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Diabetes overview Flashcards

1
Q

metformin/glyburide

A

glucovance

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2
Q

Actoplus

A

metformin/pioglitazone; Actos= pioglitazone

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3
Q

Avandamet

A

metformin/rosiglitazone; rosiglitazone is Avandia

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4
Q

Janumet

A

metformin/sitagliptin; (sitagliptin is Januvia)

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5
Q

What is the max daily dose of metformin?

A

2550mg

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6
Q

What is the BB warning with metformin?

A

lactic acidosis

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7
Q

When is metformin CI?

A

SCr> 1.5 males SCr > 1.4 females

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8
Q

When should you temporarily d/c metformin?

A

when using IV contrast

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9
Q

metformin is weight ____

A

neutral

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10
Q

What are the most common side effects of metformin & how are they mitigated?

A

diarrhea, nausea, vomiting, flatulence; often goes away take with food

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11
Q

You should not use sulfonylureas with ______ due to _____ or with _____ due to increased risk of hypoglycemia

A

meglitinides (Starlix and Prandin); similar MOA:

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12
Q

glipizide

A

Glucotrol

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13
Q

glimepriride

A

Amaryl

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14
Q

glyburide

A

dyabeta

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15
Q

What are the primary SEs of sulfonylureas?

A

hypoglycemia; weight gain

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16
Q

why is glyburide not a recommended agent?

A

has partially active, renally cleared metabolite; should avoid if CrCl less than 50

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17
Q

name the sulfonylureas

A

chlorpromamide glipizide glimepiride glyburide

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18
Q

name the meglitinides

A

repaglinide nateglinide

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19
Q

Starlix

A

nateglinide

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20
Q

What are the common SEs of meglitinides?

A

hypoglycemia, mild weight gain, upper respiratory infections

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21
Q

sulfonylureas and meglitinides work by______ and are generally taken

A

stimulating insulin secretion from the beta cells
Glipizide IR: 30 min b/4 breakfast & dinner or 30 min b/4 1st meal
Glipizide ER: with first meal of the day
Glyburide: daily with 1st meal

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22
Q

If you miss a dose of nateglinide what should you do?

A

skip dose and take next one

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23
Q

What is the MOA of thiazolidinediones?

A

peroxisome proliferator activated gamma (PPARgamma) agonists which cause increased peripheral insulin sensitivity

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24
Q

pioglitazone

A

Actos

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25
Q

rosiglitazone

A

Avandia

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26
Q

rosiglitazone/glimepiride

A

Avandaryl

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27
Q

Which antidiabetic class can exacerbate HR?

A

thiazolidinediones

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28
Q

Which drug has an increased risk of bladder cancer when used beyond 1 year?

A

pioglitazone

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29
Q

What are some good SEs of pioglitazone?

A

increases HDL, and decreases TG/total cholesterol

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30
Q

What are the SEs of the TZD clasS?

A

peripheral edema, weight gain, URTIs

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31
Q

alpha glucosidase inhibitors do what?

A

inhibit the enzyme found int he intestine that hydrolyzes carbs to glucose, therfore minimizing glucose absorption and lowering post prandial glucose

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32
Q

acarbose and miglitol belong to which class?

A

alpha glucosidase inhibitors

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33
Q

How should acarbose and miglitol be taken?

A

both are started at 25mg with the first bite of each main meal!

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34
Q

what are CI to using alpha glucosidase inhibitors (MAKES SENSE!)

A

IBD, colonic ulcerationn, intestinal obstruction (this is where they work)

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35
Q

Which drugs are weight neutral?

A

metformin acarbose/miglitol

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36
Q

Precose

A

acarbose

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37
Q

What is the MOA of DPP4 inhibitors?

A

prevent the enzyme from breaking down incretin hormones (GIP and GLP1) which help regulate blood glucose by increasing insulin release from the pancreaus and decreasing glucagon secretion from alpha cels!

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38
Q

Name the DPP4 inhibitors

A

sitagliptin, saxagliptin, linagliptin, alogliptin

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39
Q

sitagliptin

A

Januvia

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40
Q

Saxagliptin

A

Onglyza

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41
Q

sitagliptin/metformin

A

Janumet

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42
Q

Tradjenta

A

linagliptin

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43
Q

All DPP4 inhibitors require renal adjustment EXCEPT

A

linagliptin

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44
Q

Which class is associated with nasopharyngitis, URT infections and UTIs as well as peripheral edema

A

DPP4 inhibitors

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45
Q

Saxagliptin and linagliptin are major ____ substrates

A

3A4

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46
Q

Invokana

A

canagliflozin

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47
Q

What are the SEs associated with canagliflozin

A

female genital mycotic infections, UTIs, hyperkalemia, increased urination, renal insufficency, hypovolemia

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48
Q

What is the brand/generic of the SGLT2 inhibitor?

