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IPAP JUNIOR SEM. > Diabetes Pharm III Lecture > Flashcards

Diabetes Pharm III Lecture Flashcards

1
Q

What is the cause of Type I Diabetes

A

Results from autoimmune destruction of B cells in the pancreas

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2
Q

What is the cuase of type II Diabetes

A

Results from progressive insulin resistance, decreased insulin resistiane, increased hepatic glucose output

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3
Q

What is a fasting, glucose that shows diabetes

A

126 or more

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4
Q

What is an A1C that is assoc with diabetes

A

Greater than 6.5

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5
Q

In a diabetic pt, dropping the DBP from 90 to 80, what is the reduction in major CV risk

A

50 % reduction

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6
Q

What is the ratio of A1c and Microvascular complications

A

Q 1% drop in A1c reduces the micro vasc risk by 40%

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7
Q

What is the leading cause of blindness in pts aged 20-74 y/o

A

DM

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8
Q

What is the 1st line medicaiton for DM

A

Metfromin

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9
Q

What is the perferrec agent in gestastional DM

A

Insulin

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10
Q

What is hypoglycemia

A

Blood glucose less than 70 mg/dl

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11
Q

What is level 1 hyporglycemia

A

60~70 mg/dl

Tx: 15/15/15 rule

15 gram carbs, wait 15 minutes(eval) , and then treat 15 more grams

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12
Q

What is level 2 hypoglycemia

A

Glucose 41~59 *( this pt can have CNS defects)

30/15/30 rule

30 mg of Carbs, wait 15 - eval, then 30 more Carbs

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13
Q

What is level 3 hypo gl

A

Less than 40

These pts may have SZR,

Tx with Glucagon 1 mg Sub Q ot 50 mls of D5W

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14
Q

What is the gl goal for hypoglycemia

A

Gl level above 70 and resolution of negative s/s

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15
Q

Wha is DKA

A

DM keto acidosis

Inability to produce insulin

(Common in Type I pts)

Hallmark labs are hyper gl, acidosis, anion gap, large ketones in the urine

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16
Q

What is a glucose higher than 600

A

HHS

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17
Q

What are the rapid acting insulins

A

Lispro, aspart, gluilisine

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18
Q

What is afrezza

A

Inhaled insulin

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19
Q

How must inhaled insulin be used

A

Must be used with a long acting insulin

Caution in use with Asthma pts or Smokers

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20
Q

What are the two short acting insulins

A

Humilin R or Novolin R

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21
Q

What are the DOC for IV insulin infusions

A

Short acting insulins ( humilin or Novolin)

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22
Q

What is the formulation of Insulin that is use in severe insulin resistance pts

A

U-500 Insulin ( short acting)

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23
Q

What are the two versions of NPH insulin

A

Humulin N and Novolin N

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24
Q

What are the two types of long acting insulin

A

Glargine and detemir

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25
Q

What is the DOC for pregnant insulin meds

A

reg insulin U-100

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26
Q

What are the two approaches to T1DM tx

A

Multi daily dose or continous subq infusion

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27
Q

What is the insulin dosing for Type1DM

A

0.5units/ Kg

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28
Q

What is the relationship between insulin and CHO ratio

A

1 unit of insulin for every 15 gm of CHO

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29
Q

What is the number to remember for regular insulin CHO coverage

A

450/TDD

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30
Q

What is the number to remember for rapid acting insulin CHO coverage

A

500/TDD

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31
Q

What is the corrective coverage for regualar insulin

A

1500/TDD

Corrective dose would be (current BG-desired BG) / (1500/TDD)

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32
Q

What is the corrective dose with rapid acting insulin

A

1800/TDD

Corretive dose (Current BG-deisred BB) / ( 1800/TDD)

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33
Q

What is the dawn phenomenon

A

Insuff evening basal insulin leads to AM hyperglycemia ( solution increase evening basal insulin)

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34
Q

What is the somogyi effect

A

To much insulin in the evening leads to hypoglycemia at night with compensatory hyperglycemia in the AM
(Drop the evening insulin)

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35
Q

What are the risk fx for DM2

A 
Sedetery lifestyle 
Diet 
Hyperlipidieam 
Black people 
Women 
Obesity
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36
Q

What is the goal of A1C in DM2

A

Less than 7

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37
Q

What are the excercise recommendations for DM

A

150 min of moderate intensity for more than 3 adays a week with no more than 2 days without excercise

Resestiance training at least 2 times a week

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38
Q

Because of the viscocity of the blood in a pt with DM what anitplatlet drug is recommended

A

Asprin

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39
Q

A pt presents with an AIC above 6.5%, what is the 1st step of DM2 Tx

A

Start metformin if A1C is below 10

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40
Q

A pt presents with an A1C above 10%, what is the 1st step in tx

A

Start insulin

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41
Q

A pt presents with an A1C thats 1.5% thier goal (6.5) what is the first step

A

Ao Metformin + a second agent

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42
Q

Can GLP-1s be used with DPP-4s in DM2 managment

A

NO!

