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Q3 Clin Med II Final (Endocrine) > DM tx > Flashcards

DM tx Flashcards

1
Q

Insulin secretagogues do?

Drug classes?

A

stim insulin secretion

sulfonylureas
meglitinides

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2
Q

Sulfonylureas action?

S/E?

A

bind β-cell receptors -> ↑ sensitivity to glu -> ↑ insulin release

QD dosing

hypogly
weight gain

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3
Q

Meglitinides action?

A

bind K+ receptors -> ↑ insulin

rapid/short

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4
Q

Insulin sensitizers do?

Drug classes?

A

↑ sensitivity of liver/mm to insluin,
↓ glu and insulin levels

biguanides
thiazolidinediones

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5
Q

Biguanides action?

S/E?

A

↓ gluconeogenesis, ↑ glu uptake

QD dosing

GI
Lactic acidosis

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6
Q

Thiazolidinediones action?

S/E?

A

↑ membrane response to insulin -> ↓ amount of insulin needed

Long lead time (wks)

hepatotoxic

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7
Q

α-glucosidase inhibitors action?

S/E?

A

delay CHO absorp

before meals

GAS

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8
Q

Pathogennesis of DM?

A

↑ insulin resistance ->
↓ insulin secretion ->
↑↑ glucagon secretion ->
impaired incretin effect

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9
Q

Incretin hormones include?

A

GLP1 (glucagon-like peptide),

GIP (glucose-dependent insulinotropic peptide)

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10
Q

GLP1 and GIP do what?

A

Looks like glucagon but ACTS LIKE INSULIN

respond to food -> bind β-cells -> stim insulin secretion

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11
Q

Incretin mimetic drugs action?

A 
synthetic GLP1:
insulin release in response to food,
↓ gluconeogenesis,
satiety,
slow emptying
(P) also ↑ β-cell mass
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12
Q

Incretin mimetics used when?

S/E?

A

DM2 failure on other txs
preprandial

acute pancreatitis

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13
Q

Synthetic Amylin drug actions?

Used when?

A

similar to incretin mimetics

DM1 or 2 adjunct to other txs
preprandial

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14
Q

DPP4 inhibitors action?

A

stop DPP4 from degrading GLP1 ->

↑ action of incretins

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15
Q

Meds for pancreatic failure?

A

sulfonylureas

incretin mimetics

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16
Q

Meds for high hepatic glucose prdxn?

A

biguanides (Metformin)

DPP4 inhib

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17
Q

Meds for over eating (high postP glucose)?

A

incretin mimetics
α-glucosidase inhibitors
DPP4 inhib

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18
Q

Meds for insulin resistance?

A

biguanides (Metformin)

thiazolidinediones

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19
Q

DOC for DM2?

Combine w/ what if needed?

A

metformin

sulfonylurea, incretin mimetic

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20
Q

DM2 tx Stage A?

A

lifestyle ∆

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21
Q

DM2 tx Stage B?

A

lifestyle ∆

+ oral

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22
Q

DM2 tx Stage C?

A

lifestyle ∆
+ oral
+ bedtime med/long acting insulin

23
Q

DM2 tx Stage D?

A

lifestyle ∆
+ QD long insulin + premeal rapid insulin

Or

+ BID interm insulin + premeal rapid/short insulin

24
Q

Start insulin in DM2 at what HbA1c level?

A

~8% regardless of optimal oral tx

25
Q

Rapid insulin:

Onset

Peak

Duration

A

Onset < 15 min

Peak 1 hr

Duration 2-4 hrs

26
Q

Short/Regular insulin:

Onset

Peak

Duration

A

Onset 0.5-1 hr

Peak 2-3 hrs

Duration 3-6 hrs

27
Q

Intermediate insulin:

Onset

Peak

Duration

A

Onset 2-4 hrs

Peak 6-12 hrs

Duration 10-16 hrs

28
Q

Long insulin:

Onset

Peak

Duration

A

Onset 1-2 hrs

Peak NONE

Duration 20-24 hrs

29
Q

Dosing regimen?

A

peakless (long) as base + rapid premeal

30
Q

Insulin requirement DM1?

Dosing?

A

1/2 unit/kg

split daily total in 1/2s:
1/2 as long
1/2 as bolus in 1/3s premeal

31
Q

Microvascular complication of DM? (3)

A

retinopathy
nephropathy
neuropathy

32
Q

Macrovascular complications of DM? (3)

A

CAD
peripheral vascular dz
cerebrovascular dz

33
Q

Other complications of DM? (2)

A

hypoglycemia

hyperglycemia (DKA)

34
Q

Ocular complications of DM?(3)

A

cataracts
retina proliferation
exudates

35
Q

Nephropathy may lead to?

Tx?

A

proteinuria
HTN
↓ GFR -> renal fail

ACE

36
Q

Neuropathy effects on peripheral?

A

Affects long axons:
numb/tingling/cramps in feet,
hyper- hyposensitivity to touch,
loss of balance/coord

37
Q

Neuropathy effects on autonomics?

A

urinary incontinence,
lost sex arousal,
gastric stasis
ortho hypoTN

38
Q

Peripheral vascular dz leads to?

A

ulcers
gangrene
necrosis
amputation

39
Q

Hypo or hyperglycemia develops rapidly?

A

hypogly -> death in minutes

hyper -> not as critical but still emergent

40
Q

Hypoglycemia sxs: adrenergic?

A

(from ↑↑ epi release)

sweat
tachy
weak
hunger
tremor
anxiety
41
Q

Hypoglycemia sxs: neuroglycopenic?

A

(from ↓↓ CNS glucose)

HA
dizzy
clouded vision
confusion
seizure
coma
42
Q

Hypoglycemia tx?

A 
STAT blood sugar
Glucose ASAP (carbs)
43
Q

Morning Hyperglycemia from waning insulin?

Tx?

A

p.m. dose worn off

↑ dose or ∆ timing

44
Q

Morning Hyperglycemia from Dawn Phenom?

Tx?

A

↑ GH secretion b/w 3-7 a.m.

↑ dose or ∆ timing

45
Q

Morning Hyperglycemia from Somogyi?

Tx?

A

rebound hypergly from p.m. hypo followed by secretion of cortisol, glucagon, GH

↓ dinner/bedtime dose or snack at bedtime

46
Q

Brittle DM is?

A

DM w/ high/low glucose extremes

Hugh response to small insulin adjustments

47
Q

Diabetic Ketoacidosis caused by?

A

(U) Type 1

insuff insulin
infection
major stressors (MI, pregnancy)

48
Q

DKA signs/sxs?

A 
N/V/Abd pain
hypervent
hypoTN
dehydration
acidosis w/ > anion gap
high glucose
serum ketones
49
Q

DKA lab findings?

A

High blood/urine glucose
Low CO2
+ urine ketones
+ serum ketones

50
Q

DKA tx?

A

Goals:

1) Restore fluid vol (iso saline)
2) Correct e- imbal (K+, PO4, Na+)
3) Reverse acidosis (bicarb)
4) Stop ketogenesis (insulin)
5) Clear ketones

Tx till normal pH and no ketonemia

51
Q

NKHS caused by?

A

(U) Type 2

2º to severe stress w/ ↓ renal excr of glu

52
Q

NKHS signs/sxs?

A

severe hypergly (glu > 500)
dehydration (plasma osmo > 320)
NO ketonemia

53
Q

NKHS tx?

A

Fluid/e- replacement

Insulin

Q3 Clin Med II Final (Endocrine) (6 decks)

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