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Pediatric Pharm Exam 3 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Epidemiology (6)

A
  1. 18 million individuals diagnosed in the US

High risk groups

  1. African Americans
  2. Hispanics
  3. American Indians
  4. Asian Americans

Complications
6. Leading cause of blindness, end-stage renal disease, amputations, and infection; will be cumulative with duration of uncontrolled blood sugar

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2
Q

Fasting Plasma Glucose (FPG)

A

No caloric intake for at least 8 hourss

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3
Q

Oral Glucose Tolerance Test (OGTT)

A

Administration of glucose containing:
75 grams anhydrous glucose
1.75 g/kg of body weight to a maximum of 75 grams

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4
Q

Impaired Glucose Tolerance (IGT) (2)

A
  1. Measure of carbohydrate intolerance 2 hours following OGTT
  2. Also known as ‘Pre Diabetes’
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5
Q

Impaired Fasting Glucose (IFG)

A

Measure of disturbed carbohydrate metabolism

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6
Q

Classification

Type 1 Diabetes (T1DM) (3)

A
  1. Autoimmune destruction of B cells of the pancreas
  2. Onset usually preschool to teenage (can see neonatal diabetes)
  3. Antibody formation:
    - Islet cells
    - Glutamic acid decarboxylase
    - Insulin
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7
Q

Classification Type 2 Diabetes (T2DM) (2)

A
  1. Insulin resistance and a relative lack of insulin secretion
  2. Metabolic Syndrome
    - Hypertension
    - Dyslipidemia
    - Elevated plasminogen activator-1 inhibitors (PAI-1)
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8
Q

Miscellaneous Causes (6)

A
  • Pancreatitis
  • Cystic Fibrosis (CF-Related Diabetes)
  • Cushing syndrome or medication induced
  • Hyperthyroidism
  • Infections (Congenital rubella or cytomegalovirus)
  • Monogenic (Neonatal diabetes)
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9
Q 
Associated with genetic syndromes (2)
Other syndrome (1)
A

Associated with some genetic syndromes

  1. Down’s syndrome
  2. Prader-Willi syndrome

Other: Gestational diabetes

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10
Q

Screening by American Diabetes Association (5)

A
  1. Overweight (BMI > 85% percentile)

With at least two of the following:

  1. Family history
  2. Race (Native Americans, African Americans, Hispanic Americans, Asians/South Pacific Islanders)
  3. Signs of insulin resistance
  4. Screen every 2 years starting at 10 years of age or onset of puberty
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11
Q

Signs and Symptoms of DM (6)

A
  1. Polyuria, Polydipsia, Polyphagia
  2. Blurred vision
  3. Weight loss
  4. Fatigue
  5. DKA
  6. Slow healing wounds
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12
Q

Neuropathies (Microvascular) Diabetic (2)

A
  1. Sorbitol accumulation

2. Protein glycosylation (thickened basement membrane)

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13
Q

Neuropathies (Microvascular) Peripheral (2)

A
  1. Parathesia and pain

2. Begins in distal extremeties but progresses proximally

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14
Q

Neuropathies (Microvascular) Autonomic (6)

A
  1. Impotence
  2. Gastroparesis
  3. Diarrhea
  4. Neurogenic bladder
  5. Orthostatis
  6. Diminished response to hypoglycemia
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15
Q

Neuropathies (Microvascular) Retinopathy (6)

A
  1. Leading cause of new blindness

Retinal changes

  1. Microaneurysms
  2. Increased permeability
  3. Occlusion
  4. Proliferation of new blood vessels
  5. Cancers
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16
Q

Nephropathy (microvascular) (5)

A
  1. 30-40% of all diabetic patients may develop
  2. Proteinuria
  3. Decreased GFR
  4. Increased arterial blood pressure
  5. Microalbuminuria
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17
Q

Dyslipidemia (macrovascular) (4)

A
  1. Increased risk of coronary artery disease
  2. Goal LDL < 100 mg/dL
  3. Dietary intervention needed
  4. Statins should be considered; Age > 8 years
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18
Q

Hypertension (macrovascular) (4)

A
  1. Goal BP determined by age, gender, height
  2. Lifestyle modifications
  3. ACE Inhibitors drug of choice
  4. Renal protective effects
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19
Q

Treatment Goals for Age < 6 years
FBG
Bedtime
HbA1C

A

Age < 6 years

FBG – 100-180

Bedtime – 110-200

HbA1C –7.5-8.5%

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20
Q

Treatment Goals for Age 6-12 years
FBG
Bedtime
HbA1C

A

Age 6-12 years

FBG 90-180

Bedtime 100-180

HbA1C <8%

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21
Q

Treatment Goals for Age 13-19 years
FBG
Bedtime
HbA1C

A

Age 13-19 years

FBG 90-130

Bedtime 90-150

HbA1C <7.5%

22
Q

Goals for therapy (5)

