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Clinical Medicine Lecture - Professor Kramer > DM TII medications > Flashcards

DM TII medications Flashcards

1
Q

Biguanides example ?

A

Metformin

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2
Q

Metformin MOA ?

A

Reduces hepatic glucose production

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3
Q

Metformin promotes ?

A

Promotes weight loss and reduces triglycerides

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4
Q

Metformin SE ?

A

Commonly causes dyspepsia, kidney injury, B12 deficiency

tough for kidney to remove - issues

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5
Q

Metformin avoid if ?

A

Avoid if creatinine >1.4

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6
Q

Sulfonylureas examples ?

A

Glyburide,

glipizide,

glimepiride

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7
Q

Sulfonylureas potentiate ?

A

insulin secretion - helps push out insulin from beta cell

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8
Q

Sulfonylureas SE ?

A

Commonly cause weight gain and hypoglycemia

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9
Q

Thiazolidinediones (TZDs)

examples ?

A

Pioglitazone,

rosiglitazone

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10
Q

Thiazolidinediones (TZDs)

sensitize ?

A

Sensitize peripheral tissues to insulin

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11
Q

Thiazolidinediones (TZDs)

avoid if ?

A

Avoid if CHF NYHA III-IV or liver disease

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12
Q

Thiazolidinediones (TZDs)

increase risk of ?

A

Increased risk of bladder cancer, fractures

increase risk of sudden cardiac death - fallen to the way side

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13
Q

A-Glucosidase inhibitors

examples ?

A

Acarbose

miglitol

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14
Q

A-Glucosidase inhibitors

delays what ?

A

absorption of carbohydrates by blocking a-glucosidase enzyme at intestine

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15
Q

A-Glucosidase inhibitors

commonly causes what ?

A

GI SE

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16
Q

A-Glucosidase inhibitors

duration ?

A

4 hrs

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17
Q

Glucagon like peptide 1 (GLP1) receptor agonists examples ?

A

Exenatide (Byetta), liraglutide

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18
Q

Glucagon like peptide 1 (GLP1) receptor agonists slows what ?

A

Slows gastric emptying,

stimulates insulin response to glucose,

reduces glucagon release after meals

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19
Q

Glucagon like peptide 1 (GLP1) receptor agonists route ?

A

Injected

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20
Q

Glucagon like peptide 1 (GLP1) receptor agonists commonly causes ?

A

nausea, pancreatitis, weight loss, thyroid cancer

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21
Q

Glucagon like peptide 1 (GLP1) receptor agonists contraindicated in ?

A

gastroparesis

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22
Q

Dipeptidyl peptidase (DPPs) examples ?

A

Saxagliptin,

sitagliptin,
vildagliptin,
linagliptin

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23
Q

Dipeptidyl peptidase (DPPs) inhibit ?

A

DPP4 activity

Prolong action of GLP1, stimulate insulin secretion, suppress release of glucagon

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24
Q

Dipeptidyl peptidase (DPPs) dosage ?

A

Dosed once daily oral

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25
Q

Dipeptidyl peptidase (DPPs) can causes ? but it is limited.

A

pancreatitis

angioedema

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26
Q

Dipeptidyl peptidase (DPPs) does NOT cause ?

A

hypoglycemia

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27
Q

Amylin synthetic

example ?

A

Pramlintide

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28
Q

Amylin synthetic

produced by ?

A

pancreatic B-cel

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29
Q

Amylin synthetic

delays ?

A

gastric emptying

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30
Q

Amylin synthetic

surpresses ?

A

glucagon

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31
Q

Amylin synthetic

decreases ?

A

appetite

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32
Q

Amylin synthetic

route ?

A

Injected

33
Q

Amylin synthetic

only approved for patients on ?

A

insulin therapy

34
Q

Bile acid sequestrants

examples ?

A

Colesevelam

35
Q

Bile acid sequestrants

also treats ?

A

hypercholesterolemia

36
Q

Bile acid sequestrants

bind to ?

A

intestinal bile acids and glucose

37
Q

Bile acid sequestrants

does NOT cause ?

A

hypoglycemia

38
Q

Bile acid sequestrants

contraindicated ?

A

very high triglyceride levels

39
Q

Bile acid sequestrants

interfere with absorption of ?

A

nutrients and medications

40
Q

Dopamine 2 agonist

examples ?

A

Bromocriptine

41
Q

Dopamine 2 agonist improves ?

A

insulin sensitivity

42
Q

Dopamine 2 agonist does NOT cause ?

A

hypoglycemia

43
Q

Dopamine 2 agonist contraindicated ?

A

with ergot medications (migraine)

44
Q

Insulin add if ?

A

fail other treatment

45
Q

___ of all DM II take insulin in addition to other hypoglycemics or alone

A

33%

46
Q

Hypoglycemia tx: if not altered ?

