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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
Diabetic Kidney disease txm
ACEi or ARB SGLT2i if eGFR > 20 Finerenone if on max dose ACEi/ARB
26
Diabetes foot care info
daily wash, moisturize top/bottom of feet not between toes Feet checked each visit Annual foot exam elevate feet when sitting
27
BP control diabetes goal
Goal < 130/80
28
BP control diabetes if no albuminuria
Thiazide DHP CCB ACEi ARB
29
BP control diabetes if albuminuria or CAD
ACEi ARB
30
IF patient has ASCVD, HF or CKD then start what at baseline for diabetes?
GLP-1 agonist or SGLT2
31
If patient A1c is 8.5%-10% then start what at baseline for diabetes?
2 drugs (GLP1-agonist + SGLT20
32
GLP1-agonist MOA
analogs of incretin hormone GLP-1, inc glucose-dependent insulin secretion, decrease glucagon secretion, slow gastric emptying and improve satiety
33
GLP1-agonists
Liraglutide = Victoza or Saxenda Dulaglutide = Trulicity Semaglutide = Ozempic or Wegovy
34
GLP1 and GIP agonist
Tirzepatide = Mounjaro
35
Boxed warnings for GLP1-a
except Byetta** risk of thyroid C-cell carcinomas
36
GLP1 agonist warnings
pancreatitis not rec in severe GI disease, including gastroparesis Ozempic/Mounjaro = inc complications with diabetic retinopathy
37
GLP1-a and GLP1-a/GIP shouldn't be used with...
DPP-4 inhibitors
38
Side effects of GLP1-a
weight loss nausea = reduced with titration
39
Byetta and Victoza dont come with..
needles
40
SGLT2-i mechanism of action
drugs inhibit SGLT2, reducing reabsorption of glucose and inc urinary glucose excretion which reduces BG concentrations works at proximal renal tubules
41
SGLT2-is
Canagliflozin = invokana Dapagliflozin = Farxiga Empagliflozin = Jardiance
42
SGLT2-i contraindications
Dialysis
43
Warnings for SGLT2-i
Ketoacidosis Genital mycotic infection, urosepsis, pelo, necrotizing fasciitis Hypotension, AKIO Canagliflozin = inc risk of leg/foot amputations
44
SGLT2i Side effects
weight loss inc urination and thirst inc Mg/PO4
45
Inc risk of volume depletion and AKI if SGLT2i used with.....
diuretics RAAS inhibitors NSAIDs
46
Metformin mechanism of action
dec hepatic glucose production, inc insulin sensitivity and dec intestinal absorption of glucose 1st line for T2D and prediabetes
47
Metformin boxed warning
Lactic Acidosis, risk inc with renal impairment, contrast dye and alc use
48
Metformin CI
eGFR < 30 acute or chronic metabolic acidosis
49
Metformin warnings
dont start if eGFR 30-45 monitor B12 lvls
50
Metformin Side effects
GI side effects: D/N/Farting/cramping
51
Metformin notes
can dec A1C 1-2%, no hypoglycemia, weight neutral
52
How to reduce metformin GI side effects?
dose titration
53
How long after imaging procedure can Metformin be restarted?
48hrs
54
Insulin secretagogues
Sulfonylureas Meglitinides
55
Insulin secretagogues mechanism of action
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
Sulfonylurea contraindications
Sulfa allergy
57
Sulfonylurea warnings
Hypoglycemia
58
Sulfonylurea side effects
Weight gain nausea
59
Glimepiride and Glyburide not preferred in elderly due to....
hypoglycemia risk
60
Meglitinides Contraindications
T1D DKA
61
Meglitinides warnings
hypoglycemia
62
Meglitinide side effects
weight gain
63
Meglitinides should be taken.....
1-30min before meals
64
DPP-4 inhibitor Mechanism of action
prevent enzyme DPP-4 from breaking down incretin hormones, GLP-1 and GIP
65
DPP-4 meds
Sitagliptin = Januvia Linagliptin = tradjenta
66
DPP-4 inhibitor warnings
pancreatitis severe joint pain renal failure risk of heart failure
67
DPP-4 inhibitors should,d not be used with....
