Q

What are S/Sx of T1DM

A

Polyuria, polydipsia, polyphagia, weight loss, lethargy w/ hyperglycemia

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6
Q

What are S/Sx of T2DM

A

lethargy
polyuria, nocturia, polydipsia
overweight/obese

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7
Q

What are criteria for Diabetes Dx

A

FPG 126+
OGTT 200+
A1c 6.5%+
Symptoms + random BG 200+

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8
Q

What is metabolic syndrome

A 
TG >150 
FPG >100
BP >130/85
Waist (M>40) (W>30) 
HDL (M<40) (W<50)
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9
Q

What are microvascular complications in Diabetes

A

Neuropathy
Nephropathy
Retinopathy

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10
Q

What are macrovascular complications in Diabetes

A

CAD, stroke
HTN
PVD

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11
Q

What is the “lending a hand” tool for complications of DM and mortality

A

Thumb to little finger:

  1. smoking cessation
  2. BP control
  3. metformin therapy
  4. lipid reduction
  5. glycemic control
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12
Q

What can frequently affect A1c levels

A

Anemia! low RBC count= low glucose binding

Statins elevate A1c

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13
Q

What are reasonable A1c goals for different people

A

Healthy: <7.5%
Complex: <8%
Poor health: <8.5%

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14
Q

What should be in every treatment plan for a diabetic

A

HTN control!

Also dyslipidemia management and CKD surveillance

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15
Q

What are statin recommendations in diabetic patients

A

<40, no ASCVD: NONE
<40, yes ASCVD: High intensity stain
>40, no ASCVD: moderate statin
>40, yes ASCVD: High statin

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16
Q

What meds BLOCK the symptoms of hypoglycemia

A

Bets blockers

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17
Q

What are the different strength statin

A

Mod: Atorv 10-20, Rosuv 5-10
High: Atorv 40-80, Rosuv 20-40

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18
Q

Where do you prick with SBGM

A

NOT where fingertips touch when you put them together

Should be more lateral

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19
Q

Why do you check different BG levels

A

FPG: measures how effective basal insulin is (decreases hepatic gluconeogenesis overnight)
Pre-prandial BG: Helps calculate bolus dose
2hr Post-prandial: Measures effectiveness of bolus insulin
Bedtime: Avoid early morning hypoglycemia

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20
Q

What are the levels of hypoglycemia

A

level 1: 70 or below (can correct with fast acting carbs)
level 2: <54
level 3: need external assistance

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21
Q

How do you correct hypoglycemia

A

15g carbs every 15 min, retest every 15 min until BG normalizes
*Fat slows the absorption of sugar

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22
Q

What is the rate of rise of BG

A

Infections/corticosteroids cause a rise quickly

Do not chase BG through the day!

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23
Q

Sx of hypoglycemia are

A 
shaky 
tachy
sweaty
dizzy
anxious
weak
fatigue
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24
Q

What is the ADA algorithm (start, just three determinations)

A

A1c <9%: Monotherapy + lifestyle change
A1c >9%: Dual therapy + lifestyle change
Aic>10%: Combo injectable

25
Q

What are the specifics of the ADA algorithm

A

Monotherapy: recheck A1c at 3 months. If at target, keep monitoring q3-6 months. If not at target, consider dual
Dual therapy: recheck A1c at 3 mo. If at target, keep monitoring q3-6 mo. If not at target, consider triple
Triple therapy: recheck A1c at 3 mo. If at target, keep monitoring q3-6 mo. If not at target, consider injectable

26
Q

Major concerns with diabetes medications are

A

hypoglycemia, weight change, CV effects, Renal adjustments, and FDA warnings

27
Q

Which drugs cause hypoglycemia

A

Sulfonylureas

Insulin

28
Q

Which drugs cause weight gain

A

TZD
Sulfonyluras
Insulin

29
Q

Which drugs cause weight loss

A

+/- Metformin
GLP-1 Agonist
SGLT2 inhibitors
(DPP4 are weight neutral)

30
Q

Which drugs are CV beneficial

A

Liraglutide, Semaglutide (GLP)
Canagliflozin, Empagliflozin (SGLT2)
+/- Metformin

31
Q

Which drugs are renally beneficial

A

Liraglutide (GLP1)

Canagliflozin, Empagliflozin (SGLT2)

32
Q

Metformin is contraindicated in

A 
Renal insufficiency (GFR <30) 
But we start watching renal function with a GFR at 50-60
33
Q

What other glucose lowering agents can be used in T2DM

A 
Bile acid sequestrate (Colesevelam)- increase incretin level
Dopamine agonist (Bromocriptine)- increase insulin sensitivity
34
Q

What is your first line med, always

A

METFORMIN!
Enhances insulin sensitivity, increase glucose uptake
-but start low, go slow