A

Food OR

Oral glucose

47
Q

Hypoglycemia tx: if AMS ?

A

IV/IM/SQ Glucose

Hydrocortisone

48
Q

Hypoglycemia tx: if sulfonylurea OD ?

A

IV/IM/SQ Glucose

Octreotide - somatostatin so it stops the process
esophageal varies

49
Q

Hypoglycemia patient education ?

A

Proper medication use

Proper feeding

50
Q

Hypoglycemia pharmacology ?

A

Glucose oral or IV (1g/kg dextrose in 50% solution)

Glucagon 1mg IM or SC if no IV access

10% dextrose solution may be required to maintain level above 100mg/dl

Hypoglycemia refractory to glucose may require hydrocortisone 100mg IV or glucagon 1mg IV

Octreotide has been used in preventing recurrent sulfonylurea-induced hypoglycemia

51
Q

Diabetes mellitus type I tx ?

A

Lifestyle measures
Insulin
Regular monitoring

52
Q

DMTI tx: rapid insulin example ?

A

Lispro

Aspart

Glulisine

53
Q

DMTI tx: regular insulin example ?

A

Regular

54
Q

DMTI tx: longer acting insulin example ?

A

Neutral protamine Hagedorn (NPH)

55
Q

DMTI tx: basal insulin examples ?

A

Glargine

Detemir

56
Q

Rapid insulin peak ?

A

60-90 min

57
Q

Rapid insulin duration ?

A

4-5 hours

58
Q

Rapid insulin notes ?

A

Take 20 minutes before meal

59
Q

Regular insulin peak ?

A

2-4 hours

60
Q

Regular insulin duration ?

A

5-8 hours

61
Q

Regular insulin notes ?

A

Take 30 minutes before meal

62
Q

Longer acting insulin peak ?

A

5-8 hours

63
Q

Longer acting insulin duration ?

A

12-24 hours

64
Q

Longer acting insulin notes ?

A

Usually twice daily

65
Q

Basal insulin peak ?

A

No peak - so helps maintain G levels

66
Q

Basal insulin duration ?

A

12-24 hours

67
Q

Basal insulin notes ?

A

Usually once daily (detemir may be twice)

**basal important cause it is better to stay constantly high rather than be up and down

68
Q 
Analog insulins ( synthetic) 
 examples ?
A

Rapid

Basal

69
Q

Human insulin less antibody response than animal

examples ?

A

regular

NPH

70
Q

Diabetes mellitus type I surgery or procedure ?

A

Insulin pump

Pancreas transplant

71
Q

Insulin pump notes ?

A

Basal rate AND/OR

Bolus before meal calculations

72
Q

Pancreas transplant

notes ?

A

Research indicates graft success 78% at 1 year and 54% at 5 years

Currently only indicated is severe uncontrolled cases

73
Q

Diabetes mellitus type I Lifestyle measures ?

A 
Diet
-Individualized
-Must consider activity and ideal body weight
-Carbohydrate training
1 unit of short acting insulin per 10-15g carbohydrate
-Recommend
Complex carbohydrates (vs simple)
Low fat
High fiber
Consider using artificial sweeteners

Moderate exercise

Meticulous hygiene

74
Q

Diabetes ketoacidosis typical patient TX ?

A

Normal saline IV - most important!!!!!!!!!!!!!!!!!!!!!!!!!

Insulin IV

  • Bolus then
  • Infusion

Monitor and correct electrolytes
Treat underlying cause, MI, PNA, UTI

75
Q

Diabetes ketoacidosis Isotonic fluid ?

A

Average has body water deficit of 5-10 Liters

Stop vomiting with antiemetic ( zofran, phenergran, reglan ( gastropuresis)

76
Q

Diabetes ketoacidosis Insulin ?

A

Bolus IV/ SQ (sliding scale) THEN

Continuous IV infusion 0.1 mg/kg/hr.
-(regular insulin avg half life is 5mins)
Shut off ketosis and resume glucose utilization
Double rate each hour if no response. (insulin resistance)

77
Q

Diabetes ketoacidosis extra Tx ?

A

Potassium

Sodium

Magnesium

Bicarbonte

78
Q

Diabetes ketoacidosis disposition ?

A

ICU admission

79
Q

Diabetes ketoacidosis monitoring ?

A

Glucose, anion gap, potassium and bicarbonate levels hourly until recovery well established.

Cerebral edema occurs predominantly in children
Develops 4-12 hours into treatment and manifests as deterioration of neurologic function
Associated with rehydration rates exceeding 50ml/kg in the first 4 hours of treatment
If exceeded and suspected, give mannitol 1g/kg and confirm on CT scan

Clinical Medicine Lecture - Professor Kramer (28 decks)

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