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NAPLEX review 2024 RXPrep Book > Endocrine Conditions: Diabetes > Flashcards

Endocrine Conditions: Diabetes Flashcards

1
Q

Diabetes background info

A

BG high while dec insulin secretion/sensitivity

Insulin produced by beta-cells, moves glucose out of blood into cells
Glucagon produced by alpha-cells, pulls glucose back into circulation (glycogen -> glucose) when BG is low.
If glycogen low, fat cells make ketones

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2
Q

Type 1 Diabetes

A

auto-immune destruction of beta-cells

no insulin = glucose cant enter cells = fat turned to ketones = can lead to DKA = med emergency

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3
Q

Type 2 Diabetes

A

95% of all cases

beta cells produce less insulin as they become damaged
Strongly associated with obesity, physical inactivity, family history, and other comorbid conditions

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4
Q

Prediabetes

A

increased risk of developing diabetes
BG higher than normal but not high enough to be diabetes

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5
Q

Metformin use in prediabetes useful if patients…

A

BMI > 35kg/m2
age < 60 yrs old
women history of gestational diabetes mellitus

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6
Q

Two types of diabetes in pregnancy

A
  1. develop before pregnancy
  2. develop during pregnancy
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7
Q

Babies born to moms with hyperglycemia are….

A

larger than normal
at high risk for developing obesity ad diabetes later in life

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8
Q

When are pregnant women tested for GDM?

A

24-28 wks
Oral glucose tolerance test (OGTT)

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9
Q

Which med is preferred for diabetes in pregnant patients?

A

Insulin

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10
Q

Diabets risk factors

A

physical inactivity
BMI > 25kg/m and 23kg/m in asians
high risk race or ethnicity = AA, Asian, Latino, native, Pacific Islander
Hx of gestational diabetes
A1C > 5.7%
1st deg relative with diabetes
HTN
CVD hx or smoking hx

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11
Q

Classical symptoms of hyperglycemia

A

Polyuria - excessive urination
Polyphasic = excessive hunger or inc appetie
Polydipsia = excessive thirst

Fatigue, blurry vision, ED = other symptoms

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12
Q

diabetes screening

A

no risk factors = begin testing at 35yrs old

children, adolescents and adults who are BMI > 25 or > 23 (asian) + 1 risk factor tested

test every 3 years

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13
Q

Diabetes A1C diagnosis

A

> 6.5

5.7-6.4 = pre diabetes

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14
Q

Diabetes Fasting plasma glucose

A

> 126
100-125 = pre diabetes

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15
Q

Usual A1c goal for diabetes?

A

< 7%
8% maybe appropriate if have to be less stringent

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16
Q

How often to test a1c

A

Quarterly if not at goal
Q6 months if at goal

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17
Q

Diabetse lifestyle modifications

A

Goal waste circumference < 35in female, < 40 in males
stop drinking
stop smoking
at least 150min exercise per week
weight loss >5% if obese/overweight

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18
Q

Antiplatelet therapy in diabetes

A

baby aspirin for secondary prevention, dont use for risk
clopidogrel 75 if allergic to aspirin
use in pregnancy to decrease preeclampsia

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19
Q

Diabetic retinopathy info

A

eye exam every 1-2yrs, early if diagnosed with retinopathy

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20
Q

High dose statin therapy if diabetes with….

A

Comorbid ASCVD
Age 40 - 75yrs old with > 1 ASCVD risk factor

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21
Q

Moderate intensity statin therapy if diabetes with….

A

age 40-75, no ASCVD
< 40 yrs old, w/ ASCVD risk factors

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22
Q

Goal LDL lvls for diabetes patients

A

< 55 if ASCVD
< 70 all others

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23
Q

Neuropathy diabetes info

A

annual: 10-g monofilament test + 1 other to assess sensation
annual comprehensive foot exam

txm options: gabapentin, pregabalin, duloxetine, TCA

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24
Q

Diabetic Kidney Disease defined as

A

eGFR < 60
and/or
urine albumin > 30/24hrs or UACR > 30

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25
Q

Diabetic Kidney disease txm

A

ACEi or ARB
SGLT2i if eGFR > 20
Finerenone if on max dose ACEi/ARB

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26
Q

Diabetes foot care info

A

daily wash, moisturize top/bottom of feet not between toes
Feet checked each visit
Annual foot exam
elevate feet when sitting

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27
Q

BP control diabetes goal

A

Goal < 130/80

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28
Q

BP control diabetes if no albuminuria

A

Thiazide
DHP CCB
ACEi
ARB

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29
Q

BP control diabetes if albuminuria or CAD

A

ACEi
ARB

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30
Q

IF patient has ASCVD, HF or CKD then start what at baseline for diabetes?

A

GLP-1 agonist or SGLT2

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31
Q

If patient A1c is 8.5%-10% then start what at baseline for diabetes?

