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PHRM 844 Therapeutics > Exam 2 - Diabetes Kania > Flashcards

Exam 2 - Diabetes Kania Flashcards

1
Q

normal UACR (urinary albumin-to-creatinine ratio)

A

< 30 mg/g

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2
Q

normal eGFR

A

> 60 mL/min/1.73m2

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3
Q

most common ocular complication of diabetes

A

retinopathy

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4
Q

for T1DM, have an initial eye exam

a. at time of diabetes diagnosis
b. within 5 years after onset of diabetes

A

b. within 5 years after onset of diabetes

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5
Q

for T2DM, have an initial eye exam

a. at time of diabetes diagnosis
b. within 5 years after onset of diabetes

A

a. at time of diabetes diagnosis

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6
Q

treatment for ocular complications

A

-photocoagulation therapy or anti-vascular endothelial growth factor, ranibizumab

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7
Q

what is a diabetes monofilament test?

A

test done on the feet to check for nerve damage (peripheral neuropathy)

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8
Q

what 3 drugs are recommended as initial therapy for peripheral neuropathy?

A

pregabalin
duloxetine
gabapentin

(others: TCAs such as amitriptyline, venlafaxine, carbamazepine, tramadol, capsaicin and tapentadol as last resort) .

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9
Q

what is postural hypotension?

A

sudden drop in BP and dizziness when you change positions (ex. going from lying down to standing)

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10
Q

leading cause of morbidity and mortality in type 2 diabetes pts

A

atherosclerotic cardiovascular disease (ASCVD)

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11
Q

ADA BP goal for:

T2DM or T1DM?
DM + pregnancy?

A

< 130/80 T2DM or T1DM
110-135/85 DM + pregnancy

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12
Q

ACC BP goal for pts with diabetes

A

< 130/80

(< 140 SBP acceptable for elderly due to fall risk)

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13
Q

ACEIs or ARBs are preferred antihypertensive agents for diabetes management. Use at max tolerated doses, especially for pts with UACR > or equal to _____

A

300 mg/g

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14
Q

why can’t we use ACEIs or ARBs in combo?

A

due to risk of hyperkalemia, syncope, and renal dysfunction

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15
Q

CVD risk factors include LDL > or = to _____, HTN, smoking, CKD, albuminuria, and family history of early ASCVD

a. 50 mg/dL
b. 75 mg/dL
c. 100 mg/dL
d. 150 mg/dL

A

c. 100 mg/dL

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16
Q

DM + ASCVD in all ages = _____ _____ statin therapy + _____

A

high intensity; LSM

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17
Q

for pts with DM + ASCVD, target lower LDL by > or = ___% and goal LDL < ___

A

50%; 55

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18
Q

when can we add ezetimibe or a PCSK9 inhibitor for pts with DM + ASCVD?

A

if LDL elevated despite max tolerated statin dose (goal LDL < 55)

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19
Q

ACC/AHA recommendations for DM pts 40-75 yo: primary prevention

A

moderate-high intensity statin depending upon risk factors

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20
Q

ACC/AHA recommendations for DM pts 40-75 yo: for secondary prevention, what strength statin would we use, and what is goal LDL level?

A

high intensity statin and goal LDL < 70

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21
Q

high intensity statin doses (2 of them)

A

atorvastatin 40-80 mg/day OR rosuvastatin 20-40 mg/day

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22
Q

leading cause of non-traumatic amputations

A

diabetes

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23
Q

use of antiplatelet agents in pts with diabetes:
-use aspirin (75-162 mg) as _____ prevention in those with diabetes and a history of CVD.
-for pts with CVD and aspirin allergy, use _____

A

secondary; clopidogrel (75 mg/day)

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24
Q

which pts can we use aspirin (75-162 mg) for primary prevention in pts with diabetes?

