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ClinPhar II Lec > DM > Flashcards

DM Flashcards

1
Q

Most common endocrine disorder

A

Diabetes mellitus

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2
Q

A group of metabolic disease characterized by inappropriate chronic hyperglycemia with disturbances of carbohydrates, fats and protein metabolism resulting from defect in insulin secretion, insulin action or both

A

Diabetes mellitus

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3
Q

T/F: DM is a chronic condition

A

True

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4
Q

Identify the year (DM Classification):
* Infantile or Childhood
* Young
* Adult
* Elderly

A

1965

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5
Q

Identify the year (DM Classification):
* Insulin dependent DM
* Non-Insulin Dependent DM
* Other Types

A

1985

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6
Q

Identify the year (DM Classification):
* Type 1 * Type 2

A

1999

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7
Q

Identify the year (DM Classification):
* Type 1
* Type 2
* Specific Type
due to other
causes
* Gestational
diabetes

A

2023

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8
Q

(DM Type) Destruction of pancreatic beta cell responsible of insulin production

A

Type 1 DM

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9
Q

(DM Type) Associated with autoimmune disease

A

Type 1 DM

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10
Q

(DM Type) Usually develops in children and young adult

A

Type 1 DM

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11
Q

(DM Type) Associated with a faster onset of symptoms, leading to dependency on extrinsic insulin for survival

A

Type 1 DM

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12
Q

(DM Type) More common type of diabetes

A

Type 2 DM

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13
Q

(DM Type) Occurs in adults older than 40 years

A

Type 2 DM

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14
Q

(DM Type) Peaks onset between 60 and 70
years

A

Type 2 DM

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15
Q

(DM Type) Caused by a relative insulin deficiency and the body’s inability to effectively use insulin

A

Type 2 DM

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16
Q

(DM Type) Symptoms are slower in onset and less marked than those of Type 1 DM

A

Type 2 DM

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17
Q

Hyperglycemia that is first detected during pregnancy, usually diagnosed during the 2nd or 3rd trimester

A

Gestational diabetes

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18
Q

Gestational diabetes is usually diagnosed during ______ or ______ trimester

A

2nd or 3rd

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19
Q

Gestational diabetes is associated with adverse outcomes, including hypertension or _________, ___________ or fetal death

A

pre-eclampsia, fetal macrosomia

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20
Q

(DM Type) onset is acute-symptomatic

A

Type 1 DM

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21
Q

(DM Type) onset is slow-often-asymptomatic

A

Type 2 DM

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22
Q

(DM Type) clinical picture: weight loss, polyuria, polydipsia

A

Type 1 DM

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23
Q

(DM Type) clinical picture: obese, strong family history, pcos

A

Type 2 DM

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24
Q

T/F: Type 1 and Type 2 DM has the same clinical picture but Type 2 DM has additional

A

True

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25
Q

Ketosis: Almost always present

A

Type 1

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26
Q

No ketosis

A

Type 2

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27
Q

Antibodies: ICA+, Anti-Gad+, ICA512+

A

Type 1

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28
Q

Antibodies: ICA-, Anti-GAD-, ICA 512-

A

Type 2

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29
Q

Therapy: Insulin

A

Type 1

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30
Q

Therapy: Lifestyle, oral anti-diabetic agents, insulin

A

Type 2

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31
Q

Associated auto-immune diseases

A

Type 1

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32
Q

Not associated with auto-immune diseases

A

Type 2

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33
Q

C-peptide is ________ in Type 1

A

Low or absent

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34
Q

C-peptide is ________ in Type 2

A

Normal or elevated

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35
Q

Hormones affecting sugar levels in the body

A
  • Insulin
  • Counterregulatory hormones
  • Incretin hormones * Amylin
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36
Q

Regulates CHO, CHON and lipid metabolism by promoting glucose uptake into the cell

