Brainscape's Knowledge GenomeTM

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


See full index

SMUPASPG19-PHARM 1 > Diabetes Melletius > Flashcards

Diabetes Melletius Flashcards

1
Q

What is treatment for Type 1 and Type 2

A

Type 1
insulin
Amylin mimetic

Type 2
Lifestyle AND/or
oral meds AND/or
insulin

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

what is screening criteria for Type 2?

A

all adults 45y
overwt/obese (BMI >25 or 23 Asians) w/ risk
Repeat min 3yrs

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

What is normal, ADA, AACE guidelines for glycemic contol

A

NORMAL
Pre prandial glucose- <100
Peak post prandial glucose- <140
Hgb A1C- 4-5%

ADA
Pre prandial glucose- <80-130
Peak post prandial glucose- <180
Hgb A1C- <7%, elderly 8%

AACE
Pre prandial glucose- <110
Peak post prandial glucose- <140
Hgb A1C- <6.5%

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

What are looser targets?

A

A1c- 7.5-8% older comorbidities +2, hypogly prone
tigher younger <6.5, <7 healthy

If not at goal 3mo check up

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

Why is hypoglycemia a concern?

A

TREat at BG <70
54 clinically significant
Sx/ shaking, tachycardia, diaphoresis, weak, anxious, huger, HA, dizzy, irritable

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

Exercise goals for DM?

A

LOW CHO
achieve 5% loss
150min/wk moderate-intense activity
Resistane 2-3x/wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

name wt loss meds

A 
Short term Phetermine
Long- Orlistat
Lorcaserin
Naltrexone/buproion
LIIRAGLUTIDE

Surgery-consider BMI >40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is standard of care for prediabest and DM?

A

All METFORMIN and lifesyle changes

Insulin- hyperglycemia, >10%A1C

Dual RX- if AIC great than 1.5% of NEW GOAL

RE-eval Q3 mo , add/changes if NO T AT GOAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What drug is benefical for CV?

A

SGLT2 inhibitors- CHF

GLP1s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Who are the GLIPTINS?

A 
DDP-4 INHIBTORS
Sitagliptin
Saxagliptin
Linagliptin
Alogliptin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the FOZINS?

A

SGLT-2 INHIBITORS
Canaglifozin
Dapaglifozin
Empaglifozin

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

MEET THE GLINIDES?

A

METGlNIDE
Repaglinide
Nateglinide

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

MEET SUGAR BOSE…

A

ALPHA- GLUCOSIDASE INHBITOROS
Acarbose
Miglitol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

WHO ARE THE BILE ACID SEQUESTORS?

A

Colesevalem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

NAME THAT TZD-ZONE?

A

THIASOLADINEDIONES
Rosiglitazone
Pioglitazone

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

What is 1st line along w/ diet and exercise with LITTLE CAUSE FOR HYPOGLYCEMIA?

A

Biguanide (METFORMIN)
Prediabetes benefits
NO HYPOGLYCEMIA

MOA- 1- DEC LIVER glu output- dizzy when fasting
2. INC peripheral glu uptake
NO effect on INSULIN SECRETION
Dec A1c, FBG, LDL, TG
INC HDL
PK-RENAL
DOSE LOW, START SLOW
ADE- AN, N initiaitn-titrate, DIARRHEA, DEC B12
RARE- NEUROPATHY, METALIC,
BBW- LACTIC ACIDOISIS

AVOID- RENAL IMPAIRMENT, CR<30-45
D/C PRIOR TO CONTRAST IMAGING-24HRS
Cimetidne (gi ulcer)- inc levels

17
Q

What is dose for Metformin?

A

Iniital 500mg BID or 850 QD w/ meals
progress to 500/wk

MAX- 2000/dy

18
Q

If A1c not met at 3 mo., BUT pt does NOT have ASCVID OR CKD, then….add one of the following

A 
SGLT2
GLP
DDP4
sulfonylurea-$
TZDs

BasAl Inulin

19
Q

What RX helps with major CV event and mortality?

A

SGLT2s: Empagliflozin > canagliflozin

GLP-1 receptor agonist: Liraglutide > semaglutide > exenatide extended release

20
Q

What RX help w/ Reduction in HF and reduction in CKD progression?

A

SGLT2s: empagliflozin, canagliflozin

21
Q

What RX in DM help w/ Weight Loss?

A

SGLT2s
GLP-1 RA:
#1Semaglutide
> Liraglutide > dulaglutide > exenatide >lixisenatide

22
Q

What RX mimic incretin hormone with DM2 who are not adequately controlled with metformin, need to lose wt and has CVD risk, BUT has Hypoglycemic risk?

A

GLP-1 Receptor agonists: TIDES
MOA: Mimics the effects of an incretin hormone called glucagon-like peptide-1 (GLP-1)
Stress response to high BG levels
Inhibits release of glucagon after meals
Slows the rate of gastric emptying-full quicker..less wt

stimulates production of insulin

ADE- HYPOGLYCEMIA, NVD, dizzy. INJ site reaction***
BBWC- medullary THYROID carcinoma Cell Tumor
SLOW gi- altr oral drugs rates

AVOID- Renal impaired CrCL<30
GI dz
Pancreatitis

23
Q

What is regimen for GLP-1?