A

men or women 50 or older with one major risk factor who are not at an increased risk of bleeding

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25
Q

true or false: we can use aspirin for primary prevention for those at low CVD risk

A

false

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26
Q

ADA fasting BG target range

A

80-130 mg/dL

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27
Q

AACE fasting BG target

A

< 110 mg/dL

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28
Q

ADA random or postprandial BG target

A

< 180 mg/dL

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29
Q

AACE random or postprandial BG target

A

< 140 mg/dL

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30
Q

when to do SMBG for intensive insulin regimens? (3 of them)

A

prior to meals and at bedtime; prior to snacks or activity; suspicion of hypoglycemia and after treatment

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31
Q

when to do SMBG for pts on basal insulin + non-insulin medications?

A

once daily (fasting blood glucose)

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32
Q

when to do SMBG for non-insulin regimens?

A

as needed

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33
Q

what is the goal for most pts for each of these CGM values?

TAR > 250 mg/dL
TAR > 180 mg/dL
TIR (time in range) 70-180 mg/dL
TBR < 70 mg/dL
TBR < 54 mg/dL

A

< 5%
< 20%
> 70%
< 4%
< 1%

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34
Q

ADA target for A1C

A

< 7%

(< 6% in certain pts and pregnant women)

35
Q

AACE target for A1C

A

< or = to 6.5%

36
Q

according to the UK prospective diabetes study (UKPDS), every 1% drop in A1C leads to a ___% reduction in risk of CVD events

A

18%

37
Q

according to the VA diabetes trials (VADT), severe __________ is associated with increased _____ mortality

A

hypoglycemia; CVD

38
Q

a 1% change in A1C can represent a ___-___ mg/dL change in mean blood glucose

A

25-35

39
Q

formula for relationship between A1C and estimated avg glucose (eAG)

A

28.7 * A1C - 46.7 = eAG

40
Q

advantages of A1C (2 of them)

A

-can be measured without fasting
-levels not subject to acute changes in insulin dosing, exercise, or diet

41
Q

disadvantages of A1C (3 of them)

A

-does not replace SMBG or CGM
-it is an avg of all #s the past 3 months
-conditions that affect red blood cell turnover may impact results

42
Q

when to measure A1C: how many times per year if meeting treatment goals?

A

twice

43
Q

when to measure A1C: how many times per year if therapy has changed or not meeting treatment goals?

A

4 times (quarterly)

44
Q

if A1C is very high, which should we fix first?

a. FBG
b. post-prandial BG

A

a. FBG

45
Q

if A1C is low, which should we fix first?

a. FBG
b. post-prandial BG

A

b. post-prandial BG

46
Q

long-term hyperglycemia leads to _____ damage

A

organ

47
Q

organ involvement in glucose homeostasis: glucose uptake by the brain is insulin

a. dependent
b. independent

A

b. independent

48
Q

organ involvement in glucose homeostasis: glucose uptake by muscle and fat is insulin

a. dependent
b. independent

A

a. dependent

49
Q

alpha cells of the pancreas produce _____ to oppose the action of insulin and stimulate the liver to make more glucose

A

glucagon

50
Q

glucagon causes increase in __________ and __________, and inhibition of _____ release

A

glycogenolysis; gluconeogenesis; insulin

51
Q

the egregious eleven

A
  1. beta cells destroyed/stop working
  2. dec incretin effect
  3. alpha cell defect (inc in glucagon)
  4. insulin resistance in adipose tissue
  5. insulin resistance in muscle
  6. insulin resistance in liver
  7. brain -> change in appetite hormones
  8. gut microbiome -> dec GLP-1 secretion
  9. immune system -> autoimmune rxn and inc inflammation can destroy beta cells
  10. quick stomach emptying -> inc glucose absorption
  11. kidney -> upreg of SGLT2 can lead to inc glucose reabsorption through kidney
52
Q

normal plasma glucose is usually maintained at what range?

a. 100-200 mg/dL
b. 60-120 mg/dL
c. 60-140 mg/dL
d. 100-125 mg/dL

A

c. 60-140 mg/dL

53
Q

min concentration range of glucose needed for CNS to function

A

40-60 mg/dL

54
Q

resorptive capacity of the kidneys

A

~180 mg/dL

(above this point = osmotic diuresis)

55
Q

muscle and fat use glucose as an energy source, but without glucose, AAs and FA will be used for fuel and an increase in _____ will occur

A

ketones

56
Q

what is happening during ketoacidosis?

