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Endocrine Pathology > Diabetic Pharmacology > Flashcards

Diabetic Pharmacology Flashcards

1
Q

What does rapid acting insulin form a basal bolus of?

A

A basal bolus regime

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2
Q

What is short acting insulin used in?

A

Pumps

Sliding scale

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3
Q

What does biphasic insulin consist of?

A

Two phases

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4
Q

What is biphasic insulin a mix of?

A

Intermediate acting insulin

Short acting insulin

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5
Q

What do intermediate and long acting insulins provide?

A

All day cover

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6
Q

Intermediate vs Long acting

A

Intermediate there is a bit more of a peak than long acting and therefore risk of hypos

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7
Q

When does long acting insulin tend to be used and how often?

A

T1DM

Twice daily

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8
Q

When is biphasic insulin useful?

A

Elderly
Problems injecting
Sedentary lifestyle

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9
Q

What is the issue with biphasic insulin overnight?

A

Hypos overnight so will need a snack at bedtime

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10
Q

What does a basal bolus consist of?

A

50% short acting

50% something else

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11
Q

What does carb counting consist of?

A

Count how much CHO and adjust insulin

Check 2 hours later and adjust if need

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12
Q

What kind of control is the insulin pump good for and in what kind of people?

A

Erratic control

Good for athletic people

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13
Q

What do you still expect in T2DM?

A

Slight insulin production from the pancreas

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14
Q

What is the aim of treatment of T2DM?

A

Just need a bit of insulin to take the stress off their pancreas

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15
Q

What type of metformin is tolerated the best?

A

Slow release

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16
Q

What change in HbA1c does metformin give?

A

A decrease by 11mmol

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17
Q

What is metformins influence on weight?

A

Decrease / stays the same

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18
Q

Side effects of metformin

A

GI

Lactic acidosis

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19
Q

Does metformin give you hypos?

A

No

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20
Q

Can metformin be used in renal impairment?

A

Yes, but not when < 30ml

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21
Q

Is metformin cheap?

A

Yes

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22
Q

Why does metformin not make you put on weight?

A

As it does not produce insulin

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23
Q

Why does metformin not give you hypos?

A

As it does not produce insulin

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24
Q

How do sulphonyureas work?

A

Promote secretion of insulin in a non glucose dependent manner

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25
Q

What change in HbA1c does sulphonyureas give?`

A

Decrease by 11mmol

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26
Q

Effect of sulphonyureas on weight

A

Increases weight

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27
Q

Side effects of sulphonyureas

A

GI

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28
Q

Can sulphonyureas give you hypos?

A

Yes

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29
Q

Example of a sulphonyurea

A

Glycoside

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30
Q

Can sulphonyureas be used in renal impairment?

A

Yes but monitored

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31
Q

Is sulphonyureas cost effective?

A

Yes, they are cheap

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32
Q

How much does pigoglitazone decrease the HbA1c by?

A

A decrease by 11mmol

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33
Q

How does pigoglitazone work?

A

PRR receptor agonist

Makes more of the receptors by making more of a gene

34
Q

How long does pigoglitazone take to work?

A

5 - 6 months to work as creating new receptors

35
Q

Pigoglitazone effect on weight

A

Increases your weight

36
Q

Side effects of pigoglitazone

A 
Changes in metabolism leading to increased lipid upload into the cells
Oedema
Weight gain 
Fracture risk 
Cancer risk 
Congestive Heart failure effects
37
Q

Does pigoglitazone give you hypos?

A

No

38
Q

Can pigoglitazone be used in renal impairment?

A

Yes

39
Q

How much does pigoglitazone cost per month?

A

£16 / month

40
Q

How much do DPP4 inhibitors decrease your HbA1c by?

A

Decrease in 8-9mmol/l (not as good as the others)

41
Q

DPP4 inhibitors effect on your weight?

A

A slight decrease in weight

42
Q

Does DPP4 inhibitors give you hypos?

A

No

43
Q

How much for DPP4 inhibitors cost per month?

A

£32 per month

44
Q

What has DPP4 inhibitors been linked with?

A

CCF admissions

45
Q

How is GLP1 given?

A

Injectable

46
Q

Who is GLP1 good for?

A

Young people

47
Q

How does GLP1 work?

A

Naturally occurs in gut - incretin
Produced when you eat and tells the pancreas to produce insulin - decreasing glucagon secretion and increasing satiety
Only does this in the presence of glucose (no hypos)
Blocks active GLP1 to inactive GLP1 and so more GLP1 is produced
Makes you lose weight as you feel full

48
Q

What does GLP1 do to your weight?

A

Decreases it (big amount)

49
Q

Side effects of GLP1

A

Nausea and vomiting

50
Q

Does GLP1 cause hypos?

A

No

51
Q

How much does GLP1 cost per month?

A

£72 per month

52
Q

How much does GLP1 decrease your HbA1c by?

A

BIG decrease (11mmol)

53
Q

How much does SGLT2 decrease your HbA1c by?

A

11mmol

54
Q

Effect of SGLT2 on weight

A

Lose weight

55
Q

Side effects of SGLT2

A

UTI
DKA (even in T2DM)
Genital tract infection

56
Q

Does SGLT2 cause hypos?

A

No

57
Q

Can SGLT2 be used in renal impairment?

A

No

58
Q

How much does SGLT2 cost per month?

A

£36 / month

59
Q

How does SGLT2 work?

A

Blocks the kidney from reabsorbing glucose which is also filtered so you are peeing out glucose

60
Q

Why does SGLT2 give UTIs?

A

Sugary urine

61
Q

Why cant SGLT2 be used in renal impairment?

A

As have to have filtering capacity

62
Q

What occupations are especially a problem with T2DM and why?

A

Shift workers

Diet, convenience foods etc

63
Q

What happens to patients with T2DM after 10 years diagnosis?

A

They loose their ability to make their own insulin

64
Q

What is the target of HbA1c in the elderly compared to everyone else? Why is this?

A

Higher target

To reduce risk of hypos / falls

65
Q

Protocol before adjusting insulin levels

A

Monitor BG at different times of the day
Look at the pattern
Adjust accordingly

66
Q

What makes up metabolic syndrome?

A

HTN
Increased total cholesterol
Increased BG

67
Q

Which of SGLT2 and DPP4 has a better weight loss?

A

SGLT2

68
Q

If adjust the dose of a medication for example levothyroxine, when should the TFTs be checked?

A

6 - 8 weeks later

69
Q

What is the volume distribution?

A

The volume in which a drug will dissociate

70
Q

What needs to be done in respect to volume distribution if a patient loses weight?

A

Need to alter the dose of the drug as the concentration of the drug in the body would increase if lost weight

71
Q

What is the goal of metformin?

A

To utilise the insulin they are producing

72
Q

What is the first line GLP1?

A

Loragradtiade

73
Q

What insulin does the insulin pump use? What does this consist of?

A

Novorapid

- short acting amounts over 24 hours

74
Q

Who is eligible for an insulin pump?

A

T1DM
Carb counting
Proficient carb counting confirmed by the dietician

75
Q

What does the libra monitoring system measure the blood glucose of?

A

The interstitial fluid

76
Q

Why is the libra monitoring system only 80% accurate?

A

Delay behind the blood

77
Q

What is a positive value for ketones?

A

> 1.0

78
Q

What is a ketone value indicating some are present but more insulin is needed?

A

0.6 - 1.0

79
Q

What value indicates that there is no ketones present?

A

< 0.6

80
Q

What needs to be done to any insulin pen that is cloudy?

A

Mixing

Endocrine Pathology (11 decks)

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