A

Insulin

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37
Q

Promotes conversion of glucose to glycogen

A

Insulin

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38
Q

Facilitates cellular uptake of amino acids

A

Insulin

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39
Q

Decreases the breakdown of fatty acids into ketone bodies

A

Insulin

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40
Q

Produced during low glucose levels to increase the amount of glucose in the body

A

Counterregulatory hormones

41
Q

Antagonizes insulin effects

A

Counterregulatory hormones

42
Q

Promotes conversion of glycogen to glucose

A

Counterregulatory hormones

43
Q

glucagon, growth hormones, catecholamines, cortisol

A

Counterregulatory hormones

44
Q

Released or secreted after meal or nutrient intake to stimulate release of insulin

A

Incretin hormones

45
Q

Inhibits inappropriate glucone secretion and increases beta cell growth and reproduction

A

Incretin hormones

46
Q

Suppresses appetite

A

Incretin hormones, Amylin

47
Q

Gastric inhibitory peptide (GIP) and Glucagon-like peptides (GLP)

A

Incretin hormones

48
Q

Co-secreted with insulin

A

Amylin

49
Q

Lowers post-prandial blood glucose level by prolonging the gastric emptying time

A

Amylin

50
Q

Reduces post-prandial glucagon secretion

A

Amylin

51
Q

___________ and __________ appear to code for either disease susceptibility or resistance of T1DM

A

Human Leukocyte Antigen (HLA) DQA and DQB

52
Q

Environment factors in the pathophysioogy of T1DM

A

Viral, chemical or dietary

52
Q

Autoimmunity in T1DM

A
  • Anti-insulin ,anti-beta cell antibodies
  • Antibodies to glutamic acid decarboxylase
53
Q

T/F: there is a > 90% concordance rate in identical twins if one has T2 DM

A

True

54
Q

T2DM: __________dysfunction -> improper insulin secretion

A

Beta cell

55
Q

Post-receptor binding, a decreased number of insulin receptor or defects in insulin receptors can lead to hyperglycemia (T2DM)

A

Peripheral site defect

56
Q

For T2DM: Screening should be considered in ___________ who have overweight or obesity and who have one or more additional risk factors

A

youth

57
Q

Risk factors of T2DM

A
  • Maternal history of DM or GDM during the child’s gestation
  • Family history of T2 DM in first- or second-degree relative
  • Race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander)
  • Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS, or small-for-gestational-age birth weight)
58
Q

(Most Common) Symptoms of Diabetes

A
  • Glucosuria
  • Polyuria
  • Polydipsia
  • Polyphagia * Weight loss
59
Q

Symptoms of Diabetes

A

Systemic weight loss
Sexual problems
Always Tired
Frequent Urination
Always Hungry
Wounds won’t heal
Blurry vision
Vaginal Infections
Always thirsty
Numbness or tingling in hands or feet

60
Q

Fasting Blood Glucose Level

A

≥ 126 mg/dL

61
Q

Random Blood Glucose Level

A

≥ 200mg/dL

62
Q

Oral Glucose Tolerance Test

A

≥ 200 mg/dL

63
Q

Hemoglobin A1c

A

≥ 6.5%

64
Q

Criteria for dx of diabetes:

FPG = ______________
2h PG = ________________ using _____ anhydrous glucose dissolved in water
A1C ___________
random plasma glucose _______

A

FPG = >/= 126 mg/dL (7.0 mmol/L)
2-h PG = >/= 200 mg/dL (11.1 mmol/L)
A1C = >/= 6.5% (48 mmol/mol)
random plasma glucose = >/= 200 mg/dL (11.1 mmol/L)

65
Q

Testing for Asymptomatic Individuals:

A
  • Physical activity
  • 1st degree relative with diabetes
  • High-risk ethnicity (African Americans, Latino, Native Americans, Asian
    Americans, Pacific Islander)
  • Women who delivered a baby weighing ≥ 9 lbs. or diagnosed with GDM
  • Hypertension (≥ 140/90 mmHg or on therapy for HTN)
  • HDL level < 35 mg/dL and/or triglyceride level > 250mg/dL
  • Women with polycystic ovaries syndrome
  • Previous testing indicative of pre-diabetes
  • Clinical condition with insulin resistance
  • History of CVD
66
Q

Diabetes complications

A

Atherosclerosis (Stroke, Heart Attack, Artery Disease)
Retinopathy (Cataract, Glaucoma)
Neuropathy (Diabetic Foot)
Nephropathy

67
Q

Treatment Goals

A
  • Prevent Complications * Optimize Quality of Life
68
Q

Decision Cycle for Person-Centered Glycemic Management (T2DM)

A
  • Assess Key Person Characteristics
  • Consider Specific Factors that Impact Choice of Treatment
  • Utilize Shared Decision-Making to Create a Management Plan
  • Agree on Management Plan
  • Implement Management Plan
  • Provide Ongoing Support and Monitoring * Review and Agree on Management Plan
69
Q

Required for glycemic management in individuals with T1DM

A

Insulin

70
Q

May be used in combination with oral agent or amylin agonist

A

Insulin

71
Q

May also be initial or adjunctive agent for individual with T2DM

A

Insulin

72
Q

Stimulates hepatic glycogen synthesis

A

Insulin

73
Q

Increase protein synthesis

A

Insulin

74
Q

Facilitates triglyceride synthesis and storage by adipocytes

A

Insulin

75
Q

Inhibits lipolysis

A

Insulin

76
Q

Stimulates peripheral uptake of glucose

A

Insulin

77
Q

Pramlintide

A

Amylin Receptor Agonists

78
Q

Enhance post-prandial control in individual with T1DM and T2DM

A

Amylin Receptor Agonists

79
Q

CI: Gastric motility disorder

A

Amylin Receptor Agonists

80
Q
  • Slow gastric emptying time
  • Decrease post-prandial glucagon secretion * Suppresses appetite
A

Amylin Receptor Agonists

81
Q

GLP-1 agonist

A

Incretin mimetics

82
Q

Exenatide, Liraglutide, -glutides

A

Incretin mimetics

83
Q

Management of T2DM

A

Incretin mimetics

84
Q

CI: Severe GI motility, pancreatitis, renal or hepatic impairment

A

Incretin mimetics

85
Q

MOA
* Increase glucose-dependent insulin secretion, * Decrease hepatic glucose output
* Increase beta cell growth and replication
* Slow gastric emptying time
* Enhance satiety or feeling of fullness to suppress appetite

A

Incretin mimetics

86
Q

Sitagliptin, Saxagliptin, Linagliptin

A

Dipeptidyl peptidase IV (DPP IV) inhibitors

87
Q

Indication: Patients with T2DM with normal or impaired
hepatic and renal function

A

Dipeptidyl peptidase IV (DPP IV) inhibitors

88
Q

CI: Pancreatitis

A

Dipeptidyl peptidase IV (DPP IV) inhibitors

89
Q

MOA:
* Prevents the inactivation of incretin hormones by the enzyme DPP IV during hyperglycemia
* Inhibits the breakdown of GLP-1 allowing increased insulin secretion and decrease hepatic glucose production

A

Dipeptidyl peptidase IV (DPP IV) inhibitors

90
Q

Targets fasting blood glucose level

A

Sulfonyureas

91
Q

Binds to and inhibits the ATP-sensitive potassium channels to
increase the beta cell sensitivity to glucose and stimulate the
secretion of insulin

A

Sulfonyureas

92
Q

Protein-bound

A

Sulfonyureas

93
Q

Prone to drug-drug interactions

A

Sulfonyureas

94
Q

1st Generation Sulfonyureas

A

Tolbutamide, Tolazamide, Chlorpropamide

95
Q

Typically not prescribed since 2nd gen has fewer ADR

A

1st Generation Sulfonyureas

96
Q

Associated with thrombocytopenia, agranulocytosis, hemolytic anemia, hyponatremia, SIADH, disulfiram-like reactions

A

1st Generation Sulfonyureas

97
Q

2nd Generation Sulfonyureas

A

Glyburide, Glipizide, Glimepiride

98
Q
A

ClinPhar II Lec (6 decks)

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