Diabetez pt 1 (basics, oral meds) Flashcards

1
Q

When do we treat prediabetes with pharm therapy and what do we use? How often do we monitor?

A

When BMI is greater than 35, age < 60, or women with history of gestational diabetes

Use metformin

Monitor annually

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2
Q

Gestational diabetes - goals? Treatment?

A

Fasting < 95, 1-hour post meal < 140, 2-hours post meal < 120

Insulin is preferred treatment

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3
Q

When should we test someone for T2DM? How often should we repeat if tests are normal?

A

Screen adults who are overweight or obese (BMI > 25 or > 23 in Asian Americans) and who have one or more additional risk factor

Test after age 45 regardless of risk factors

Normal test results should be repeated every 3 years

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4
Q

Waist circumference goals

A

< 35 in for females, < 40 in for male

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5
Q

Nutritional supplements recommended

A

Omega-3 fatty acids (EPA and DHA) and omega-3 linolenic acid (ALA)

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6
Q

Carbohydrate serving is how many grams?

A

15

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7
Q

Which diabetic agents have been shown to decrease cardiovascular and all-cause mortality when added to standard treatment?

A

Empagliflozin (Jardiance)

Liraglutide (Victoza)

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8
Q

When should aspirin be added to diabetes therapy?

A

Primary prevention: age > 50 years who have diabetes and at least one additional ASCVD risk factor

Secondary prevention: everyone

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9
Q

When are statins recommended with diabetes therapy?

A

In most patients with diabetes, intensity of dosing is based on ASCVD risk
ACC/AHA: Recommend high intensity in patients age 40-75 who have diabetes plus ASCVD risk

ADA recommends:
Age < 40 years, only if they have ascvd risk factors
Age > 75 years, mod intensity of they have no risk factors or mod/high if they have risk factors

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10
Q

Preferred anti-htn in diabetes?

A

ACEi or ARB preferred in patients with albuminuria (urine albumin > 30 mg/24 hours or UACR > 30 mg/g)

Otherwise any agent from the preferred classes are fine

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11
Q

How to monitor for renal disease progression in diabetes?

A

Annual urine albumin excretion

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12
Q

How to monitor for retinopathy in diabetes?

A

Eye exams every 2 years

Women with preexisting diabetes who become pregnant: higher risk, check each trimester and up to 1 year postpartum

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13
Q

How to monitor for neuropathy?

A

Assess annually using 10-g monofilament and at least one additional test (pinprick, temperature, or vibration sensation)

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14
Q

Preferred agents for neuropathy per the ADA?

A

Duloxetine, pregabalin

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15
Q

How to monitor for foot ulcers etc?

A

Comprehensive foot exams once per year

All patients with diabetes should inspect their feet daily

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16
Q

Foot care counseling

A

Underlined:
Check feet every day
Avoid walking barefoot
Protect feet from hot and cold

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17
Q

Vaccinations for patients w diabetes

A

Annual flu
Pneumococcal (23 x 1 between age 2-64
13 then 23 after age 65, spaced at least 1 year apart and 23 separated by 5 years after previous admin)
Hepatitis B vaccine? approved ages 19-59, per ACIP can be used in age > 60

18
Q

How often should A1C be measured?

19
Q

Drugs that can cause hyperglycemia

A
Beta blockers (or hypo)
Diuretics (thiazides/loop)
Immunosuppressants (cyclosporine, tacrolimus)
Niacin
Protease inhibitors
Quinolones (or hypo)
Second-gen antipsychotics
Statins
Steroids
20
Q

Janumet

A

Metformin and sitagliptin

21
Q

Qtern

A

Saxagliptin and dapagliflozin

DPP-4 inhibitor and SGLT2 inhibitor

22
Q

Xultophy

A

Liraglutide and insulin degludec

GLP-1 agonist + long acting insulin

23
Q

Soliqua

A

Lixisenatide and insulin glargine

GLP-1 agonist + long acting insulin

24
Q

Metformin boxed warnings

A

Lactic acidosis, increased risk with intravascular iodinated contrast, age > 65, hypoxic states, dehydration, alcohol

