DM

Question 1

Name 6 drugs that cause hyperglycemia.

Answer 1

Glucagon
Steroids
Epi
Thyroid hormones
OCPs
Diuretics (HTCZ)

Question 2

Lispro is a _______-acting insulin that closely mimics human insulin. It is has a _______ onset and _______ duration.

Answer 2

immediate
quick onset
short duration

Question 3

Short term insulin is called ________.

Answer 3

regular

Question 4

Name an intermediate insulin that lasts about 12 hours and takes 2 hours to take effect.

Answer 4

NPH

Question 5

Name a long-acting insulin.

Answer 5

Glargine or Detemir

Question 6

When starting insulin treatment, you should start a patient on ___% of their actual dose.

Answer 6

75%

Question 7

Give an example of a normal insulin regimen for a 100 kg patient.

Answer 7

BIPHASIC
Start with 75u. Give 70% NPH and 30% Regular
In the AM, give 75% of 75 = 52u
In the PM, give 25% = 23u
Do q6 finger sticks and keep BG log.

Question 8

Standard strength for insulin is…Why should you be cautious?

Answer 8

100u/ml
Because that means that each ml has 100 units of insulin in it. Therefore, when pulling it from a 1000u vial, you should ONLY use a 1ml or 1cc syringe. 1u/kg is a typical dose.

Question 9

Infections cause an _______ in BG.

Answer 9

increase

Question 10

When pregnant, you should switch to _________. Why?

Answer 10

insulin because it is a larger molecule and will not cross placenta.

Question 11

What cardiac drug masks the signs of hypoglycemia? What are these signs?

Answer 11

BETA BLOCKERS.

Signs: tremor, HA, malaise, increase in HR

Question 12

Where do you inject insulin?

Answer 12

SQ in fat at a 45 degree angle.

Question 13

What are the 4 major classes of oral agents for glycemic control?

Answer 13

Sulfonylureas
Biguanides
Thiazolidinediones
SGPT-2 inhibitors

Question 14

Sulfonylurea use requires what organ to function?

Answer 14

30% pancreatic function

Question 15

Are Ss PPB?

Answer 15

yes

Question 16

Ss do what in hepatic, adipose and muscle cells?

Answer 16

enhance insulin effects (make body more sensitive)

Question 17

Why should long acting Ss be avoided in the elderly?

Answer 17

risk of bottoming out

Question 18

2nd generation Ss are more ________ and can be administered in ________doses.

Answer 18

more potent

lower doses

Question 19

MOA of Biguanides…. They are are _______ without insulin.

Answer 19

Reduce hepatic glucose production.

ineffective w/o insulin

Question 20

What is the sole Biguanide?

Answer 20

Metformin

Question 21

What should you caution with Metformin? With what specific patients should you be cautious with especially?

Answer 21

Lactic acidosis.
renal or hepatic dysfunction
cardiogenic/septic shock
pregnancy
Anyone getting injected with contrast dye.

Question 22

Thiazolidinediones or _________ have what effect on patients? They are _____line agents.

Answer 22

Glitazones
sensitize patients to insulin via stimulating PPARy
2nd line

Question 23

What patients should NOT take thiazolidinediones?

Answer 23

people with heart or hepatic failure

Question 24

Meglitinides are similar to what class of oral agents?

Answer 24

3rd generation Ss

Question 25

Exenatide or _______ is structurally similar to what? Can it be given alone? How is it administered?

Answer 25

Byetta
GLP-1 that enhances insulin secretion and promotes satiety
No, it is adjunctive.
SQ

Question 26

Which oral agent has a black box warning? what is the warning for?

Answer 26

Long-acting GLP-1 agonists

thyroid c-cell tumors

Question 27

What is Januvia?

Answer 27

DPP-4 inhibitor that prevent metabolism of GLP-1.

Question 28

Which two adjunctive therapies cause GI distress?

Answer 28

Acarbose and Miglitol.

Question 29

Which adjunctive therapy reduces post-prandial glucagon secretion, slows gastric emptying and reduces caloric intake.

Answer 29

Pramlinitide or Symlin (mimics amylin)

Question 30

Which drug causes the patient to waste glucose in the urine? What are some AEs? Which patients are these helpful in ONLY?

Answer 30

Canaglifozen, which inhibits SGPT-2
Yeast infections, UTIs, balanitis, increased LDL, possibly decreased bone density
Type II

Question 31

How should DKA be treated?

Answer 31

insulin gtt at 0.5-10u per hour titrated to q1-2h FS
reach BG of 60
K and phosphate replacement

Question 32

Orlistat, which ________absorption of dietary fat, causes what side effect? What else should you co-prescribe for these patients?

Answer 32

prevents 30% of dietary fat
GI distress, (addictive)
fat soluble vitamins–ADEK

Question 33

Phentermine directly/indirectly increases metabolic rate. What schedule is this drug?

Answer 33

directly via activation of CNS.

C-4

Question 34

Lorcaserin is a __________receptor agonist.
BMI requirement of ____ or ___+RF.
It is a C-___ drug.

Answer 34

serotonin
>30 or 27+RF
C-4

Question 35

Who should NOT take Lorcaserin?

Answer 35

pregnant women –teratenogenic!!

Question 36

Phentermine and Lorcaserin should only be taken for ___ weeks.

Answer 36

12 weeks

Question 37

Phentermine and Topirmate has the same BMI requirement, C-4 classification and pregnancy category X as _________.

Answer 37

Lorcaserin