Final Exam Part 1 Flashcards
List 7 risk factors for osteoporosis.
- Smoking/Alcohol
- Advanced age
- Low body weight
- RA
- Disease states
- History of fractures/steroid treatment
- Family hx of hip fracture
What is the role of estrogen in preventing osteoporosis?
Estrogen promotes osteoclast cell death and osteoblast activity
List 5 effects of estrogen and hormone replacement therapy .
- Female sex characteristics
- Endometrial proliferation
- Increase in HDL
- Decrease in Osteoclast activity
- Increase osteoblast activity
List 4 indications for the use of estrogen and hormone replacement therapy.
- Estrogen deficiency
- Severe vasomotor symptoms in menopause
- Postmenopausal osteoporosis
- Birth control
List 3 ADRs associated with the use of bisphosphonates.
- Ulcer
- Esophagitis
- Osteonecrosis of the jaw in patients with cancer when given via IV
List 3 MOAs of bisphosphonates.
- Inhibit bone reabsorption by binding to hydroxyapatite crystals in bone
- Inhibit osteoclast mediated bone resorption.
- Enhances osteoclast cell death, absorbed directly into calcium crystals
Bisphosphonates have poor oral ____. Describe their dosing (3).
Poor oral BIOAVAILABILITY
- Must take oral dose with full glass of water
- Maintain upright position for 30 min
- Abstain from taking drug with food, calcium, iron, coffee, tea and orange juice
What is the most significant ADR associated with the use of bisphosphonates? What will the patient report?
Rare atypical fractures with minimal impact (diaphyseal mid shaft fx of the femur) in patients who have taken drugs 10 yrs.
Patient reports dull aching pain in thigh/groin before fx occurs (watch for unexplained joint pain)
How often should a patient with Type 1 diabetes check their blood glucose level?
6-10 times a day
List 7 instances when blood glucose levels should be monitored.
- Before meals
- Before exercise
- Before bed (2am- night monitor 1x/moth)
- Before a critical tasks (driving)
- 2 hrs after meal
- After treatment
- When low blood glucose is suspected
List 4 insulin injection sites.
- Upper outer arms
- Abdomen
- Buttocks
- Upper outer thighs
What should the PT avoid doing at the site of injection? (2)
Avoid exercising and massaging the area with the site of injection because exercise increases the absorption of insulin.
Wait 2-3 hours before exercising that area to surpass peak insulin levels
List 2 things that increase the absorption of insulin.
- Exercise
2. Heat
Rate of insulin absorption is greater in the ____ than in the ____.
ABDOMEN than in the LEG
List the normal ranges for blood glucose levels. (4)
Fasting: 70-100 mg/dL
Hypoglycemia: Below 70 mg/dL
Pre-diabetic: Above 100 mg/dL
Diabetic/Hyperglycemic: Above 126 mg/dL
What type of insulin is Lispro?
Ultra Short Acting
List 4 types of insulin.
- Ultra Short Acting
- Regular Insulin
- Intermediate insulin
- Peak-less long acting insulin (Glargine)
When should ultra short acting insulin be taken? Duration? Peak action?
- Take 5 min before meal
- Duration 3-5 hours
- Peaks at 1 hr
When should regular insulin be taken? Duration? Peak action?
- Take 30 min before meal
- Duration: 6-8 hours
- Peaks at 2 hrs
What is the onset of intermediate insulin? Duration? Peak action?
- Onset: 1-4 hours
- Duration: 14-24 hours
- Peak: 6-12 hours
What is the onset of peak-less long acting insulin (Glargine)? Duration? Peak action?
- Active about 20 hours: represents basal level of insulin
- Onset within 1 hour
- Duration close to 24 hours
- No peak- continuous
______ is a type of intermediate insulin.
Neutral Protamine Hagedorn insulin (NPH)
What types of insulin should be taken before breakfast, lunch, dinner, and bedtime as per the multiple pre-meal injections with bed time long acting regime?
Breakfast: Short-acting insulin
Lunch: Short-acting Insulin
Dinner: Short-acting insulin
Bedtime: long-acting peakless (glargine)
What are 2 types of insulin regimens?
- Split and Mixed: regular or short-acting insulin mixed with intermediate, given before breakfast and dinner
- Split and mixed with bedtime intermediate: For purposes of improving morning fasting reading control the second intermediate-acting insulin can be held until bedtime (9:00PM)
List 4 ADRs associated with the use of insulin.
- Lipohypertrophy or lipoatrophy at injection site
- Weight gain
- Rebound hyperglycemia
- Hypoglycemia
What must a diabetic patient reduce prior to exercise? Why?