Underlined: contrast, alcohol, eGFR stuff

25
Renal dosing metformin
based on eGFR Contraindicated in eGFR < 30 Not recommended to initiate if between 30-45, assess benefit if already taking if eGFR < 45 and already taking
26
Side effects metformin
N/V/D Flatulence Abdominal cramping (give w/ meal) Vitamin B12 deficiency
27
Sulfonylureas and meglitinides MOA
Insuline secretagogues; work by stimulating insulin secretion from the pancreatic cells to decrease postprandial blood glucose
28
Sulfonylureas and meglitinides side effects, counseling
Meglitinides (nateglinide, repaglinide): Take 15-30 mins before meals Sulfonylureas: once or twice daily Can cause weight gain, hypoglycemia Take before meals (sulfonylureas take 30 min before breakfast, except glipizide IR take 30 mins before any meal Hold doses if NPO!
29
True or false: It's ok to use sulfonylureas and insulin together
False - high risk of hypoglycemia
30
Thiazolidinediones MOA
Increase peripheral insulin sensitivity by agonizing PPAR-gamma receptors
31
Actos dosing, generic, drug class, contraindications/warnings, side effects
Pioglitazone Thiazolidinediones 15-30 mg daily Contraindicated in Class III/IV heart failure Can cause hepatic failure, edema (including macular edema) Increased risk of bladder tumors, do not use in patients with active bladder cancer Can cause peripheral edema, weight gain Monitor for s/sx of HF
32
SGLT-2 inhibitors MOA
Increases reabsorption of filtered glucose in the proximal renal tubule (underlined) Increases urinary glucose excretion
33
Invokana generic, MOA, dose
Canagliflozin 100 mg daily but can inc to 300 mg daily Decrease based on eGFR - if 45-59, dec to 100 mg daily max Not recommended in 30-44, contraindicated < 30 SGLT-2 inhibitor
34
SGLT2 inhibitor boxed warnings, warnings, side effects, monitoring
Canagliflozin has a boxed warning for increased risk of leg and foot amputations Contraindicated in eGFR < 30 Warnings of ketoacidosis, genital mycotic infections, urosepsis, and pyelonephritis Also can cause intravascular volume depletion (hypotension, dehydration) when used with diuretics, RAAS inhibitors, or NSAIDs Canagliflozin can cause hyperkalemia Side effects: wt loss, hypoglycemia Monitor: renal fx
35
Jardiance generic, MOA, dose
``` Empagliflozin SGLT-2 inhibitor 10 mg daily, up to 25 mg daily Not recommended in eGFR 30-44 Contraindicated eGFR < 30 ```
36
DPP-4 inhibitor MOA
Increases insulin release from pancreatic beta cells and decreases glucagon excretion from pancreatic alpha cells
37
Januvia generic, MOA, dose
``` Sitagliptin DPP-4 100 mg daily CrCL 30-49: 50 mg daly CrCL < 30: 25 mg daily ```
38
Warnings w DPP-4, side effects, counseling
DPP-4 Acute pancreatitis Saxagliptin (Onglyza) and alogliptin (Nesina) can inc risk of heart failure SIde effects: nasopharyngitis, URTI's, UTI's
39
Onglyza generic, MOA, dose
Saxagliptin DPP-4 inhibitor 2.5-5 mg daily eGFR < 45: 2.5 mg daily
40
Tradjenta generic, MOA, dose
Linagliptin DPP-4 5 mg daily No renal dose adjustment!
41
Nesina generic, MOA, dose
``` Alogliptin DPP-4 25 mg daily eGFR 30-59: 12.5 mg daily < 30: 6.25 mg daily ```
42
Which drugs require glucose (not sucrose) for tx of hypoglycemia if caused by another drug?
Acarbose (Precose) or miglitol Glyset) These block metabolism of intestinal sucrose, which delays glucose absorption to reduce BG Need glucose gel or tablets if pt is on these