A

Invokana/canagliflozin

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49
Q

Byetta

A

exenatide

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50
Q

Bydureon

A

exenatide ER

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51
Q

What is the dosing/administration of IR exenatide?

A

start at 5mg SC BID (about 60 mins before morning/evening meals) abdomen preferred; count to 5 before withdrawing

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52
Q

How is exenatide ER given?

A

2mg SC every 7 days without regards to meals

53
Q

Can exenatide be stored at RT

A

yes up to 30 days

54
Q

What is the BB warning with Bydureon and Victoza?

A

CI in patients with hx of thyroid carcinoma or with multiple endocrine neoplasia syndrome (MEN2)

55
Q

pancreatitis is a warning associated with which antidiabetic agents

56
Q

Which class requires a medguide?

A

GLP1 agonist

57
Q

Which drugs can cause weight loss?

A

Byetta, SYmlin and Victoza

58
Q

What is the main SEs with GLP1 agonists?

A

NAUSEA!!!! Vomiting; diarrhea; weight loss; hypoglycemia

59
Q

BB warning for thyroid/endocrine neoplasms/carcinoma?

A

Victoza and Bydureon

60
Q

What is the DAILY SC injection that can be given without regard to meals?

61
Q

Which SC injection should you never inject after a meal due to risk of hypoglycemia?

A

Byetta IR always right before meals!

62
Q

What is the name of the amylin mimetic?

A

pramlintide (has amlin in it…close!)

63
Q

pramlinitide

64
Q

If starting Symlin what must you do if patient is on insulin?

A

decrease rapid; short acting; and mixed insulins by 50%!

65
Q

What is the MOA of pramlinitide?

A

amylin analog; slows gastric emptying, prevents increase in serum glucacon following a meal and increases satiety

66
Q

Nausea is a MAJOR SE of which medications?

A

exenatide, liraglutide, pramlinitide

67
Q

Which injectables should be given before meals?

A

Byetta and Symlin

68
Q

All injectable antidiabetics (besides insulin) can be stored at RT for _____

69
Q

welchol

A

colesevelam

70
Q

Who is Welchol approved for?

A

lipids and DM2! (dereases LDL and decrease A1C/postprandial

71
Q

What is a major SE with Welchol?

A

constipation

72
Q

what are the rapidacting insulins and when are they to be administered?

A

lispro (HumaLog), aspart (NovoLog),glulisine (Apidra) *given up to 15mins prior to eating, right when starting to eat or right after a meal….last about 3 to 5 hours

73
Q

How should regular insulin be given?

A

30 mins prior to meal, last 6

74
Q

How does NPH appear?

75
Q

what is the intermediate insulin, what is its onset/duration?

A

NPH (Novolin/Humulin N) onset is 1 to 2h and duration is up to 24 hours; usually peaks at 6 to 8h given 1 to 2 times daily

76
Q

Which basal insulin peaks and puts a patient at increased risk of hypoglycemia?

77
Q

What is in Novolog/Humalog Mix?

A

NovoLog 70/30: insulin aspart protamine suspen + reg. insulin aspart

HumaLog 50/50, 75/25: lispo protamine suspension + reg lispro

78
Q

What is in Novolin/Humulin mixes?

A

contains both NPH and regular insulin

79
Q

how should insulin be drawn into a syringe when mixing?

A

CLEAR before CLOUDY!! (alphabetical!)

80
Q

What insulins can be mixed with NPH?

A

regular and rapid

81
Q

When looking at insulin mix numbers which number belongs to which insulin? ex. 70/30

A

70% intermediate or long acting (1st part); 30% shorter acting (second part)

82
Q

What is the typical starting insulin dose for patients with Type 1?

A

0.6 units/kg/DAY

83
Q

How should basal bolus be divided? how about NPH/regular?

A

50/50 (the 50% bolus is divided amongst the 3 meals) and 2/3 should be NPH and 1/3 should be regular (generally dosed twice daily)

84
Q

What is the insulin to carb ratio?

A

A ratio used to adjust insulin dose for carbs in a meal

85
Q

one way to determine the insulin to carb ratio is using the Rule of ______

A

500 for rapid acting and 450 for regular

86
Q

What is the equation to determin the amount of carbs covered by 1 unit of rapid insulin & what is this called?

A

500/total daily dose (TDD) of insulin = gram of carbs covered by 1 unit rapid acting insulin (Rule of 500)

87
Q

What is the equation to determin the amount of carbs covered by 1 unit of regular insulin & what is this called?

A

450/total daily dose (TDD) of insulin = gram of carbs covered by 1 unit rapid acting insulin (Rule of 450)

88
Q

How do you determine a correction insulin dose?

A

using correction factors (1800 for rapid and 1500 for regular)

89
Q

What is the correcton factor equation for rapid acting insulin

A

1,800/TDD insulin = correction factor for 1 unit of rapid insulin

90
Q

What is the correcton factor equation for regular acting insulin

A

1,500/TDD insulin = correction factor for 1 unit of regular insulin

91
Q

How should insulin be initiated in a type 2 diabetic?