A

INJECT
Exenatide IR .
0.5 – 1 % BID

Exenatide ER
1.5- 2 % Weekly

***Liraglutide- FDA APPROVed wt loss and CVD
1-1.5 %Daily

Dulaglutide ,Semaglutide
1-1.5 %Weekly

24
Q

What DM RX has Benefit in decreasing ASCVD/CHF/CKD Weight loss, BUT INC risk of UTIs?

A

Sodium Glucose Co-Transporters

MOA-Inhibits glucose and sodium reabsorption in renal proximal tubule. INC urinary glucose excretion

DEC: A1c 0.6-1.2%, FBG and PPG. weight and BP

PK- LIVER, Excretion: fecal and renal

ADE- Hypoglycemia risk is low
too much acid in the blood   
Polyuria 
UTI 
Hypotension 
Dapaglifozin: Nasopharyngitis

AVOID- RENAL DZ., Elderly, LIVER DZ

25
Q

WHat is a 3rd line option that prolongs incretin hormone/ GLP?

A 
DPP4 GLIPTINS,,
Inhibits DPP-4 enzyme that activates GLP, thus GLP last longer.  GLP reacts to INC sugar, slow emptying.
Maintains BS homestatis. DEC GLUCAGON
Insulin secretion- NO HYPOGLY
DEC A1C- 0.7%
DEC FBG

PK-RENAL ADJ, T1/2 = 12.4 hrs
Lina: BILE elim, T1/2 = >100hrs

ADE- HA, PANCRETITIS, URI, JT PAIN**
SITA- FDA- JT PAIN, PANCREATISIS
Sax: UTI, SKIN, CHF-FDA**
Lina- HYPOGLY, JT PAIN

AVOID- LIVER FAILURE

26
Q

What DM is rarely used, avoided in CHF and induce CYP3A4?

A

THIAZOLIDINEDIONES-ZONES

MOA
Peroxisome proliferator activated receptor (PPAR) agonist to incr glu uptake
INC insulin sensitivity 
DEC hepatic glu OUTPUT 
NO HYPOGlYCemia
↓ A1C- 0.6-1.3%, 
↓ FBG
↑HDL &amp; LDL- ROS
↓ TG - PIO

PK- SLOW ONSET OF ACTION 4 MONTHS

ADE-WT GAIN, HEPATIC DZ- monitor LFT
Edema-CHF risk
Anemia
BBW-Avoid heart failure- PIO
PREG D,X
Liver Dz
***Bladder CAncer- PIO
MI- Rosi
FX risk

DI- PIO- CYP3A4-DEC; ***OCP, HMGCOA
Osteoporosis

AVOID- CHF

27
Q

What is the older agent with increase in hypoglycemia?

A

Sulfonylureas- P/B-rides

MOA-Stimulate insulin secretion pancreatic β cells
Clinical- $, old, >40 new onset, <5y, dec vessel damage, easy
↓FPG by 60-70 mg
↓A1c 1-2%

PK-All LIVER, EXCEPT***glyburide- KIDNEY feces

ADE- HYPOglycemia***, Wt gain,
GI
Derm-rash photosens
PREG D,X

DI- INC SU effects- antacids, fluconazole
DEC SU effects- rifampin, cyclo

Hepatic meta
Renal excrete:
Tolazamide; glyburide - careful
dose adj in elderly hypoglycemia MC; wt gain, derm: rash, photosen, pruritus, hyersen rxn, GI: N/V, abnrml LFT, dyspepsia, abnrml taste, dizziness, drowsiness, constipation ↑hypogly: antacids, H2 blockers, PPIs, large dose ASA, Gemfibrozil
↓hypogly: rifampin Oldest agent, inexpensive, FBG <200, good choice for new-onset >40yo or have DM <5yrs, no previous tx w/ insulin
not 1st line in overwt pts,

glipizide/ glimepriride prefer in CrCl <50

28
Q

What is not longer due to INC risk of HYPOGLY?

A

Glyburide

29
Q

HYPOGLYCEMIA risk?

A

glyburide, glipizide, glimepiride- Sulfonylureas–
repaglinide, nateglinide- Metaglinide

Insulin

30
Q

What inhibit hepatic glucose output?

A

Metformin

Colesevelam- UKNO

31
Q

What are the insulin sensitizers?

A

PIOglitazone
ROSgliazone
Metformin-periphery

32
Q

What slow absorption of CHO

A

Acarbose

Miglitol

33
Q

What INC glucose dependent- insulin AND DEC glucagon secretion?

A

GLP- glutides, tides

DDP4-gliptins

34
Q

Which cause wt gain?

A

TZD-zone
SU- B/P-ide
Metglinides
INsulin

35
Q

Which are ideal for Wt loss?

A

Metformin-min
GLP- slow gastric empty-full
SGLT-diuetic
Pramitdine

SMUPASPG19-PHARM 1 (17 decks)

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