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PHARM 2 > Glucose Control > Flashcards

Glucose Control Flashcards

1
Q

What are characteristics of DM type I

A 
Onset before age 30
abrupt onset
Requires exogenous insulin
Ketoacidosis prone
Wide fluctuations in BG concentration
Thin body habitus
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2
Q

What are signs and symptoms of DM type I?

A

Hyperglycemia
ketoacidosis (1/3)
3 P’s: polyuria, polydipsia, polyphasic

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3
Q

Characteristics DM type II

A 
adult onset (historically)
may require exogenous insulin
not ketoacidosis prone
relatively stable BG concentration
Obese body habitus
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4
Q

What are signs and symptoms of DM type II?

A

3 Ps

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5
Q

What 4 types of meds can cause hyperglycemia?

A

glucocorticoids
antipsychotics
HIV meds
Octreotide

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6
Q

What BG levels to be diagnosed with DM

A

Fasting BG >/= 126

Random BG >200

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7
Q

What are 4 different ways to monitor glucose?

A

BG monitor
Blood or plasma glucose
Glycosylated Hgb (Hgb A1c)
Urinary Ketones

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8
Q

What are the ISO guidelines for a BG monitor?

A

<75 meter should read within 15 mg/dl

>/= 75 meter should read within 20%

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9
Q

What is a normal HgbA1c?

A

4-6%
ADA recommends < 7-8.5% depending on age of diabetic pt

*gives an idea of BG control over past 3 months

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10
Q

Urinary ketones are used to monitor patients at risk for _________________

A

Diabetic ketoacidosis (DM type I)

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11
Q

What are 3 ways to treat diabetes?

A

diet
oral hypoglycemic agents
insulin

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12
Q

T/F: Insulin is considered a hormone

A

True

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13
Q

Insulin binds to __________ __________ ________ receptors

A

plasma membrane insulin receptors

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14
Q

What facilitates glucose diffusion into cells?

A

Glucose transporters

  • shift intracellular glucose metabolism towards storage (glycogenesis)
  • Stimulate cellular uptake of amino acids, phosphate, potassium, and magnesium
  • Stimulate protein synthesis and inhibits proteolysis
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15
Q

Why does re-feeding syndrome occur?

A

Glucose transporters stimulate cellular uptake of amino acids, phosphate, potassium, and magnesium.
*generally a lack of phosphorus and respiratory failure is the most common death with this

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16
Q

This occurs when their is an impaired intracellular insulin signal that results in decreased recruitment of glucose transport proteins to the plasma membrane and subsequent decrease in glucose uptake

A

Insulin resistance

*Compensatory hyperinsulinemia occurs to overcome this resistance

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17
Q

This occurs with low circulating concentrations of insulin

A

Insulin receptor saturation

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18
Q

Insulin receptor number in ___________ related to the plasma concentration of insulin

A

Inversely

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19
Q

T/F: Despite rapid clearance from the plasma, there is a sustained pharmacologic effect for 30-90 minutes before insulin is tightly bound to tissue receptors

A

True

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20
Q

SQ insulin if released more_______ into the circulation to produce a ______ biological effect

A

Slowly

Sustained

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21
Q

What is the basal rate of insulin secretion from the pancreas?

A

1 unit/hr

*food prompts a 5-10 fold increase in secretion

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22
Q

What is the total daily secretion of insulin?

A

About 40 units/day

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23
Q

Insulin response to glucose is ______ for oral ingestion than for IV infusion

A

Greater

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24
Q

What is the longest acting insulin?

A

Degludec (Tresiba)

lasts up to 42 hrs

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25
Q

T/F: People can not be allergic to insulin

A

False
older agents were made from beef or pork. newer agents are produced by recombinant technology and no longer a significant problem

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26
Q

Which insulin can be given IV?

A

only regular

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27
Q

What are 5 side effects of insulin?

A 
hypoglycemia
allergic reactions
lipodystrophy
insulin resistance
drug interactions
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28
Q

What is the most serious side effect of insulin?

A

hypoglycemia

  • symptoms reflect compensatory effects of increased epi: diaphoresis, tachycardia, HTN
  • diagnosis under GA is difficult
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29
Q

What causes rebound hyperglycemia?

