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Pharm Test: Diabetes, Thyroid, Adrenal > Diabetes Type 2 > Flashcards

Diabetes Type 2 Flashcards

1
Q

Physiologic problems with DM Type 2?

A

Reduced Glucagon-like peptide-GLP-1
Insulin resistance
Loss of amylin

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2
Q

What is Glucagon-like peptide (GLP-1)?

A

Released from distal ileum and colon in response to foods containing carbs and fats

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3
Q

Risk factors for DM Type 2?

A

HDL>250
Delivering baby over 9 pounds
History of vascular disease
Atypical psychotics

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4
Q

Who should we screen for diabetes?

A

BMI>25 + other risk factor

Over age 45

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5
Q

What children should be screened for Type 2 DM?

A

BMI>85th percentile or wt. for ht.>85th percentile or wt.>120% of ideal plus 2 risk factors

  • Start at age 10 or at puberty
  • FPG every 2 years
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6
Q

What are other causes of insulin resistance?

A

PCOS
Acromegaly
Cushing’s syndrome

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7
Q

Most common microvascular complication in Type 2 DM?

A

Neuropathy

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8
Q

When should the average woman be screened for GDM?

A

24-28 weeks

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9
Q

How is GDM diagnosed?

A

FPG>95
1 hr>180
2 hr>155
3 hr>140

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10
Q

How often should a person on insulin check their blood sugars?

A

3x per day

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11
Q

Which drugs are the secretagogues?

A

Sulfonylureas

Meglitinides

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12
Q

How do Sulfonylureas work?

A

Stimulate insulin release

At higher doses decrease hepatic glucose release

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13
Q

Which drugs are Sulfonylureas?

A

Glyburide
Glipizide
Glimepiride

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14
Q

ADRs of Sulfonylureas?

A

Hypoglycemia: elderly, renal impairment
Weight gain
Rash, photosensitivity, blood dyscrasias, weakness, confusion, cholestatic jaundice

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15
Q

What is best Sulfonylurea to use?

A

Glipizide

-Give 30 mins before first meal

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16
Q

Drug interactions/contraindications with Sulfonylureas?

A

Propanolol
ETOH-do not take
Contraindicated in pregnancy
Sulfonamides/Salicylates

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17
Q

Which Secretagogues are short-acting?

A

Meglitinides

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18
Q

Which Meglitinide is a derivative of phenylalanine?

A

Nateglinide

-Less A1C reduction but more rapid than Repaglinide

19
Q

ADRs of Repaglinide?

A

Hypoglycemia

20
Q

Which drugs are Biguanides?

A

Metformin

21
Q

Drug of choice for Type 2 DM?

A

Metformin

22
Q

ADRs of Metformin?

A

GI symptoms: 50%
Lactic acidosis: patients w/ renal failure, CHF, hypoxemia, ETOH
No hypoglycemia
No weight gain

23
Q

Contraindications with Metformin?

A

Metabolic acidosis
Renal impairment:
-SCr>1.5 men
-SCr>1.4 women

24
Q

What are the TZDs?

A

Rosiglitazone

Pioglitazone

25
Q

Which TZD can we not give insulin with?

A

Rosiglitazone: edema

26
Q

How do TZDs work?

A

PPAR gamma receptor activators

  • Regulate glucose metabolism
  • Increased insulin sensitivity in fat, liver, and skeletal muscle
27
Q

Cardio effects of TZDs?

A

Rosiglitazone: increased HDLs and decreased TGs
Pioglitazone: increased LDLs and HDLs

28
Q

ADRs of TZDs?

A

Edema/weight gain
Cardiac failure
-Especially w/insulin

29
Q

Contraindications to TZDs?

A

Liver disease
Class III and IV heart failure
ETOH abuse

30
Q

Which TZD has a risk for MI?

A

Rosiglitazone

31
Q

What are the Alpha-Glucosidase inhibitors?

A

Miglitol
Acarbose
-No weight gain or hypoglycemia

32
Q

Adverse effects of Alpha-Glucosidase inhibitors?

A

Gas and diarrhea: bacteria want carbs

33
Q

How do Alpha-Glucosidase inhibitors work?

A

Inhibit carb absorption in intestines

34
Q

Contraindications to AG inhibitors?

A

Cirrhosis

Intestinal disease

35
Q

What are the DPP-4 inhibitors?

A

Sitagliptin

Saxagliptin

36
Q

What is Colesevelam?

A

Bile acid sequestrate

  • Not for mono therapy
  • Adjunct to diet and exercise
  • Previously used for LDL reduction
37
Q

Adverse effects of Colesevelam?

A

Constipation/nausea/indigestion

Increases TGs

38
Q

Contraindications for Colesevelam?

A

Bowel obstruction
Hypertriglyceridemia-induced pancreatitis
TG>500

39
Q

What is Exenatide?

A

GLP-1 agonist; not oral: injection

Adjunct therapy

40
Q

What monitoring do we need with Exenatide?

A

Renal function

41
Q

ADRs for Exenatide?

A 
N/V/D: 40%
Weight loss
Hypoglycemia
Antibodies to drug
Can't use in Type 1 DM
42
Q

Treatment for hyperosmolar hyperglycemia?

A

Fluids

Insulin bolus

43
Q

Which diabetes patients get most CVD benefits from blood sugar control?

A

Type 1 DM patients

Pharm Test: Diabetes, Thyroid, Adrenal (4 decks)

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