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P&T P3 > Diabetes therapeutics > Flashcards

Diabetes therapeutics Flashcards

1
Q

What is A1c actually measuring

A

The % of hemoglobin that is glycated, which reflects the average blood glucose over 2-3 months

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2
Q

How often A1c should be checked if not at goal

A

every 3 months

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3
Q

How often A1c should be checked if at goal

A

every 6 months

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4
Q

General A1c goal

A
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5
Q

General FBG goal

A

80-130 mg/dL

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6
Q

General 2hr post-prandial glucose goal

A
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7
Q

General BP goal for diabetic pts

A
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8
Q

Statin therapy if

A

no statin

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9
Q

Statin therapy if 100, smoking, HTN, obesity)

A

moderate/high intensity

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10
Q

Statin therapy if

A

high intensity

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11
Q

Statin therapy if >40 y/o and no risk factors

A

moderate intensity

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12
Q

Statin therapy if 40-75 y/o with CVD risk factors (LDL>100, smoking, obesity, HTN) or overt CVD

A

high intensity

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13
Q

Statin therapy if your >75 y/o with CVD risk factors (LDL>100, smoking, obesity, HTN)

A

moderate or high intensity

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14
Q

Statin therapy if >75 y/o with overt CVD

A

high intensity

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15
Q

When to recommend aspirin therapy in diabetic patients

A

primary prevention if 10 year CV risk >10% or if secondary prevention

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16
Q

lab test that can differentiate type I from type II DM

A

C-peptide

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17
Q

Cloudy insulins

A

NPH, NPL

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18
Q

Insulin that is acidic and can cause burning when injected

A

glargine

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19
Q

Initial daily insulin dose for Type I DM

A

0.5-1 units/kg/day, 50% basal and 50% bolus (split between meals)

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20
Q

How to determine the grams of carbs covered by 1 unit of short acting insulin

A

500/TDD

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21
Q

How to determine the glucose lowering effect (mg/dL) of 1 unit of rapid acting insulin

A

1700/TDD

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22
Q

How to determine the glucose lowering (mg/dL) effect of 1 unit of regular insulin

A

1500/TDD

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23
Q

Conversion from NPH to glargine/detemire

A

~80% of long acting dose

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24
Q

Conversion from glargine/detemire to NPH

A

1:1

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25
Q

Class of insulin used in an insulin pump

A

rapid-acting

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26
Q

Initial dose of pramlintide

A

15 mcg with meals

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27
Q

Vitamin deficiency that can result from metformin therapy

A

Vitamin B12

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28
Q

SrCr level under which metfromin is contraindicated

A

1.5 mg/dL for men or 1.4mg/dL for women

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29
Q

Target dose for metformin

A

2000 mg/day usually given 1000 mg BID

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30
Q

glucose lowering effect of metformin

A

dec. FBG 50-60 mg/dL and A1c 1.5-2%

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31
Q

glucose lowering effect of TZDs

A

Dec. FBG 50-60 mg/dL and A1c 1-2%

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32
Q

4 side effects of TZDs

A
  1. fluid retention/weight loss
  2. cholesterol (rosiglitasone)
  3. bladder cancer
  4. loss of bone density with long term use
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33
Q

Glucose lowering effect of sulfonylureas

A

Dec. FBG 50-60% and A1c 1.5-2%

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34
Q

3 main side effects of sulfonylureas

A
  1. hypoglycemia
  2. weight gain
  3. hyperinsulinemia (decrease time to beta-cell burn out)
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35
Q

Sulfonyl urea that should not be used in CrCl

A

glyburide

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36
Q

Glucose lowering effect of meglitinides

A

Dec. A1c 1.4-1.9%

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37
Q

Limiting side effect of alpha-glucosidase inhibitors

A

GI (constipation and bloating)

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38
Q

Where incretin is released from

A

intestinal mucosa cells

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39
Q

4 effects of GLP-1 for DM2 treatment

A
  1. glucose-dependant insulin secretion
  2. inhibits beta-cell apoptosis
  3. Beta-cell proliferation
  4. Upregulation of insulin biosynthesis
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40
Q