A

SNS activity in response to hypoglycemia may mask the correct diagnosis (somogyi effect)

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30
Q

Treatment for hypoglycemia

A

50% dextrose 50-100 ml IV

Glucagon 0.5 - 1 mg IV

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31
Q

What may lead to development of antibodies to protamine?

A

Chronic NPH use

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32
Q

What is lipodystrophy?

A

atrophy of fat –> rotate injection sites to avoid

33
Q

Pts that are insulin resistant require > ____ units of insulin a day

A

100

34
Q

Acute insulin resistance is associated with what 3 things?

A

trauma
surgery
infection

35
Q

Hypoglycemic effects of insulin can be countered by what 3 types of meds?

A

ACTH or glucocorticoid steroids
Estrogen
Glucagon

36
Q

How does Epinephrine affect insulin?

A

Inhibits the secretion of insulin

stimulate glycogenolysis

37
Q

What percentage of total insulin should be administered as long-acting (basal insulin)

A

70%

  • given at bedtime
  • remaining 30% given as rapid-acting at each meal - doses based on BG and/or anticipated carb intake
38
Q

what type of insulin is used in an insulin pump?

A

rapid acting

  • regular
  • Lispro

*basal rate of 0.5 - 1 unit/hr

39
Q

What route of administration is Afreeza

A

inhaled

rapid acting insulin

40
Q

T/F: Insulin sliding scales can be used alone

A

False

need some sort of basal glucose control

41
Q

What are 2 goals of insulin therapy

A
  1. Maintain BG levels as close to normal as possible
  2. Delay or minimize long-term complications of DM
    - neuropathy
    - atherosclerosis
    - nephropathy
    - retinopathy
42
Q

What are 5 peri-op risks of hyperglycemia?

A 
micrangiopathy
impaired leukocyte function
cerebral edema
impaired wound healing
post-op sepsis
43
Q

What is optimal BG intra-op?

A

80-180

*glucose infusion if < 80 bc GA can mask signs of hypoglycemia

44
Q

T/F: pts should stop their long-acting insulin prior to being NPO for surgery

A

False

they should take 1/4-1/2 the dose of intermediate or long acting insulin the last dose prior to procedure

45
Q

If a pt has an insulin pump should you leave it on or turn it off?

A

maintain basal infusion rate, turn off preprandial boluses

-measure BG every hour

46
Q

What are the 8 types of oral hypoglycemic?

A 
sulfonylureas
alpha-glucosidase inhibitors
meglitanides
biguanides
thiazolidinediones
DPP-IV inhibitors
incretin mimetics
SLGT2 inhibitor
47
Q

What is the MOA of sulfonylureas?

A

Act on pancreatic beta cells to stimulate release of insulin

48
Q

T/F: you want to avoid sulfonylureas in pts with sulfa allergy

A

True

49
Q

What group of hypoglycemic has a high failure rate?

A

sulfonylureas - 20% primary failure rate. Each year 10-15% secondary failures

50
Q

Sulfonylureas are metabolized by ______ and excreted by ______

A

liver

kidney

51
Q

Hypoglycemia is greatest with which 2 sulfonylureas bc of their long DOA

A

glyburide

chlorpropamide *longest acting. may last 72 hrs

52
Q

What are 3 contraindications of sulfonylureas?

A

Hypersensitivity to sulfonamides
pts with poor hypoglycemic awareness
poor renal function

53
Q

Name 3 - 2nd generation sulfonylureas?

A

glyburide
glipizide
glimepiride

54
Q

Name 3 - 1st generation sulfonylureas?

A

Tolbutamide-shortest acting, fewest SE
Acetohexamide-kidneys excrete active metabolite
Chlorpropamide-assoc. with disulfram-like reactions (sick with ETOH)

55
Q

MOA of alpha-glucosidase inhibitors

A

Enzyme that breaks down complex carbs, block these –> less glucose in bloodstream

56
Q

Name 2 alpha-glucosidase inhibitors

A

acarbose (precise)

miglitol (glyset)

57
Q

MOA of meglitinides

A

Increase insulin secretion from islet cells like sulfonylureas

  • less rates of hypoglycemia than sulfonylureas (active only in the presence of glucose)
  • Repaglinide (prandin)
  • nateglinide (starlix)
58
Q

This is the #1 med for new type II DM

A

Metformin - Biguanide (only med in this group)

59
Q

MOA of metformin

A

Decreases hepatic glucose production
reduces glucose absorption from the intestine
increases insulin sensitivity

60
Q

What is a rare symptom seen with metformin?

