Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Therapeutics P2 > Exam 3 lecture 3 > Flashcards

Exam 3 lecture 3 Flashcards

1
Q

What is the somogyi effect

A

Nocturnal hypoglycemia and their body rebounds as hyperglycemia in the morning.
We rule this out by checking hypoglycemia in the middle of the night.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How to treat somogyoi effect

A

Move NPH from dinner to bedtime or add a bedtime snack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What to do on sick days as a diabetic

A

Let someone know you are feeling sick
continue insulin even if food intake decreases
maintain fluid intake
Test BG every 1-4 hours
Test urine for ketone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When to switch to concentrated for?

A

When there is leakage or 200-300 TDD dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some non-insulin agents

A

Metformin, SGLT-2 Inhibitors, GLP-1, DPP 4, TZD, sulfonylurea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which non insulin drugs increase insilin secretion

A

Increased by sulfonylureas
meglitinides
Incretins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which non insulin drugs decrease glucagon secretion

A

Incretins and amylin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hepatics glucose output is decreased by

A

Metformin and TZDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Glucose uptake and utilization is increased by

A

TZDs and metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Glucose reabsorption is decreased by

A

SGLT-2 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

mechanism of action of metformin

A

Decreases hepatic glucose production
increases glucose utilization
increases GLP-1 secretion
Increases uptake and utilization by muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When to use metformin? Uses of metformin?

A

On type 2 patients and obese type 1 pts. Decrease CV risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Metformin CV risk? hypoglycemia risk? effect on weight? Price? Lipid levels?

A

lowers risk for CV event
minimal risk for hypoglycemia
neutral effect on weight
not expensive
decrease LDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A1c reduction by metformin

A

1.5-2% (not as efficacious as insulin, but better than other non-insulin meds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

metformin might cause_____ which can be a disadvantage

A

lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who is at risk for developing lactic acidosis when taking metformin

A

Alcoholics, HF patients, Post MI and COPD, decreased renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do we consider when dosing metformin

A

eGFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MEtformin and surgery?

A

Dx metformin before and a little after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Metformin can cause what deficiency

A

B12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What side effects does metformin have

A

GI side effects (food helps decrease side effects)
(nausea, diarrhea)
gets better with time
titrate from 500 per day to 2000 grams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

dosing for metformin based of EGFR

A

> 60- Monitor Scr annually, no problems

between 45 and 60- safe to start therapy, monitor scr every 3-6 months

between 30 and 45- starting metformin not recommended, decrease dose by 50% if already taking. Monitor every 3 months

below 30- do not start
stop if already taking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do SGLT2 inhibitors work?

A

They lead to renal glucose excretion via urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the initial therapy for type 2 diabetics

A

SGLT-2 inhibitors or GLP-1 inhibitors with or without metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What other conditions does SGLT-2 inhibitors affect

A

Used in type 2 at risk for CVD, HF and CKD.

25
Can SGLT-2 inhibitors be used in HF patinets
Yes
26
Efficacy of sglt-2 inhibitors
Weaker than GLP-1 and metformin in reduction of A1c Lowers weight Lowers BP very effective at post prandial reduction
27
What drugs are good for BP reduction
SGLT-2 inhibitors
28
Side effects of SGLT2 inhibitors
UTIs (because of sugar in urine) and genital fungal infections (yeast infection) hypotension Can increase cholesterol
29
FDA warnings for SGLT2 inhibitors
-DKA (seen in type 2 patients with elevated bs, caused by dehydration or lowering of insulin) (do not give pt SGLT-2 with hx of DKA) bone fractures (especially in canagliflozin) -acute kidney injury -foot amputations (becareful in pts with acute foot infections) -fourniers gangrene (seek immediate medical attention if soreness or pain in taint area)
30
How long before a surgery should we hold SGLT2?
3 days 4 days for ertugliflozin restart after baseline food/oral intake is back to normal
31
Can you use SGLT2 inhibitors on dialysis?
No, you can not pee it out.
32
when not to start SGLT2 inhibitors based on eGFR
<30 Of already on it, monitor
33
name SGLT-2 drugs
Canagliflozin dapagliflozin empagliflozin
34
HF an kidney disease patients with diabetes should use
SGLT2 inhibitors, these drugs are expensive
35
Name GLP-1 antagonist drugs
Liraglutide, dulaglutide, semaglutide
36
what do GLP-1 drugs do?
promote insulin secretion by stimulating basal cell growth inhibits glucagon secretion, delays gastric emptying, decreases apetite
37
Hypoglycemic risk with GLP-1 inhibitors
very low because insulin is only released when glucose is elevated
38
Initial treamment with type 2 diabetes?
SGLT 2 or GLP 1 inhibitors with or without metformin
39
GLP can reduce risk for
CV risk, CKD, HF
40
WHy is insulin +GLP 1 recommended?
Efficacy is incredible with both of these.
41
efficacy of GLP-1
Lowers A1c better than SGLT-2 but not as good as metformin Massive weight loss
42
Which GLP-1 inhibitors have a bigger effect on PPG? which ones of fasting BG?
Short acting affect PPG long affect fasting
43
What are some adverse effects of GLP-1 agonists
nausea in half of the users
44
Which type of patients is GLP-1 never used in
pancreatitis and thyroid cancer
45
What new warning id there for GLP-1 pts
Gall bladder disease (ask pt for FH), dx if there is FH
46
Avoid GLP-1 is pts with _________ and _________
gastroparesis and retinopathy
47
What are the 4 contraindications that we should look out for when giving out GLP-1s
Retinopathy, gall bladder issues, pancreatitis, thyroid cancer
48
What are the dosings of some popular GLP-1s
Trulicity- once weekly Victoza- daily Ozempic- Weekly
49
oral semaglutide name
Rybelus
50
Dosing for rybelus
Start at 3 mg po x 30 days increase dose to 7 mg, can increase to 14 mg if neededs
51
side effects of rybelus
lots of nausea
52
How to prevent nausea from rybelus
Take 30 mins before food
53
Other than improving diabetes, what other uses do GLP-1 agonists have
CV benefits and renal benefits
54
Which drug has dual action as GLP-1 and GIP RA
Mounjaro (tirzepatide)
55
Does mounjaro act in a glucose dependent manner?
Yes, it reduces glucagon in a glucose dependent manner. It also delays gastric emptying and increases satiety, causing weight loss.
56
efficacy of mounjaro
reduces A1c comparable to metformin. leads to massive weight loss and lowering of FBG
57
Mounjaro adverse effects
Ask about retinopathy, gall bladder, thyroid cancer and pancreatitis. tachycardia
58
Dosing mounjaro
Start at 2.5 mg per week adjust by 2.5 every week until 15 mg/week
59

Therapeutics P2 (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions