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YL7 Pharma Compre > DM 2 > Flashcards

DM 2 Flashcards

1
Q

sig for different types of insulin

A

rapid: 5-15 mins before meals
short: 30 mins pre meal
intermediate: bid (before bfast and dinner)
long: od to bid

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2
Q

longest acting insulin

A

newest: insulin degludec

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3
Q

types of insulin based on use

A

basal: nph, long acting insulin
prandial: regular, rapid-acting
combination

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4
Q

what is nph + regular insulin

A

3 total injections

  • morning: bolus of regular + nph
  • afternoon: regular
  • night: regular + nph
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5
Q

what is long acting + rapid acting insulin

A

4 total injections

  • 1 basal insulin
  • 3 prandial rapid acting
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6
Q

what is pramlintide

A
  • other agent approved for t1dm
  • amylin agonist
  • moa: causes appetite suppression, slows gastric emptying (satiety), inhibits release of glucagon (dec glycogenolysis)
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7
Q

glycemic targets

A

hba1c <7%
pre meal 80-130
post meal 180

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8
Q

three pronged approach to t2dm management

A
  • individualized glycemic control
  • treat associated conditions
  • screen for dm complications
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9
Q

drug classes for treating dm

A 
1 biguanides
2 sulfonylureas
3 non-su insulin secretagogues
4 a-glucosidase inhibitors
5 dpp-4 inhibitors
6 sglt-2 inhibitors
7 glp-1 receptor antagonists
8 thiazolidinediones
9 insulin
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10
Q

what are biguanides

A
  • moa: reduced hepatic glucose production
  • lowers fbs
  • contra: discontinues if hospitalized, on npo, or radiocontast given
  • metformin
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11
Q

what are sulfonylureas

A
  • moa: stimulate insulin secretion (atp sensitive k channels on beta cells)
  • dec in fbs and ppbs
  • most effective for recent onset dm
  • “g-ide”s (glipizide, glyburide, gliclazide)
  • ades: hypoglycemia, weight gain
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12
Q

what are glinides/non-su

A
  • moa: stimulate insulin secretion (sur1 portion)
  • dec ppbs
  • “glinide”s (repaglinide, mitiglinide)
  • ae: hypoglycemia
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13
Q

what are incretin based therapies: glp1 receptor agonists

A
  • moa: mimic endogenous incretins
  • dec fbs and ppbs
  • promotes weight loss
  • contra: medullary thyroid ca, pancreatic disease
  • “tide”s
  • injectable
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14
Q

what are incretin based therapies: dpp4 inhibitors

A
  • moa: prevent degradation of endogenous glp1
  • reduce ppbs
  • “liptin”s
  • oral
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15
Q

what are alpha glucosidase inhibitors

A
  • moa: reduce glucose absorption in small intestines
  • dec ppbs
  • “bose”
  • contra: gi problems
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16
Q

what are thiazolidinediones

A
  • moa: reduce insulin resistance by binding to nuclear receptor ppary, increased expression of glut4
  • promotes glucose uptake, redistribution of fat
  • “glitazone”
17
Q

what are sglt2 inhibitors

A
  • moa: urinary glucose excretion (only insulin independent drug)
  • weight loss and bp reduction (diuretic)
  • “aglifiozin”
  • ade: genital mycotic and uti, orthostatic hypotension
18
Q

strongest hba1c reduction agent

A

insulin, then mnt and lifestyle change

19
Q

other therapies

A

read: colesevelam and bromocriptine

20
Q

indications for insulin therapy in t2dm

A

initial therapy for

  • very high baseline glucose with possible glucotoxicity
  • hypercatabolic diabetics
  • renal and liver patients
  • hospitalized or acutely ill
21
Q

insulin therapy strategies

A
  • start with bedtime basal insulin

- can combine with ohas except sus

22
Q

initiation of oral medication for t2dm

A
  • <200 mgdl = 1 oral agent
  • 200-250 mgdl = 2 oral agents/dual therapy
  • > 250 mg = insulin agad
23
Q

unite for diabetes philippines cpg

A
  • hba1c <9 AND fbs <250 = monotherapy

- hba1c >9 AND fbs >250 = combination OR insulin

24
Q

guidelines of aa endo

A
  • first line: lifestyle therapy
  • hba1c <7 = monotherapy, metformin
  • hba1c 7.5-9 = dual or triple therapy with metformin as primary
  • > 9, no symptoms = dual or triple therapy
  • > 9, with symptoms = insulin +/- others
25
Q

surgical therapies

A
  • transplant

- bariatric surgery!!

YL7 Pharma Compre (14 decks)

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