3 conditions where Incretin mimetics are NOT recommended

A
  1. CrCl
41
Q

Major SE of incretin mimetics

A

N/V/D

42
Q

CrCl level that requires dose adjustment for sitagliptin

A
43
Q

CrCl level that requires dose adjustment for saxagliptan

A
44
Q

CrCl level that requires dose adjustment for alogliptan

A
45
Q

DPP4 inhibitor that dose not need dose adjustment based on kidney function

A

linagliptan

46
Q

CrCl level that is CI for canagliflozin

A
47
Q

CrCl level that is CI for dapagliflozin

A
48
Q

CrCl level that is CI for empagliflozin

A
49
Q

4 side effects for SGLT2 inhibitors

A
  1. weight loss
  2. hyperkalemia
  3. UTIs
  4. hypotension
50
Q

Initial basal insulin dose for DM2

A

0.2 units/kg/day or 10 units

51
Q

dopamine agonist that could be used adjunctively to sulfonylurea

A

bromocriptine

52
Q

Recommended % of diet that is carbs

A

45-55%

53
Q

Recommended % of diet that is fat

A

25-25% with

54
Q

Recommended fiber intake

A

14g/1000 calories

55
Q

Recommended cholesterol intake

A
56
Q

Recommended salt intake

A
57
Q

Talking to a person in a way that encourages them to make lifestyle changes

A

Motivational interviewing

58
Q

First line for pre-diabetes

A

metformin

59
Q

When to screen for GDM

A

24-48 weeks using 75g OGTT

60
Q

Diagnostic criteria for GDM

A

FBG >92 mg/dL, 1hr PPBG >180 mg/dL, 2hr PPBG >153 mg/dL

61
Q

Gold standard treatment for GDM

A

Insulin

62
Q

Diabetes that has some antibodies present but onset is typically not until >25 y/o

A

Latent Autoimmue Diabetes in Adults

63
Q

Non-antibody diabetes that has onset

A

Mature Onset Diabetes in the Young (MODY)

64
Q

treatment for hypoglycemia

A
  1. check blood sugar if possible
  2. eat simple sugar (fruit, juice, milk) 15-20 g CHO
  3. wait 15 min and recheck BG
  4. eat a small snack (crackers, small sandwich)
65
Q

Rebound hyperglycemia due to nocturnal hypoglycemia episode

A

Somogyi effect

66
Q

Morning hyperglycemia due to morning cortisol release

A

Down phenomenon

67
Q

2 treatment options for severe hypoglycemia (BG

A
  1. IM glucagon (reconstituted before use)

2. IV dextrose

68
Q

Leading cause of death in people with DM2

A

MI

69
Q

A1c diagnosis for diabetes

A

> 6.5%

70
Q

FBG diagnosis for diabetes

A

> 126 mg/dL

71
Q

2hr PPBG during 75g OGTT for diabetes diagnosis

A

> 200 mg/dL

72
Q

Random BG that is diagnostic for diabetes

A

> 200 mg/dL

73
Q

interval to repeat diabetes testing if you get a normal result

A

3 years

74
Q

Frequency of A1c testing in controlled patients

A

at least every 2 years

75
Q

Frequency of A1c testing in patients whose therapy has changed or who are uncontrolled

A

every 3 months

76
Q

A1c diagnosis for pre-diabetes

A

5.7-6.4%

77
Q

BMI over which you can consider bariatric surgery

A

> 35 kg/m2

78
Q

BP target for pregnant patients with DM

A

110-129/65-79

79
Q

How often to measure urine albumin in DM

A

annually

80
Q

Urine albumin level that indicates use of ACEI or ARB

A

> 30 mg/24 hr

81
Q

Frequency of dilates and comprehensive eye exam

A

every 1-2 years

82
Q

How often diabetic patients should have a foot exam

A

annually

83
Q

When to screen GDM patients for persistant DM

A

at 6-12 wks postpartum and every 1-3 years thereafter

84
Q

targets for women with DM2 during pregnancy

A

A1c

85
Q

targets for women with GDM, without prexisting DM

A

FBG

86
Q

The preferred method of glycemic control in hospitalized pts

A

Insulin

87
Q

BG level when you should initiate insulin in hospitalized patients

A

> 180 mg/dL

88
Q

glycemic targets for non-critically ill hospitalized patients

A

FBG

89
Q

BG goal for most critically ill patients

A

140-180 mg/dL

90
Q

Influenza vaccine recommendation for DM pateints

A

annually in all pt’s >6 months old

91
Q

PPSV23 vaccine recommendation for DM pts

A

all pts >2 y/o

92
Q

PCV13 recommendation for DM patients

A

if >65 and previously vaccinated with PPSV23, administer PCV13 followed by PPSV23 6-12 months after PCV13 and at least 5 years since most recent PPSV23 dose

93
Q

Hep B vaccine recommendations for DM patients

A

all unvaccinated adults age 15-59, consider if >60

94
Q

3 ketone bodies produced in ketoacidosis due to FA breakdown

A

acetone, acetoacetate, beta-hydroxybutyrate

95
Q

Route of the problem when pH and PaCO2 are both acidic or alkaline

A

respiratory

96
Q

Route of the problem when PH an HCO3 are both acidic or both alkaline

A

metabolic

97
Q

Calculation of anion gap

A

Na - (Cl + HCO3)

98
Q

An elevated anion gap

A

> 12-15

99
Q

2 reasons why A1c may be inaccurate

A
  1. High RBC turnover (anemia, pregnancy)

2. Recent blood transfusion (dialysis)

P&T P3 (10 decks)

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