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Pharmacy > Diabetes Treatment > Flashcards

Diabetes Treatment Flashcards

1
Q

Biguanides

A

Metformin
dose related transient (except diarrhea) GI s/e
titrate slowly and take w food
alcohol increases risk of hypo
DDI radio contrast media
renal dose adjust

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2
Q

Sulfonylureas

A

Gliclazide, Glyburide, Glimepiride
AE: weight gain and hypoglycemia: don’t skip meals
renal dose adjust

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3
Q

Meglitinide

A

Repaglinide
AE: hypoglycemia
Take 0-30min before food

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4
Q

Thiazolidinediones

A

Rosiglitazone, Pioglitazone
CI: HF (edema)
AE: wt gain, increased risk of: fractures (both), MI (R), bladder cancer (P)

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5
Q

Alpha-glucosidase Inhibitors

A

Acarbose
AE: diarrhea, flatulence, cramps
Avoid in GI obstruction, ulceration, hernia
Hypoglycemia must be treated with dextrose NOT sucrose
Take w 1st bite of each meal

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6
Q

DPP4 Inhibitors

A

Sitaglitpin, Linagliptin, Saxagliptin, Alogliptin
AE: headaches, UTI, URTI, gas, bloating
rare: pancreatitis, severe joint pain

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7
Q

GLP1 Agonists

A

Subcut
Delaglutide, Exenatide, Liraglutide, Semaglutide, Lixisenatide
AE: n/v/d initially, allergic rxn (E), retinopathy (S)
CI: medullary thyroid cancer, MEN2 family hx
Caution or CI below eGFR 15-30

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8
Q

SGLT2 Inhibitors

A

Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin
AE: wt loss, lowers SBP, UTI, genital yeast infections, volume depletion, hyperkalemia, increased SCr, fracture risk
Renal: ineffective below 60 eGFR
Dose before breakfast

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9
Q

SADDMANS

A

Sulfonylureas
ACEI
Diuretics
Direct Renin Inhibitors
Metformin
ARBs
NSAIDs
SGLT2 inhibitors

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10
Q

Goal is to reach target A1C within

A

3-6 months

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11
Q

Symptoms of hypoglycemia

A

Confusion, drowsiness, dizziness, weakness, headache, vision changes, insomnia, nausea, hunger, trembling, palpitations, anxiety, sweating

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12
Q

Treatment of hypoglycemia

A

15g of carbs q15min until BG>4
eg. 3 tsp sugar, 1 tbsp honey, 4 Dex4 tabs

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13
Q

Statins indicated in diabetes when

A

age 40+, clinical CVD, microvascular complications, diabetes for over 15y and age >30, other risk factors eg ACR>2

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14
Q

ACEi/ARB indicated in diabetes when

A

age >55 w CV risk factors or end organ damage, clinical CVD, microvascular complications

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15
Q

Antihyperglycemic drugs w CV benefit

A

old: Empa, Cana, Lira
new: Dapa, Dela, Sema

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16
Q

Antihyperglycemic drugs w renal benefit

A

Empa, Cana, Dapa

17
Q

Cloudy insulins

A

NPH and protamine mixes are cloudy

18
Q

Somogyi effect

A

nocturnal hypoglycemia causes surge of counterregulatory hormones leading to nightmares, hunger, sweating and high AM FBG - treat by lowering evening dose of postponing dinner NPH

19
Q

Dawn phenomenon

A

mildly elevated AM FBG due to decrease in tissue sensitivity to insulin at 5-8am caused by counterregulatory hormones - treat by increasing evening dose or NPH and bedtime

20
Q

DKA signs and symptoms

A

Diabetic Ketoacidosis
signs: BG>14
sx: headache, n/v/dry mouth, abdominal pain, fruity acetone breath, deep laboured breathing, decreased LOC

21
Q

DKA causes

A

alcohol, extensive exercise, infection, less food or insulin, drugs (clozapine, olanzapine, cocaine, lithium, terbutaline)

22
Q

DKA treatment

A

fluid, electrolytes, insulin

23
Q

DKA when to go to the ER

A

unable to take fluids or keep BG>4, taking extra insulin but BG stilll elevated, diarrhea/vomitting>4h, ketones>3

24
Q

Urine vs blood ketone testing

A

urine is delayed, blood is quicker more accurate
go to ER if ketones >3

25
Q

Aspart, Lispro, Glulisine onset, duration

A

rapid acting
10-15m onset
3-5h duration

26
Q

Regular insulin onset, duration

A

short acting
30m onset
6.5h duration (17-24h with U500 Entuzity)

27
Q

NPH insulin onset, duration

A

intermediate acting
1-3h onset
12-18h duration

28
Q

Glargine, Detemir onset, duration

A

long acting
1.5h onset, 24h duration (36h toujeo)

29
Q

Degludec onset, duration

A

ultra-long acting
1h onset, 42h duration

30
Q

What does 30 mean in Novomix 30?

A

30% short acting (aspart) 70% intermediate (NPH)

31
Q

what does 25 or 50 mean in Humalog mix 25 or 50?

A

25 or 50% short acting (lispro) the rest is NPH

32
Q

which antihyperglycemics cause weight gain? loss?

A

gain: sulfonylureas, thiazolidinediones
loss: GLP1 and SGLT2

33
Q

which antihyperglycemics cause hypoglycemia?

A

sulfonylureas, repaglinide

34
Q

Ozempic key points

A

2mg pen usually for 0.25mgx4weeks then 0.5mgx2 weeks total 6 wks

4mg pen for 1mg/wk total 4wks

Comes with 4-6needles, dial air shot, inject sc (pinch, 90 angle) around stomach (rotate sites), hold for 5 sec, discard in sharps count.

Same needles as insulins

35
Q

Saxenda initial titration and days supply

A

90mg/box = 44 days supply following usual dose schedule: Start at 0.6mg/wk and inc by 0.6mg every week until maintenance dose of 3mg.

36
Q

Saxenda Vs Victoza

A

Both liraglutide
Victoza for diabetes 2x3ml pack
Saxenda for weight loss 5x3ml pack

Pharmacy (43 decks)

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