A

start with HS intermediate or long acting or AM long acting at 10 units or 0.2 units/kg

92
Q

In type 2 diabetics how should you approach increasing units of insulin?

A

based on fasting glucose, increase by 2 units every 3 days until it’s consistently in target range of 70 to 130; can increase by larger units ie 4 if fasting >180

93
Q

sliding scale

A

varies; generally similar to > 150; give 2 units for every 50 over (ex. for 200 250 give 4 units) of rapid or short acting

94
Q

unused vials and pens should be ______ but if they’re in current use can be stored at _____

A

refrigerated; room temp up to a certain period of time

95
Q

after treating hypoglycemia how soon should you test blood glucose?

A

15 mins; repeat if not corrected. once stable patient should eat a meal

96
Q

When is glucagon used?

A

only if patient is unconscious or not conscious enough to self treat!

97
Q

What is DKA caused by?

A

when there is not enough insulin and the body breaks down fat to make energy; this creates ketones which rise in the blood

98
Q

Metformin cannot be used in ____ (COPD/HF)

99
Q

How do you calculate the estimated average glucose when given an A1C

A

eAG = 28.7 x A1C minus 46.7

100
Q

What are some alternate testing sites for testing glucose?

A

upper arm, thigh, calf, fleshy parts of hands

101
Q

liraglutide

102
Q

What are some treatment options for hypoglycemia?

A

15 to 20 grams of carbohydrates are recommended for treating hypoglycemia which includes 8 oz of milk, 3to 4 glucose tabs, nondiet soda (4 oz), 2 tablespoons of raisins and other items. Be sure to retest in 15 minutes and have the patient eat a small amount of food to prevent recurrence

103
Q

when should you consider starting insulin therapy?

A

when BG >300 or when A1C >10

104
Q

doses of GLP1 agonist should be separated by at least….

A

6hrs throughout day

105
Q

Which insulins are available OTC?

A

NPH and regular insulins

106
Q

How many days can a levemir flexpen be used once opened?

107
Q

What adjustment is necessary when changing twice daily NPH to glargine?

A

reduce dose by 20%

108
Q

Diagnostic criteria for diabetes includes what values?

A

Diagnostic criteria also includes a fasting plasma glucose (FPG) of 126 mg/dL or higher or a 2hour plasma glucose of 200 mg/dL or higher during a 75 g oral glucose tolerance test (OGTT). A1C > 6.5%

109
Q

How do you convert from once daily NPH to glargine or detemir

A

Itís a 1:1 ratio

110
Q

A patient has been using NPH 20units before breakfast and 10units at bedtime. The doctor wants to switch them to Lantus once daily. How many units of lantus should they use?

A

24units ( add daily dose NPH; reduce by 20%)

111
Q

How do you convert from glargine to determir or vice versa

A

1:1 conversion

112
Q

When in use, which insulin products are good for 42 days

A

Regular: Novalin R; NPH: Novolin N vial; Mixed:Novolin 70/30 vials; Long acting: Levemir (pens & vials)

113
Q

When in use, which insulin products are good for 28 days

A

all rapid acting insulin; NPH:Humalin N vials; Mixed: Humalog, Humalin & Novolog vials; Long acting: Lantus (pens & vials), Bydureon

114
Q

When in use, which insulin products are good for 30 days

A

long acting: Byetta; Victoza; Symlin vials and pens

115
Q

When in use, which insulin products are good for 14 days

A

NPH:Humalin N & Novolin N pens; Mixed: Novolog 70/30 pens

116
Q

Humalog & Humalin pens last for how many days when in use

117
Q

Humalin R 100 & 500 units last for how many days when in use

118
Q

What are the symptoms for hypoglycemia

A

dizziness HA anxiety shakiness sweating increased hunger confusion jerky movements tremors palpitations blurred vison

119
Q

Brand name for sitagliptin + Simvastatin

120
Q

Saxagliptin + metformin

A

Kombiglyze ER

121
Q

Linagliptin + metformin

A

Jentadueto

122
Q

Generic Nesina

A

Alogliptin

123
Q

Alogliptin+metformin

124
Q

Alogliptin+pioglitazone

125
Q

Brand name miglitol

126
Q

A dose reduction of sulfonylureas may be needed with initiation of which agents

A

TZD
GLP-1agonists
DDP-4 inhibitors
Canagliflozin

127
Q

What are the Actos combination products

A

Pioglitazone + metformin =Actoplus Met IR&ER
Pioglitazone + glimepride =Duetact
Pioglitazone + alogliptin =Oseni

128
Q

Which anti diabetic agents cause hypoglycemia

A

Sulfonylurea (worst): (chlorpropamide> glyburide> glimepride~ glipizide)
Meglinitides
GLP-1 agonists: (Liraglutide < Exenatide)
SGLT2: canagliflozin
DPP-4 inhibitors

Autoimmune (4 decks)

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