Pre-meal insulin dose (up to 75% but depends on patient)
Why? Because exercise increases the absorption of the insulin, so too much insulin can make the patient hypoglycemic
What are 3 recommendations for the end of an exercise session to keep in mind with diabetic patients?
- May end session with 10 sec sprint to reduce post exercise hypoglycemia
- Try to end session with pre-exercise glucose reading
- Have a snack at end of exercise if exercising later in the day to prevent nocturnal hyperglycemia
Glucose utilization ____ during moderate exercise and _____ during maximal 10 sec sprint.
Increases with moderate exercise
Decreases with maximal 10 sec sprint
Blood glucose levels will ____ during moderate exercise and ____ during maximal 10 sec sprint.
Decrease with mod exercise
Increase with max 10 sec sprint
Metformin decreases _____ in the liver by inhibiting gene expression and increases _____ sensitivity.
Decreases gluconeogenesis
Increases insulin sensitivity
_____ is the drug of first choice in treating diabetes unless there are ___ and ___ issues present
Metformin
Unless there are renal/hepatic issues present
List 6 additional MOAs of metformin.
- Stimulates glycolysis in the peripheral tissues (skeletal muscle)
- Reduces carbohydrate absorption
- Reduces circulating LDLs and triglycerides
- Increases fatty acid oxidation
- Increases insulin binding to its receptor
- Modest weight loss
What is a major advantage of using metformin?
Does NOT cause hypoglycemia
List 3 ADRs associated with the use of Metformin.
- Nausea
- Diarrhea
- Rarely lactic acidosis
When should Metformin be taken? (2)
Twice a day
Before breakfast
Before Dinner
List 4 functions of incretins.
- Released from the GI tract when food is ingested and is an early stimulus to insulin secretion
- Inhibit pancreatic glucagon secretion
- Slow rate of absorption of digested food by reducing gastric emptying
- Reduces appetite
_____ is the enzyme that terminates incretins.
Dipeptidyl peptidase-4 (DPP-4)
Incretin mimetics enhance ____ release and act as ____.
Insulin release
Incretin
List 4 MOAs of incretin mimetics.
- Glucagon-like peptide (GLP-1) analog
- inhibit endogenous glucagon secretion
- Suppress appetite and induce satiety
- Reduce rate of gastric emptying
What is the dosing for incretin mimetics (Exenatide)?
Administered 2x/day by injection-pre morning and evening meals, one with breakfast and the second with dinner
List 4 ADRs associated with the use of incretin mimetics.
- Nausea
- Vomiting
- Diarrhea
- Risk of mild to moderate hypoglycemia when used with a sulfonylurea so reduce the sulfonylurea dose
Incretins decrease ___ production and _____ secretion.
Glucose production
Glucagon secretion
Sulfonylureas are ________.
Insulin secreatogues
What are 3 MOAs of Sulfonylureas?
- Block ATP sensitive K+ channels
- Facilitate insulin release
- Block glucagon BUT stimulate appetite and cause weight gain
What is the dosing of sulfonylureas? List 3 ADRs associated with their use.
Dosage: 1/day dosing
- Hypoglycemia especially in elderly
- Mild wt gain
- Bind to albumen
____ are insulin sensitizers
Glitizones
List 4 MOAs of Glitizones (Thiazolidinedione)
- Increase insulin sensitivity in muscle, liver, and adipose tissue
- Improves insulin resistance
- Improves lipid and cholesterol levels
- May also delay progression of the disease
List 4 ADRs associated with the use of Glitizones.
- Fluid retention
- Weight gain
- Increased risk of fractures
- Possible risk of bladder cancer with Actos
What is the treatment for hypoglycemia?
- Eat 15 grams of carbohydrate
- Recheck glucose level in 15 min
- If reading is not above 70, eat another 15 g
- Test again in 15 min, if not above 70 consume another 15 g of CHO and call MD
15 grams = 4oz. Of juice or soda (not diet), 1Tbl of table sugar, honey, orange juice—any simple sugar (non a complex CHO)
List 2 MOAs of pipeptidyl Peptidase-4 inhibitors.
- Competitively inhibit DPP-4 enzyme
- Slows incretin degradation-potentiating glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP)
List 2 ADRs associated with the use of pipeptidyl Peptidase-4 inhibitors.
- Nasopharynigitis
2. Nausea
What confirms the diagnosis of diabetes and prediabetes?
Pre-diabetes: FBG 100-125, A1c 5.7-6.4%
Diabetes: FBG >126, A1C >6.5%
What is diabetic ketoacidosis?
- Decreased insulin levels = inability for glucose to be transported into the cell for energy
- Body breaks down fat as fuel for muscle energy resulting in build up of ketones (fatty acids in the body)