A

2 drugs (GLP1-agonist + SGLT20

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32
Q

GLP1-agonist MOA

A

analogs of incretin hormone GLP-1, inc glucose-dependent insulin secretion, decrease glucagon secretion, slow gastric emptying and improve satiety

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33
Q

GLP1-agonists

A

Liraglutide = Victoza or Saxenda
Dulaglutide = Trulicity
Semaglutide = Ozempic or Wegovy

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34
Q

GLP1 and GIP agonist

A

Tirzepatide = Mounjaro

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35
Q

Boxed warnings for GLP1-a

A

except Byetta**

risk of thyroid C-cell carcinomas

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36
Q

GLP1 agonist warnings

A

pancreatitis
not rec in severe GI disease, including gastroparesis

Ozempic/Mounjaro = inc complications with diabetic retinopathy

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37
Q

GLP1-a and GLP1-a/GIP shouldn’t be used with…

A

DPP-4 inhibitors

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38
Q

Side effects of GLP1-a

A

weight loss
nausea = reduced with titration

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39
Q

Byetta and Victoza dont come with..

A

needles

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40
Q

SGLT2-i mechanism of action

A

drugs inhibit SGLT2, reducing reabsorption of glucose and inc urinary glucose excretion which reduces BG concentrations

works at proximal renal tubules

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41
Q

SGLT2-is

A

Canagliflozin = invokana
Dapagliflozin = Farxiga
Empagliflozin = Jardiance

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42
Q

SGLT2-i contraindications

A

Dialysis

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43
Q

Warnings for SGLT2-i

A

Ketoacidosis
Genital mycotic infection, urosepsis, pelo, necrotizing fasciitis
Hypotension, AKIO

Canagliflozin = inc risk of leg/foot amputations

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44
Q

SGLT2i Side effects

A

weight loss
inc urination and thirst
inc Mg/PO4

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45
Q

Inc risk of volume depletion and AKI if SGLT2i used with…..

A

diuretics
RAAS inhibitors
NSAIDs

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46
Q

Metformin mechanism of action

A

dec hepatic glucose production, inc insulin sensitivity and dec intestinal absorption of glucose

1st line for T2D and prediabetes

47
Q

Metformin boxed warning

A

Lactic Acidosis, risk inc with renal impairment, contrast dye and alc use

48
Q

Metformin CI

A

eGFR < 30
acute or chronic metabolic acidosis

49
Q

Metformin warnings

A

dont start if eGFR 30-45
monitor B12 lvls

50
Q

Metformin Side effects

A

GI side effects: D/N/Farting/cramping

51
Q

Metformin notes

A

can dec A1C 1-2%, no hypoglycemia, weight neutral

52
Q

How to reduce metformin GI side effects?

A

dose titration

53
Q

How long after imaging procedure can Metformin be restarted?

A

48hrs

54
Q

Insulin secretagogues

A

Sulfonylureas
Meglitinides

55
Q

Insulin secretagogues mechanism of action

A

stimulate insulin secretion from beta cells to decrease postprandial BG

Meglitinides fast onset and shorter duration

Meglitinide ends in glinide
SU start with G- end in -ide

56
Q

Sulfonylurea contraindications

A

Sulfa allergy

57
Q

Sulfonylurea warnings

A

Hypoglycemia

58
Q

Sulfonylurea side effects

A

Weight gain
nausea

59
Q

Glimepiride and Glyburide not preferred in elderly due to….

A

hypoglycemia risk

60
Q

Meglitinides Contraindications

A

T1D
DKA

61
Q

Meglitinides warnings

A

hypoglycemia

62
Q

Meglitinide side effects

A

weight gain

63
Q

Meglitinides should be taken…..

A

1-30min before meals

64
Q

DPP-4 inhibitor Mechanism of action

A

prevent enzyme DPP-4 from breaking down incretin hormones, GLP-1 and GIP

65
Q

DPP-4 meds

A

Sitagliptin = Januvia
Linagliptin = tradjenta

66
Q

DPP-4 inhibitor warnings

A

pancreatitis
severe joint pain
renal failure
risk of heart failure

67
Q

DPP-4 inhibitors should,d not be used with….

A

GLP-1 agonists

68
Q

Thiazolidinediones (TZD) med

A

Pioglitazone

69
Q

TZD (pioglitazone) boxed warnings

A

can cause or exacerbate heart failure
dont use with NYHA Class III/IV HF

70
Q

Pioglitazone warnings

A

edema
risk of fractures

71
Q

Pioglitazone side effects

A

peripheral edema
weight gain
UTIs

72
Q

Basal insulins

A

glargine
detemir
deluded = ultra long acting

onset 3-4hrs, last 24hrs, mostly for fasting glucose

73
Q

Intermediate acting insulin

A

insulin NPH

onset 1-2hrs, peaks 4-12hrs, lasts 14-24hrs

can cause hypoglycemia due to unpredictable duration

P = protamine = extend duration

74
Q

Rapid acting insulin

A

aspart
lispro
glulisine

onset 15min, peak 1-2hrs, duration 3-5hrs

75
Q

Short acting insulin

A

regular insulin

onset 30min, peak 2hrs, lasts 6-10hrs

76
Q

General insulin warnings

A

hypoglycemia
hypokalemia

77
Q

General insulin side effects

A

Weight gain
Lipoatrophy = loss of fat at injection side and fat lumps under injection side = rotate sites

78
Q

Rapid acting insulin info

A

give 5-15min before meals
dosed often with sliding scale if need BG correction
preferred insulin for pumps

aspart (Novolog) lispro (Humalog)

79
Q

Short acting insulin info

A

inject 30min before meals
dosed often with sliding scale if need BG correction
Preferred for IV infusions

regular insulin (Humulin R/ Novolog R)

80
Q

Intermediate action insulin info

A

given typically twice daily as add on to oral drugs

NPH (Humilin N/Novolog N)

81
Q

Long acting insulin info

A

usually given once daily

detemir = levemir
glargine = Lantus/Toujeo

Lantus = 100u/ml, Toupee = 300u/ml***

82
Q

Insulin should not be used with….