A
  1. Weight loss or maintain appropriate weight & growth (good diet)
  2. Increase in exercise capacity
  3. Normalization of glycemia
  4. Control of comorbidities
  5. Education is HUGE!!!
23
Q

Pharmacologic Treatment for DM Type 1

24
Q

Pharmacologic Treatment for DM Type 2 (6)

A
  • Insulin
  • Biguanides
  • Sulfonylureas
  • Meglitinides
  • Alpha Glucosidase Inhibitors
  • Thiazolidinediones
  • … and more
25
Endogenous Insulin (6)
1. Normal Activity 2. Increases glucose uptake in tissues 3. Increases liver glycogen 4. Decreases glycogenolysis 5. Increases fatty acid synthesis 6. Decreases fatty acid metabolism
26
Exogenous Insulin (2) Types (4)
1. Similar pharmacologic activity as endogenous chemical 2. Different types depend on structure changes Pharmacokinetic properties differentiates different types of insulin Types: 1. Rapid-acting 2. Short-acting 3. Intermediate-acting 4. Long-acting
27
Rapid Acting Insulin - 3 Types
1. Insulin Aspart (NovoLog) 2. Insulin Lispro (Humalog) 3. Insulin Glulisine (Apidra)
28
Rapid Acting Insulin PK Parameters: Onset, Peak, Duration
- Onset: 15 min - Peak: 1 – 2 hrs - Duration: 3 – 4 hrs
29
Rapid Acting Insulin: Available dosage forms (4)
Insulin vials Insulin pens - Prefilled - Re-usable
30
Short-Acting Insulin: Available products
Insulin Regular (novolin R, Humalin R)
31
Short-Acting Insulin PK Parameters: Onset, peak, duration
Onset: 30-60min Peak: 2 - 4 hrs Duration: 4-8 hrs
32
Short-Acting Insulin: Available dosage forms (1)
Insulin Vials
33
Intermediate Acting Insulin: Available Products
Insulin NPH (Novolin N)
34
Intermediate Acting Insulin PK Parameters: Onset, Peak, duration
- Onset: 1-2 hrs - Peak: 4-10 hrs - Duration: 10-18 hrs
35
Intermediate Acting Insulin: Available dosage form
Insulin vials
36
Combo Products (2)
1. NovoLIN® 70/30 | 2. HumaLOG® 70/30
37
Long Acting Insulin: available agents
Insulin Determir (Levemir)
38
Long Acting Insulin: onset, peak, duration
Onset: 6 hrs Peak: 12 – 16 hrs Duration: 2hrs
39
Long Acting Insulin Dose Frequency
q12 – q24
40
Long Acting Insulin, Approved for?
use in pregnancy
41
Insulin Glargine: onset, peak, duration
Onset: 4 – 5 hrs No peak Duration: 22 – 24hrs
42
Insulin Glargine Dose frequency
Dose freq: q24 (q12)
43
Insulin Glargine Available dosage forms (2)
1. 100 Units/mL | 2. Toujeo® 200 Unit/mL
44
``` Insulin Pearls (2) Available in... ```
Most insulin available in U-100 | 100 units of insulin per mL
45
Combination preparations available (2)
1. Pre-mixed insulin analogs - 72/25 (75% NPL, 25% lispro) - 70/30 (70% APS, 30% aspart) 2. NPH-regular combinations - 70/30 (70% NPH, 30% regular)
46
Dose Regimen Basal + Bolus (4)
1. Long-acting insulin should be 40-60% of total daily insulin requirement 2. Regular or rapid acting is the remainder 3. Regular insulin 20-30 minutes prior to eating 4. Intermediate or long-acting at bedtime or twice daily
47
Dose Regimen (2)
1. Continuous SC infusion -- Insulin pump | 2. Twice daily injections with NPH
48
ADE Insulin (5)
1. Hypoglycemia 2. Weight gain 3. Lipodystrophy 4. Lipohypertrophy 5. Lipoatrophy
49
Insulin Techniques (6)
1. Rotate injection sites; Abdomen, thigh, buttocks, lateral aspect of arm 2. Clean before/after injection 3. Examine bottle, roll gently to warm 4. Inject air and draw up desired dose 5. Pinch skin with one hand 6. Pull plunger back to look for blood
50
Insulin Pearls (4)
1. Intravenous administration - Regular insulin ONLY - Used in crisis management; DKA, Surgical procedures 2. Adjust basal insulin dose 1-2 units at a time 3. Every unit of insulin may decrease glucose by 25-50 units 4. High blood sugar at office visits - Sick days
51
Somogyi Effect (2)
1. Post-hypoglycemic hyperglycemia | 2. Decrease bedtime NPH or give evening NPH later
52
Dawn Phenomenon (2)
1. Rise in glucose in early morning hours | 2. Increase evening NPH dose

Pediatric Pharm Exam 3 (11 decks)

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