A

body starts making ketones to use for fuel since it cannot access enough glucose

57
Q

drugs that increase hepatic glucose output (3 of them)

A

-glucocorticoids
-sympathomimetics
-niacin

58
Q

how do sympathomimetics lead to increased glucose?

A

inc in growth hormone, epinephrine and cortisol leads to increased glucose

59
Q

drugs that decrease insulin secretion (4 of them)

A

-phenytoin
-beta blockers
-calcium channel blockers
-immunosuppresants (ex. cyclosporine, sirolimus, tacrolimus, etc)

60
Q

drugs that inc insulin resistance (3 of them)

A

-thiazide diuretics
-glucocorticoids and oral contraceptives
-antipsychotics

61
Q

which drug is toxic to beta cells?

A

pentamidine (prevents insulin secretion)

62
Q

drugs that stimulate appetite examples (3 of them)

A

-phenothiazines
-marijuana
-androgens

63
Q

protease inhibitors to treat HIV can cause drug-induced diabetes. What is their MOA?

A

mechanism unclear

64
Q

endocrine-related disorders that can contribute to diabetes (3 of them)

A

-Cushing’s syndrome
-hyperthyroidism
-acromegaly

(pts have inc GH, cortisol, glucagon, and epi, which leads to inc glucose)

65
Q

how can pancreatitis, trauma/pancreatectomy, and cystic fibrosis contribute to diabetes?

A

beta cells are damaged and cannot release insulin

66
Q

infections that can contribute to diabetes (2 of them)

A

CMV, rubella

(viruses destroy beta cells, leading to dec insulin production/release)

67
Q

genetic syndromes that can contribute to diabetes (4 of them)

A

-Down’s syndrome
-Turner’s syndrome
-Huntington’s chorea
-porphyria

(can have insulin deficiency or absence of beta cells)

68
Q

normal fasting blood glucose < ___ mg/dL

A

100

69
Q

normal 2-hour OGTT < ___ mg/dL

a. 200
b. 160
c. 140
d. 100

A

c. 140

70
Q

pre-symptomatic type 1 diabetes screening (5 things)

A
  1. autoantibodies to insulin
  2. glutamic acid decarboxylase (GAD)
  3. tyrosine phosphatase islet antigen 2 (IA-2 and IA-2B)
  4. zinc transporter 8
  5. presence of 2 autoantibodies has been linked to future development of type 1 diabetes
71
Q

ADA criteria for screening in asymptomatic, undiagnosed pts: test all adult individuals beginning at age ___, regardless of weight

A

35

72
Q

ADA screening in asymptomatic, undiagnosed pts: women diagnosed with gestational diabetes should have lifelong testing at least every ___ years

A

3

73
Q

pts at an increased risk of diabetes will have an A1C in what range?

A

5.7-6.4

74
Q

impaired glucose tolerance (IGT) will have a 2-hour OGTT in what range?

A

140-199 mg/dL

75
Q

what is the range for impaired fasting glucose (IFG)?

A

100-125 mg/dL

76
Q

4 M’s of diabetes therapy

A

meals, movement, medications, monitoring

77
Q

medical nutrition therapy: how many calories per day? (range)

A

500-750 calories/day

78
Q

medical nutrition therapy: how many carbs should women and men have per meal?

A

women - 45 gm/meal
men - 60 gm/meal

79
Q

medical nutrition therapy: what % of total calories should be saturated fat?

A

< 7%

80
Q

medical nutrition therapy: < ___ mg cholesterol/day or < ___ mg/day if already has high cholesterol

A

300; 200

81
Q

medical nutrition therapy: how many grams of fiber per day?

A

20-35 grams

(helps prevent constipation and dec colon cancer risk)

82
Q

for prevention and treatment of complications, how often should you seek dental care?

A

every 6 months

83
Q

for diabetic kidney disease, we should have annual screening for __________

A

microalbuminuria

(also follow SCr/BUN)

84
Q

CV risk factor prevention: control _____ and _____ _____; quit _____

A

lipids; blood pressure; smoking

PHRM 844 Therapeutics (28 decks)

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