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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
What are the specifics of the ADA algorithm
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
Major concerns with diabetes medications are
hypoglycemia, weight change, CV effects, Renal adjustments, and FDA warnings
27
Which drugs cause hypoglycemia
Sulfonylureas | Insulin
28
Which drugs cause weight gain
TZD Sulfonyluras Insulin
29
Which drugs cause weight loss
+/- Metformin GLP-1 Agonist SGLT2 inhibitors (DPP4 are weight neutral)
30
Which drugs are CV beneficial
Liraglutide, Semaglutide (GLP) Canagliflozin, Empagliflozin (SGLT2) +/- Metformin
31
Which drugs are renally beneficial
Liraglutide (GLP1) | Canagliflozin, Empagliflozin (SGLT2)
32
Metformin is contraindicated in
``` Renal insufficiency (GFR <30) But we start watching renal function with a GFR at 50-60 ```
33
What other glucose lowering agents can be used in T2DM
``` Bile acid sequestrate (Colesevelam)- increase incretin level Dopamine agonist (Bromocriptine)- increase insulin sensitivity ```
34
What is your first line med, always
METFORMIN! Enhances insulin sensitivity, increase glucose uptake -but start low, go slow
35
What are the TZD and how do they work
Pioglitazone* (rosiglitazone) Enhance insulin sensitivity in muscle, liver, fat (pio +/- decrease TG)
36
ADE of TZD are
Fluid retention fat accumulation weight gain
37
What are the Sulfonylureas/ Metaglinides
S: Glipizide, Glimepiride M: Regaglinide, Nateglinide
38
What are ADE of Sulfonylureas/ Metaglinides
weight gain hypoglycemia *Third line agents! but very patient affordable- give GOOD patient education
39
What are the GLP-1 agonists and how do they work
Exenatide, Liraglutide, Semaglutide | Increase insulin secretion, decrease hepatic glucose, slow gastric emptying
40
What are the DPP4 inhibitors and how do they work
Sitagliptan, Saxagliptan, Linagliptan, Alogliptan | Block DPP4 from degrading GLP1= increase insulin secretion, decrease hepatic glucose, slow gastric emptying
41
What are ADE of DPP4 inhibitors
Urticaria, facial edema | Rare: SJS
42
What are the SGLT2 inhibitors and how do they work
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
What are the alpha glucosidase inhibitors and how do they work
Acarbose, Miglitol | Break down carbs in small intestine= prolonged carb absorption
44
ADE of a-glucosidase inhibitors are
Flatulence, bloating, abdominal discomfort, diarrhea
45
How do Bile acid sequestrants benefit T2DM
Bind bile acid in intestine= decreased bile acid pool | Reduce LDL 12-16% (but NOT is used w/ metformin)
46
How do Dopamine agonists benefit T2DM
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
What are the categories of insulin
Basal: intermediate, long acting | Prandial (bolus): rapid acting, short
48
How can you lose and maintain weight in diabetes management
Reduce kcal intake: LOSE weight | Exercise: MAINTAIN weight
49
What meds can be used to treat obesity
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
Per AACE/ACE, what is goal BP for diabetics and what are preferred meds
<130/80 ACE/ARB If BP >150/100, ACE/ARB + CCB, BB, or Thiazide
51
Per AACE/ACE, if BP is not at goal in 2-3 months...
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
Per AACE/ACE, what should goal A1c for diabetic be
W/o serious comorbidities or risk for hypoglycemia: <6.5% | w/ comorbidities/risk for hypoglycemia: >6.5%
53
AACE/ACE says at 7.5% A1c you start
Lifestyle modifications + Monotherapy | Metformin, GLP1, SGLT2, DPP4, TZD (caution), AGi, SU/GLN (caution)
54
Per AACE/ACE, dual therapy consists of
Metformin + any previously stated, colesevelam, bromocriptine, or basal insulin (same as triple therapy)
55
If entry A1c is >9%, AACE/ACE says
Not symptomatic: dual or triple therapy | Sx: insulin +/- other agents
56
At what rate do you start basal insulin, per AACE/ACE
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
If glycemic control is not met with basal insulin, AACE/ACE says to
``` add GLP-1 (or SGLT2; or DPP4) add prandial (bolus) insulin ```
58
What is the Dawn phenomenon
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
What is the Somogyi effect
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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