A

lactic acidosis

61
Q

How long do you need to hold metformin prior to surgery?

A

48 hours - has a longer hold time than other oral meds

*also hold prior to giving IV contrast due to increased nephrotoxicity

62
Q

At what GFR is metformin contraindicated?

A

< 30: do not initiate therapy
30-45: if already on therapy can continue unless unstable

*old recommendations were based on creatine clearance

63
Q

This class of oral basal medication decrease insulin resistance and decrease hepatic glucose output

A

Thiazolidinediones

  • Rosiglitazone - Avandia
  • Pioglitazone - Actos

*Requires the presence on insulin and are esp effective in obese pts

64
Q

There are potentially higher rates of ______ deaths with Thiazolidinediones. Not seen much bc of this

A

Cardiovascular

65
Q

What type of meds are these?

Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Alogliptin)

A

DPP-4 Inhibitors

66
Q

What is the MOA of DPP-4 Inhibitors?

A

Increase pancreatic insulin secretion
Limits glucagon secretion
Slows gastric emptying
Promotes satiety

67
Q

What are 2 classes of Incretin mimetics?

A

GLP-1 analogs: prolong gastric emptying reduce postprandial glucagon secretion

Aylin analogs: Increases insulin secretion, slows gastric emptying, increases beta cell growth, central appetite suppression

68
Q

Some pts take these meds to help with weight loss

A

GLP-1 Analogs

69
Q

SLGT2 Inhibitors stands for what? What meds are in this group?

A

Sodium Glucose Transporter Type 2

*Forces them to pee out glucose

Canagliflozin (Invokan)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)

70
Q

Clinical presentation of hypothyroid (Hashimoto Disease)

A 
Cold intolerance
Dry skin
Fatigue, lethargy, weak
Weight gain
Bradycardia 
Slow reflexes
Course skin and hair
Periorbital swellilng
Painful/heavy menstruation
Myxedema coma
71
Q

Clinical presentation of hyperthyroid (Graves Disease)

A 
Weight loss/inc appetite
Heat intolerance
Goiter
Fine hair
Tachycardia
Nervous, anxiety, insomnia
Lighter periods/amenorrhea
Sweating/warm/moist skin
Exophthalmos
Thyroid storm
72
Q

This thyroid med is not longer made, but was produced from animal (pig) thyroid, and had T4 and T3 4:1

A

Armour Thyroid

73
Q

T/F: Synthroid contains both T3 and T4

A

False

It only contained T4

It is the most frequently administered drug for treatment of diseases require in thyroid hormone replacement

Long half-life (7 days) - pts do not require immediate replacement if held

74
Q

This med is T3, have a more rapid onset and shorter DOA than synthroid, and has more CV SE

A

Liothyronine

75
Q

What are some anesthetic implications of hypothyroidism

A 
Increased sensitivity to depressant drugs
Hypodynamic CV system
Slowed metabolism of drugs (esp opioids)
Unresponsive baroreceptor reflexes
Decreased intravascular volume
Impaired ventilatory response to low paO2 and/or increased PaCO2
Delayed gastric emptying
Hyponatremia
Hypothermic
Anemic
Hypoglycemic
Primary adrenal insufficiency
76
Q

What are 2 antithyroid drugs and what are their MOA

A

Propylthiouracil (PTU)
Methimazole (Tapaxole)

Blocks synthesis of thyroid hormone. Block the peripheral deiodinatin of T4 to T3 (PTU)

77
Q

What is the oldest effective treatment for hyperthyroidism?

A

Iodine’s

Lugol’s solution
Saturated KI solution

*Inhibits the release of thyroid hormone into the circulation

78
Q

What is another name for thyroid storm

A

Thyrotoxicosis

Severe exacerbation of hyperthyroidism due to the sudden excessive release of thyroid hormone

79
Q

What is treatment of thyroid storm?

A 
IV cold crystalloids
Sodium iodide IV
Cortisol IV
Propranolol IV
Proplythiouracil PO
Avoid ASA for elevated temps bc it. May displace thyroxine from carrier proteins. ** avoid all NSAIDs**

PHARM 2 (7 decks)

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