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43
Q

A DM2 Pt has ASCVD or must lose wieght what is the Tx approach

A

GLP1 or SGLT2Inhb, then add which ever one you didnt use before, then add DPP-4 inhipitor( must remove GLP-1), lastly if all that doesnt work you can add Basal insulin

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44
Q

What is the Tx approach to refractory DM2 tx

A

GLP-1 + metformin ( basal insulin)

Then add preprandial Rapid acting insulins

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45
Q

In a pt with HF/CKD with DM2 what is the tx approach

A

Metformin, plus SGLT2 inhibitor, then GLP-1, THen DDP-4 (must remove the GLP-1) then laast resort basal insulin

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46
Q

What is the MOA of biguanides

A

basically metformin

Decrease hepatic glucose production
And increase insulin sensitivity

47
Q

What is the 1st line medication for T2DM

A

Biguanides

48
Q

What are the C/I of biguanides

A

Scra greatter than 1.4 in women or 1.5 in men

Can cause lactic acidosis

49
Q

What is the marjor ADE of metformin

A

GI upset/ diarrhea ( try to convince the pts to stay on the medicaion for 2-3 weeks to out last the ADE, which can go away on its own)

50
Q

Contrast dye + metfromin leads to an increase risk of what state?

A

Acidosis

51
Q

How does climidine intereact with metformin

A

Increases the concentration of metformin

52
Q

What is the MOA of Sulfonylureas (SU)

A

Stim. Pancreating bera cell insulin release

53
Q

What are three exampples of 2nd gen (SU) drugs

A

Glipizide, glyburiode, glimepiride

54
Q

What is the common complication of Sulfonyurea

A

Hypoglycemia is the most common ADE,

55
Q

What are three 1st ine SU drugs

A

Tolbutamide, chlorpropamide, (theres one more, look it up in the slides)

56
Q

What SU is safe in pregnancy

A

2nd Gen Glyburide

Not recommended in pts with a CrCl<50

57
Q

What are the two meglitinides

A

Repaglinide and nateglinide ( basically thrid line drugs, will rarely use them)
Used as replacemnts for SU drugs at a different site

Stimulateds beta insulin release

58
Q

What are the 2 thiazolidinedions

A

Pioglitazone and rosiglitazone ( increase insulin sensitivity, at peripheral receptor sites)

59
Q

What are the ADE ot TZD meds

A

WT GAIN! Peripherral fluid retention, exacterbates CHF

60
Q

What type of cancer does pioglitazone cause

A

Bladder cancer

61
Q

What are the two types of incretin based tx

A

GLP-1 agonist

Or DPP-4 inhibitors

62
Q

What are 3 examples of a GLP-1 receptor agaonist

A

Liraglutide, exanatide, dulaglutide

All end in tide

63
Q

What are the benifits of using a GLP-1

A

Low risk hypoglycemai, suppresses gluagon, secreation slows gastric emptying, and reduces fodd intake by increaseing satiety

64
Q

What are three DDP-4 inhibitors

A

Sitagliptin
Linagliptine
Saxagliptine

65
Q

When using a DDP-4 and an SU together what must you do

A

Reduce the does of the SU by 50%

66
Q

What is the major warnign of GLP-1 agonists

A

Pancreatists ( also caused thyroid cancer in rats)

67
Q

When using a GLP-1 and a SU together, what must you do

A

Decrease the SU doose by 50%

68
Q

How must exenatide be dose and who can it not be used for

A

Prior to Am and PM meals, not recommended in CrCl <30 mls

69
Q

What medication can be used in both DM and Wt loss

A

Liraglutide and Semaglutide

70
Q

What is the major ade of alpha glucoisdase inhibitors

A

Major major GI upset, N/V/D gas gas gas

71
Q

What is the MOA of SGLT2 inhibitors

A

Reduces reabsorptions of filtered glucose so more sugar is lost in the urine ( UTI risk increase)

