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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
What change in HbA1c does sulphonyureas give?`
Decrease by 11mmol
26
Effect of sulphonyureas on weight
Increases weight
27
Side effects of sulphonyureas
GI
28
Can sulphonyureas give you hypos?
Yes
29
Example of a sulphonyurea
Glycoside
30
Can sulphonyureas be used in renal impairment?
Yes but monitored
31
Is sulphonyureas cost effective?
Yes, they are cheap
32
How much does pigoglitazone decrease the HbA1c by?
A decrease by 11mmol
33
How does pigoglitazone work?
PRR receptor agonist | Makes more of the receptors by making more of a gene
34
How long does pigoglitazone take to work?
5 - 6 months to work as creating new receptors
35
Pigoglitazone effect on weight
Increases your weight
36
Side effects of pigoglitazone
``` Changes in metabolism leading to increased lipid upload into the cells Oedema Weight gain Fracture risk Cancer risk Congestive Heart failure effects ```
37
Does pigoglitazone give you hypos?
No
38
Can pigoglitazone be used in renal impairment?
Yes
39
How much does pigoglitazone cost per month?
£16 / month
40
How much do DPP4 inhibitors decrease your HbA1c by?
Decrease in 8-9mmol/l (not as good as the others)
41
DPP4 inhibitors effect on your weight?
A slight decrease in weight
42
Does DPP4 inhibitors give you hypos?
No
43
How much for DPP4 inhibitors cost per month?
£32 per month
44
What has DPP4 inhibitors been linked with?
CCF admissions
45
How is GLP1 given?
Injectable
46
Who is GLP1 good for?
Young people
47
How does GLP1 work?
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
What does GLP1 do to your weight?
Decreases it (big amount)
49
Side effects of GLP1
Nausea and vomiting
50
Does GLP1 cause hypos?
No
51
How much does GLP1 cost per month?
£72 per month
52
How much does GLP1 decrease your HbA1c by?
BIG decrease (11mmol)
53
How much does SGLT2 decrease your HbA1c by?
11mmol
54
Effect of SGLT2 on weight
Lose weight
55
Side effects of SGLT2
UTI DKA (even in T2DM) Genital tract infection
56
Does SGLT2 cause hypos?
No
57
Can SGLT2 be used in renal impairment?
No
58
How much does SGLT2 cost per month?
£36 / month
59
How does SGLT2 work?
Blocks the kidney from reabsorbing glucose which is also filtered so you are peeing out glucose
60
Why does SGLT2 give UTIs?
Sugary urine
61
Why cant SGLT2 be used in renal impairment?
As have to have filtering capacity
62
What occupations are especially a problem with T2DM and why?
Shift workers | Diet, convenience foods etc
63
What happens to patients with T2DM after 10 years diagnosis?
They loose their ability to make their own insulin
64
What is the target of HbA1c in the elderly compared to everyone else? Why is this?
Higher target | To reduce risk of hypos / falls
65
Protocol before adjusting insulin levels
Monitor BG at different times of the day Look at the pattern Adjust accordingly
66
What makes up metabolic syndrome?
HTN Increased total cholesterol Increased BG
67
Which of SGLT2 and DPP4 has a better weight loss?
SGLT2
68
If adjust the dose of a medication for example levothyroxine, when should the TFTs be checked?
6 - 8 weeks later
69
What is the volume distribution?
The volume in which a drug will dissociate
70
What needs to be done in respect to volume distribution if a patient loses weight?
Need to alter the dose of the drug as the concentration of the drug in the body would increase if lost weight
71
What is the goal of metformin?
To utilise the insulin they are producing
72
What is the first line GLP1?
Loragradtiade
73
What insulin does the insulin pump use? What does this consist of?
Novorapid | - short acting amounts over 24 hours
74
Who is eligible for an insulin pump?
T1DM Carb counting Proficient carb counting confirmed by the dietician
75
What does the libra monitoring system measure the blood glucose of?
The interstitial fluid
76
Why is the libra monitoring system only 80% accurate?
Delay behind the blood
77
What is a positive value for ketones?
> 1.0
78
What is a ketone value indicating some are present but more insulin is needed?
0.6 - 1.0
79
What value indicates that there is no ketones present?
< 0.6
80
What needs to be done to any insulin pen that is cloudy?
Mixing

Endocrine Pathology (11 decks)

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