DM Flashcards
Name 6 drugs that cause hyperglycemia.
Glucagon Steroids Epi Thyroid hormones OCPs Diuretics (HTCZ)
Lispro is a _______-acting insulin that closely mimics human insulin. It is has a _______ onset and _______ duration.
immediate
quick onset
short duration
Short term insulin is called ________.
regular
Name an intermediate insulin that lasts about 12 hours and takes 2 hours to take effect.
NPH
Name a long-acting insulin.
Glargine or Detemir
When starting insulin treatment, you should start a patient on ___% of their actual dose.
75%
Give an example of a normal insulin regimen for a 100 kg patient.
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.
Standard strength for insulin is…Why should you be cautious?
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.
Infections cause an _______ in BG.
increase
When pregnant, you should switch to _________. Why?
insulin because it is a larger molecule and will not cross placenta.
What cardiac drug masks the signs of hypoglycemia? What are these signs?
BETA BLOCKERS.
Signs: tremor, HA, malaise, increase in HR
Where do you inject insulin?
SQ in fat at a 45 degree angle.
What are the 4 major classes of oral agents for glycemic control?
Sulfonylureas
Biguanides
Thiazolidinediones
SGPT-2 inhibitors
Sulfonylurea use requires what organ to function?
30% pancreatic function
Are Ss PPB?
yes
Ss do what in hepatic, adipose and muscle cells?
enhance insulin effects (make body more sensitive)
Why should long acting Ss be avoided in the elderly?
risk of bottoming out
2nd generation Ss are more ________ and can be administered in ________doses.
more potent
lower doses
MOA of Biguanides…. They are are _______ without insulin.
Reduce hepatic glucose production.
ineffective w/o insulin
What is the sole Biguanide?
Metformin
What should you caution with Metformin? With what specific patients should you be cautious with especially?
Lactic acidosis. renal or hepatic dysfunction cardiogenic/septic shock pregnancy Anyone getting injected with contrast dye.
Thiazolidinediones or _________ have what effect on patients? They are _____line agents.
Glitazones
sensitize patients to insulin via stimulating PPARy
2nd line
What patients should NOT take thiazolidinediones?
people with heart or hepatic failure
Meglitinides are similar to what class of oral agents?
3rd generation Ss
Exenatide or _______ is structurally similar to what? Can it be given alone? How is it administered?
Byetta
GLP-1 that enhances insulin secretion and promotes satiety
No, it is adjunctive.
SQ
Which oral agent has a black box warning? what is the warning for?
Long-acting GLP-1 agonists
thyroid c-cell tumors
What is Januvia?
DPP-4 inhibitor that prevent metabolism of GLP-1.
Which two adjunctive therapies cause GI distress?
Acarbose and Miglitol.
Which adjunctive therapy reduces post-prandial glucagon secretion, slows gastric emptying and reduces caloric intake.
Pramlinitide or Symlin (mimics amylin)
Which drug causes the patient to waste glucose in the urine? What are some AEs? Which patients are these helpful in ONLY?
Canaglifozen, which inhibits SGPT-2
Yeast infections, UTIs, balanitis, increased LDL, possibly decreased bone density
Type II
How should DKA be treated?
insulin gtt at 0.5-10u per hour titrated to q1-2h FS
reach BG of 60
K and phosphate replacement
Orlistat, which ________absorption of dietary fat, causes what side effect? What else should you co-prescribe for these patients?
prevents 30% of dietary fat
GI distress, (addictive)
fat soluble vitamins–ADEK
Phentermine directly/indirectly increases metabolic rate. What schedule is this drug?
directly via activation of CNS.
C-4
Lorcaserin is a __________receptor agonist.
BMI requirement of ____ or ___+RF.
It is a C-___ drug.
serotonin
>30 or 27+RF
C-4
Who should NOT take Lorcaserin?
pregnant women –teratenogenic!!
Phentermine and Lorcaserin should only be taken for ___ weeks.
12 weeks
Phentermine and Topirmate has the same BMI requirement, C-4 classification and pregnancy category X as _________.
Lorcaserin