35
Q

What are the TZD and how do they work

A

Pioglitazone* (rosiglitazone)
Enhance insulin sensitivity in muscle, liver, fat
(pio +/- decrease TG)

36
Q

ADE of TZD are

A

Fluid retention
fat accumulation
weight gain

37
Q

What are the Sulfonylureas/ Metaglinides

A

S: Glipizide, Glimepiride
M: Regaglinide, Nateglinide

38
Q

What are ADE of Sulfonylureas/ Metaglinides

A

weight gain
hypoglycemia
*Third line agents! but very patient affordable- give GOOD patient education

39
Q

What are the GLP-1 agonists and how do they work

A

Exenatide, Liraglutide, Semaglutide

Increase insulin secretion, decrease hepatic glucose, slow gastric emptying

40
Q

What are the DPP4 inhibitors and how do they work

A

Sitagliptan, Saxagliptan, Linagliptan, Alogliptan

Block DPP4 from degrading GLP1= increase insulin secretion, decrease hepatic glucose, slow gastric emptying

41
Q

What are ADE of DPP4 inhibitors

A

Urticaria, facial edema

Rare: SJS

42
Q

What are the SGLT2 inhibitors and how do they work

A

Canagliflozin, Empagliflozin, Dapagliflozin
Inhibit SGLT2= low renal threshold for reabsorbing glucose= increased glucose urine excretion
*Watch out for hypotension if using w/ other diuretics

43
Q

What are the alpha glucosidase inhibitors and how do they work

A

Acarbose, Miglitol

Break down carbs in small intestine= prolonged carb absorption

44
Q

ADE of a-glucosidase inhibitors are

A

Flatulence, bloating, abdominal discomfort, diarrhea

45
Q

How do Bile acid sequestrants benefit T2DM

A

Bind bile acid in intestine= decreased bile acid pool

Reduce LDL 12-16% (but NOT is used w/ metformin)

46
Q

How do Dopamine agonists benefit T2DM

A

Not fully known, may improve hepatic insulin sensitivity and decrease hepatic glucose output
Take daily WITH food w/in 2 hrs from waking up (skip if morning window is missed)

47
Q

What are the categories of insulin

A

Basal: intermediate, long acting

Prandial (bolus): rapid acting, short

48
Q

How can you lose and maintain weight in diabetes management

A

Reduce kcal intake: LOSE weight

Exercise: MAINTAIN weight

49
Q

What meds can be used to treat obesity

A

Short term: Phentermine
Long term: Lipase inhibitor (orlistat), Selective serotonin agonist (lorcaserin), smpathomimetic/antiepileptic (Phentermine/topiramate, Naltrexone/bupropion, Liraglutide
*Lorcaserin can cause HYPOglycemia, HA, fatigue

50
Q

Per AACE/ACE, what is goal BP for diabetics and what are preferred meds

A

<130/80
ACE/ARB
If BP >150/100, ACE/ARB + CCB, BB, or Thiazide

51
Q

Per AACE/ACE, if BP is not at goal in 2-3 months…

A

Add CCB, BB, or thiazide

keep rechecking every 2-3 months, and add one med from the group if goal not met until target is achieved

52
Q

Per AACE/ACE, what should goal A1c for diabetic be

A

W/o serious comorbidities or risk for hypoglycemia: <6.5%

w/ comorbidities/risk for hypoglycemia: >6.5%

53
Q

AACE/ACE says at 7.5% A1c you start

A

Lifestyle modifications + Monotherapy

Metformin, GLP1, SGLT2, DPP4, TZD (caution), AGi, SU/GLN (caution)

54
Q

Per AACE/ACE, dual therapy consists of

A

Metformin + any previously stated, colesevelam, bromocriptine, or basal insulin
(same as triple therapy)

55
Q

If entry A1c is >9%, AACE/ACE says

A

Not symptomatic: dual or triple therapy

Sx: insulin +/- other agents

56
Q

At what rate do you start basal insulin, per AACE/ACE

A

A1c <8%: 0.1-0.2 units/kg
A1c >8%: 0.2-0.3 units/kg
*Titrate q2-3 days until glycemic goal is met

57
Q

If glycemic control is not met with basal insulin, AACE/ACE says to

A 
add GLP-1 (or SGLT2; or DPP4) 
add prandial (bolus) insulin
58
Q

What is the Dawn phenomenon

A

surge of hormones the body produces in the early AM before waking (not just in diabetics)
Diabetics see fasting glucose go up bc body is making less insulin and more glucagon

59
Q

What is the Somogyi effect

A

Bedtime hypoglycemia, reflex morning hyperglycemia
*check BG at 3am!
Fix this by increasing bedtime food intake or lowering evening insulin dose

Summer pharm exam 2 (6 decks)

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