72
Q

What do SGLT2 drugs all end in

A

Flozin

73
Q

What are the ADE of SGLT2 drugs

A

UTI and increased fungal infections

74
Q

Canagliflozin has an ADE of

A

Increased stroke RISK

75
Q

SGLT2 drugs have what two ADE

A

Bladder cancer, and stroke

76
Q

What three classes of antispastic drugs are central acting agents

A

CNS depressants, A2 agonist, Gaba agonist

77
Q

What is the MOA of Flexeril

A

Similar to a TCA, depresses serotonergic neurons

78
Q

What is the MOA of Flexiril

A

TCA similar, suppression of seretonergic nuerons

79
Q

What muscle relazant is approved for tetanus

A

Robaxin

80
Q

What is the MOA of thiomaides

A

Block iodination and sythesis of thyroid hormones

81
Q

What does the acrynom SNOOP mean

A

For 2ndary HA

Systemic signs
Neuro S/s
fill in the rest

82
Q

What does OLD CART for migraine headaches mean

A 
Onset 
Location 
Ducation 
Charachter 
Aggravating/alleviating 
Radiating 
Timing
83
Q

What does POUNDing in migriane HA mean

A 
pulsatile 
One Day duration (4hrrs to 72 hrs) 
Unilateral 
Nauesea 
debillitating
84
Q

Define migraine without aura

A

(FILL it in)

85
Q

Define Migraine with aura

A

(FILL this in)

86
Q

What is the important mediator in migraine HA

A

5-HT (seretonin)

87
Q

What causes migraine pain

A

Trigeminal sensory nerves trigger vasoactive neuropeptides

88
Q

What is the MOA of trioptans

A

Stimulate 5-HT1B receptors causing vasoconstriction (reducing pressure in the brain)

89
Q

What are the pain control goals in migraines

A

Acute relief within 30 minutes with complete relief within 2 hrs

Return to function within 1 hr

90
Q

MIDAS II, what is the Tx approach

A

NSAIDS

91
Q

MIDAS III-IV, what is the Tx approach

A

Triptan

92
Q

Can you use ergotamine with a triptan

A

No, can only be used after 24hrs of triptan use

93
Q

What is ergotism

A

Exterme peripheral vasoconstriction leading to gangrene and peripheral vasc d/o

94
Q

What are the C/I to triptans

A

HX of Ischemic HDz, Uncontrolled HTN, CVA

95
Q

How many times can you use a triptan in a month

A

No more than 9-10 times

96
Q

What is the off label use of butorphanol

A

Migriane ( last resort)

97
Q

Using NSAIDs for more than 15 days can lead to what rebound phenomena

A

Rebound HA

98
Q

A pt with more than 4 HA a month or Migraines that last longer than 122 hours require…

A

HA prophylaxis

99
Q

What is the perferred anticonvulsant for Migraine prophylaxis

A

Valproate

100
Q

What are the C/I to Triptans

A

ASCVD, ACS, CVA, or HTN

101
Q

What is the BB of choice for Migraine prophylaxis

A

Propranalol

102
Q

What non dhp CCB is used to prevent migraines

A

Verapamil

103
Q

Pts who have 15 or more HA a month should get what prevent tx

A

Botulinum toxin A

104
Q

What is a useful prohylactic for HA in pregnancy

A

Mag

105
Q

How do CGRP INhibitors work

A

Activation of trigeminovascular system results in more CGRP than substance P

So inhibiting these, reduces pain in the head and face

Currently not included in Guidlines

106
Q

What are the 3 CGRP inhibitors

A

Erenumab, Fremanezumab, Glacanezumab

107
Q

Pt presents with bilateral dull non pulstaitle, pressure that occurs in a hat band pattern.. think

A

Tension HA

108
Q

What are the nonpharm tx of tension HA

A

massage, hot bath, massage, rest

109
Q

What is the DOC for tension prophylaxis

A

Amitryptyline

110
Q

What is a cluster HA

A

Is assoc. with hypothalamic D/f

More frequent at night/ circadian rhytym

14 fold increase in genetic disposition

Most severe of the primamry HA

111
Q

A pt presents with ipsilaterl, acute, with suprobital, or ipsilater watery eyes, forhead or facial swelling

Pt is siting and rocking back and forth or pacing clutching head

Think what kind of HA

A

Cluster HA

112
Q

What is the Tx appraoch to Cluster HA

A

O2, with sumatriptan are the DOC

Ergorts can be used but they really suck

Zolimtriptan can be used by is less effective

113
Q

What is the prophylaxis DOC for cluster HA

A

Verapamil

114
Q

What are two adjunctive tx for Cluster HA

A

Prednisone

And Dihydroergotamine

IPAP JUNIOR SEM. (43 decks)

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