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Adv Pharm I > Exam 1 DM > Flashcards

Exam 1 DM Flashcards

1
Q

A1c goal for DM

A

Less than 6.5-7%

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2
Q

Fasting glucose goal for DM

A

80-130 mg/dL

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3
Q

Rapid acting insulin

A

Lispro (humalog), aspart (novolog), glulisine (Aventis)

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4
Q

Rapid acting insulin onset

A

15-30 min

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5
Q

Rapid acting insulin peak

A

1-2 h

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6
Q

Rapid acting insulin duration

A

3-4h

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7
Q

When is rapid acting insulin administered?

A

Immediately before a meal

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8
Q

Short acting insulin

A

Regular Humilin R

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9
Q

Short acting insulin onset

A

30 minutes

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10
Q

Short acting insulin is administered when?

A

30-45 minutes before meals

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11
Q

Intermediate acting insulin

A

NPH humulin N and novolin N

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12
Q

Intermediate acting insulin onset

A

2-4h

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13
Q

Intermediate acting insulin duration

A

8-12h

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14
Q

Intermediate acting insulin is not used for…

A

Emergency IV use

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15
Q

Appearance of intermediate acting insulin?

A

Cloudy

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16
Q

Long acting insulin

A

Glargine: lantus, basaglar, toujeo
Detemir: Levemir
Degludec: Tresiba

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17
Q

Can long acting insulin be mixed with other types of insulin?

A

No

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18
Q

Insulin glargine characteristics

A

Onset: 4-5, no peak, clear, duration: 24h

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19
Q

Insulin detemir characteristics

A

Onset: 2h, peak 3-9h, duration 14-24h, clear

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20
Q

Insulin - careful in which patients?

A

Hepatic and Renal failure - duration of action is prolonged

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21
Q

Combination insulin products - novolin 70/30

A

70% NPH, 30% regular insulin

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22
Q

Novolog 70/30 means?

A

70% aspart protamine suspension and 30% aspart

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23
Q

Humalog 50/50 and 75/25

A

50 or 75% protamine lispro and 50 or 25% lispro

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24
Q

Insulin dose based on?

A

Total body weight - DMII is 0.2 units/kg/day

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25
Q

1 unit of insulin will lower blood glucose by how much?

A

50 mg/dL

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26
Q

How often do you adjust an insulin dose?

A

Wait at least 24 hours

27
Q

Who should insulin be held in and not held in?

A

Type 1 DM - never stop insulin

28
Q

Which types of insulin can be given IV?

A

Rapid or short acting

29
Q

Which locations are ideal for SubQ insulin?

A

Abdomen > buttocks > arm/leg

30
Q

What accelerates absorption of insulin?

A

Exercise, rubbing, heat

31
Q

How long can insulin be kept at room temperature?

A

28 days - otherwise keep in the refrigerator

32
Q

Lipohypertrophy

A

Lump under skin caused by accumulation of fat as a result of frequent injections in same site

33
Q

Signs of hypoglycemia

A

Autonomic hyperactivity - sympathetic: tachycardic, palpitations, sweating, tremulousness. Parasympathetic: nausea and hunger

34
Q

Tx of hypoglycemia - mild

A

Able to swallow: simple sugar, juice, hard candy, sugar packets

35
Q

Tx of hypoglycemia - severe

A

Unconsciousness/stupor: 20-50mL of 50% dextrose by IV; or 1mg glucagon (SubQ or IM)

36
Q

Why do patients prefer un-refrigerated insulin?

A

Less painful

37
Q

Sulfonylureas are used in which patients?

A

Type II only

38
Q

Second generation sulfonylureas

A

Glyburide, glipizide, glimepiride

39
Q

Which sulfonylurea which you choose for a patient with renal failure?

A

NOT glyburide, either glipizide or glimepiride

40
Q

How often are sulfonylureas dosed?

A

1-2x per day

41
Q

Patient prone to hypoglycemia - would you prescribe a sulfonylurea?

A

NO - biggest adverse effect

42
Q

Would you prescribe a 300 lb Type II DM a sulfonylurea?

A

NO - weight gain is an adverse effect

43
Q

Biguanide - which medication?

A

Metformin (glucophage)

44
Q

First line agent for Type II DM

45
Q

Contraindications for biguanides?

A

Renal impairment eGFR < 30 or 30-60 + contrast - hold for 48h, hepatic impairment

46
Q

Advantages of biguanides

A

Weight loss, no hypoglycemia

47
Q

Thiazolidinediones therapeutic use?

A

Type II DM - rosiglitazone and pioglitazone

“Glitazone”

48
Q

Thiazolidinediones contraindications

A

Heart failure - may cause CHF, mentor for s/s of heart failure

49
Q

GLP-1 agonists

A

Exenatide, liraglutide, albiglutide, dulaglutide

50
Q

GLP-1 Agonists downfall

A

Injection only

51
Q

DPP-4 inhibitors

A

Sitagliptin, saxagliptin, alogliptin, lingagliptin

52
Q

DPP-4 inhibitors - positive aspects

A

PO, no adverse effects, no weight gain

53
Q

SGLT 2 inhibitors

A

Canaglifozin, dapaglifozin, empaglifozin

54
Q

SGLT 2 inhibitors

A

Work in kidney to increase excretion of glucose in urine

55
Q

SGLT 2 inhibitors advantages

A

Renal protection, lower BP, weight loss

56
Q

SGLT 2 inhibitors adverse effects

A

Limp amputation, electrolyte disturbances, bacterial UTI

57
Q

SGLT 2 inhibitors - why these are chosen

A

Reduces risk of heart failure and cardiovascular disease/events

58
Q

Thioureas used for?

A

Propylthiouracil, methimazole - hyperthyroidism

59
Q

Thioureas MOA

A

Does not effect the release of preformed T4 and T3

60
Q

A1c reduction with insulin

61
Q

Thioureas takes how long to start working?

A

1-2 months

62
Q

Thioureas adverse effects

A

Rash, fluid retention, decreased WBC

63
Q

Synthetic thyroid hormones

A

Levothyroxine, liothyronine, liotrix

64
Q

Levothyroxine

A

Prodrug, takes weeks to work, adverse effects - heart failure

Adv Pharm I (8 decks)

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