GLP-1 agonists
68
Thiazolidinediones (TZD) med
Pioglitazone
69
TZD (pioglitazone) boxed warnings
can cause or exacerbate heart failure dont use with NYHA Class III/IV HF
70
Pioglitazone warnings
edema risk of fractures
71
Pioglitazone side effects
peripheral edema weight gain UTIs
72
Basal insulins
glargine detemir deluded = ultra long acting onset 3-4hrs, last 24hrs, mostly for fasting glucose
73
Intermediate acting insulin
insulin NPH onset 1-2hrs, peaks 4-12hrs, lasts 14-24hrs can cause hypoglycemia due to unpredictable duration P = protamine = extend duration
74
Rapid acting insulin
aspart lispro glulisine onset 15min, peak 1-2hrs, duration 3-5hrs
75
Short acting insulin
regular insulin onset 30min, peak 2hrs, lasts 6-10hrs
76
General insulin warnings
hypoglycemia hypokalemia
77
General insulin side effects
Weight gain Lipoatrophy = loss of fat at injection side and fat lumps under injection side = rotate sites
78
Rapid acting insulin info
give 5-15min before meals dosed often with sliding scale if need BG correction preferred insulin for pumps aspart (Novolog) lispro (Humalog)
79
Short acting insulin info
inject 30min before meals dosed often with sliding scale if need BG correction Preferred for IV infusions regular insulin (Humulin R/ Novolog R)
80
Intermediate action insulin info
given typically twice daily as add on to oral drugs NPH (Humilin N/Novolog N)
81
Long acting insulin info
usually given once daily detemir = levemir glargine = Lantus/Toujeo Lantus = 100u/ml, Toupee = 300u/ml***
82
Insulin should not be used with....
Sulfonylureas or meglitinides
83
Which insulins can be sold OTC
Regular NPH premixed 70% NPH/ 30% regular
84
Starting insulin in T2D
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
Patients with Type 1 Diabetes are mostly treated with....
insulin pump rapid acting injectable insulins and long-acting basal insulins are preferred
86
How to convert to mixed insulin from regular insulin
2/3 of TDD is given as NPH 1/3 of TDD is given as regular insulin
87
If low fasting BG trend then...
dec basal or NPH insulin
88
If high fasting BG trend then....
increase basal or NPH insulin
89
Adjusting mealtime insulin
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
Rule of 450
for regular insulin 450/ TDD of insulin = grams of carbs covered by 1 unit of regular insulin
91
Rule of 500
for rapid acting insulin 500/TDD of insulin = grams of carbs covered by 1 unit of rapid acting insulin
92
Correction factor
used to calculate bolus if BG higher than target
93
1,500 rule
for regular insulin 1,500/TDD of insulin = correction factor for 1 unit of insulin
94
1,800 rule
for rapid acting insulin 1,800/TDD of insulin = correction factor for 1 unit of insulin
95
How to calculate correction dose
(BG now - BG target)/ correction factor = correction dose
96
What to do with correction dose?
add units to amount of units normally takes before next meal/dose
97
NPH to insulin glargine conversion
use 80% of NPH dose to convert
98
When converting Toujeo to Lantus then....
use 80% of Toujeo dose
99
Insulin room temp stability
most insulin stable at room temp atleast 28 days. Toujeo/Tresiba = 56 days Humalog Mix pen & Novolog mix pens 10-14 days
100
Hypoglycemia is when BG is...
below 70
101
Hypoglycemia symptoms
dizziness anxiety/irritability shakiness sweating hunger confusion tremors palpitations
102
Severe hyperglycemia symptoms
seizures coma death
103
Hypoglycemia treatment if can swallow
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
Hypoglycemia treatment if unconscious
Dextrose if IV access Glucagon 1mg SC injection or spray
105
Drugs that cause Hypoglycemia
insulin Sulfonylureas/meglitinides = high risk other diabetes drugs low risk unless used in combo with insulin
106
15 grams of simple carbs examples
4oz juice 8oz milk 4oz regular soda 1 tb spoon sugar/honey/corn syrup 3-4 glucose tabs
107
beta blockers can mask hypoglycemia except for which symptoms
sweating and hunger
108
Target BG range for non critical and critical care patients in hospital is usually
140-180
109
DKA can be recognized by.....
BG > 250mg/dL Ketones (urine, fruity breath), ab pain, Nausea, vomiting and dehydration Anion gap (arterial pH < 7.35, anion gap > 12)
110
Hyperosmolar hyperlhycemic state
higher mortality than DKA mostly in T2D primary cause is illness that leads to less fluid intake
111
HHS recognized by...
Confusion, delirium BG < 600 and serum osmolality > 320 Extreme dehydration pH > 7.3, bicarb > 15
112
DKA and HHS treatment
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

NAPLEX review 2024 RXPrep Book (78 decks)

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