A

Sulfonylureas or meglitinides

83
Q

Which insulins can be sold OTC

A

Regular
NPH
premixed 70% NPH/ 30% regular

84
Q

Starting insulin in T2D

A

10units SC or 0.1-0.2 units/kg/day of basal insulin

titrate based on FPG, if not at goal then at 4 units prandial insulin to largest meal

if A1c not at goal then can do basal insulin daily + prandial with meals or twice daily mixed insulin

85
Q

Patients with Type 1 Diabetes are mostly treated with….

A

insulin pump
rapid acting injectable insulins and long-acting basal insulins are preferred

86
Q

How to convert to mixed insulin from regular insulin

A

2/3 of TDD is given as NPH
1/3 of TDD is given as regular insulin

87
Q

If low fasting BG trend then…

A

dec basal or NPH insulin

88
Q

If high fasting BG trend then….

A

increase basal or NPH insulin

89
Q

Adjusting mealtime insulin

A

if postprandial BG is high/low following same meal on most days, regular or fast acting insulin dose prior to meal should be increase if high BG or decreased if low BG

if preprandial BG is high/low following same meal on most days, regular or fast acting insulin dose from previous meal should be increase for high BG or decreased for Low BG

90
Q

Rule of 450

A

for regular insulin

450/ TDD of insulin = grams of carbs covered by 1 unit of regular insulin

91
Q

Rule of 500

A

for rapid acting insulin

500/TDD of insulin = grams of carbs covered by 1 unit of rapid acting insulin

92
Q

Correction factor

A

used to calculate bolus if BG higher than target

93
Q

1,500 rule

A

for regular insulin

1,500/TDD of insulin = correction factor for 1 unit of insulin

94
Q

1,800 rule

A

for rapid acting insulin

1,800/TDD of insulin = correction factor for 1 unit of insulin

95
Q

How to calculate correction dose

A

(BG now - BG target)/ correction factor = correction dose

96
Q

What to do with correction dose?

A

add units to amount of units normally takes before next meal/dose

97
Q

NPH to insulin glargine conversion

A

use 80% of NPH dose to convert

98
Q

When converting Toujeo to Lantus then….

A

use 80% of Toujeo dose

99
Q

Insulin room temp stability

A

most insulin stable at room temp atleast 28 days. Toujeo/Tresiba = 56 days
Humalog Mix pen & Novolog mix pens 10-14 days

100
Q

Hypoglycemia is when BG is…

A

below 70

101
Q

Hypoglycemia symptoms

A

dizziness
anxiety/irritability
shakiness
sweating
hunger
confusion
tremors
palpitations

102
Q

Severe hyperglycemia symptoms

A

seizures
coma
death

103
Q

Hypoglycemia treatment if can swallow

A

pure glucose tab/gel preferred

rule of 15
15-20 gram glucose
recheck Bg after 15min
repeat if still Hypoglycemia
once BG normal, eat small meal/snack

104
Q

Hypoglycemia treatment if unconscious

A

Dextrose if IV access
Glucagon 1mg SC injection or spray

105
Q

Drugs that cause Hypoglycemia

A

insulin
Sulfonylureas/meglitinides = high risk
other diabetes drugs low risk unless used in combo with insulin

106
Q

15 grams of simple carbs examples

A

4oz juice
8oz milk
4oz regular soda
1 tb spoon sugar/honey/corn syrup
3-4 glucose tabs

107
Q

beta blockers can mask hypoglycemia except for which symptoms

A

sweating and hunger

108
Q

Target BG range for non critical and critical care patients in hospital is usually

A

140-180

109
Q

DKA can be recognized by…..

A

BG > 250mg/dL
Ketones (urine, fruity breath), ab pain, Nausea, vomiting and dehydration
Anion gap (arterial pH < 7.35, anion gap > 12)

110
Q

Hyperosmolar hyperlhycemic state

A

higher mortality than DKA
mostly in T2D
primary cause is illness that leads to less fluid intake

111
Q

HHS recognized by…

A

Confusion, delirium
BG < 600 and serum osmolality > 320
Extreme dehydration
pH > 7.3, bicarb > 15

112
Q

DKA and HHS treatment

A

fluids for all patients, once BG hits 200 then change to D5W1/2NS
Regular insulin Infusion
Prevent hypokalemia, keep K+ at 4-5mEq
treat acidosis if pH < 6.9 by giving sodium bicarb

113
Q
A

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