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PEBC- OTC > Seizures, Eye, Diabetes > Flashcards

Seizures, Eye, Diabetes Flashcards

1
Q

which two agents have most benefits in CV outcomes for diabetes

A

empagliflozin and liraglutide

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2
Q

name DPP4 inhibitors- which do you use with caution in HF

A

saxagliptan (caution HF), sitagliptan, alogliptan

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3
Q

which diabetic agents cause hypoglycemia most

A

SUs, meglitinide (insulin secretagogue) insulin

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4
Q

name short acting insulins

A

aspart, glulisine, lispro

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5
Q

what renal fx is metformin CI? cautioned?

A

caution 60, CI less than 30

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6
Q

who are thiazoledinediones CI in?

A

heart failure

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7
Q

what is type 1 diabetes

A

deficiency of insulin due to autoimmune beta cell destruction

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8
Q

what is type 2 diabetes

A

insulin resistance with some degree of deficiency

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9
Q

what to start with diagnosis of type 2 diabetes

A

-A1C less than 8.5- lifestyle, metformin if not controlled in 2-3 months. If greater, start metformin right away and often need combination therapy

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10
Q

how many SMBG should be done per day for those on basal-bolus insulin (insulin more than once per day)

A

minimum 3x- mix of both pre and post prandial

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11
Q

SMBG in patients on oral therapy- with or without insulin

A

individualize based on risk of hypo, dosage changes or evaluation of new agents, concurrent illness. Infrequent is okay if achieving targets and not on agents that induce hypo. When not meeting targets, do some pre and post, individualized. If on oral and once daily insulin- test at least once daily at different times

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12
Q

how much activity is recommended in diabetes

A

greater than or equal to 150 minutes per week- exercise increases insulin sensitivity so adjust insulin accordingly (moderate exercise will likely decrease, but a stress response with intense exercise may increase blood glucose)

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13
Q

monitoring for people with diabetes

A

BP at all appropriate visits, foot exams yearly, A1C q3m, SCr and urine ACR yearly, eye exam q1-2 years,

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14
Q

which insulin regimen is inappropriate in type 1 diabetes

A

conventional

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15
Q

when around a meal do you give regular and rapid acting insulins

A

regular- 20-30 minutes before meal. rapid- shortly before or within 20 minutes of starting a meal

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16
Q

symptoms of mild-mod hypoglycemia- how to treat

A

sweating, tremors, tachycardia, hunger, N, weakness. Give 15g glucose- will raise BG about 2mmol within 20 minutes. Retest in 15, and if still below 4mmol/L, give another 15

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17
Q

symptoms of severe hypoglycemia- how to treat

A

neuroglycopenic sx like confusion, difficulty speaking, uncounsious, etc. Give 20g carbs/glucose, retest in 15 minutes, if still below 4 mmol/L give another 20

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18
Q

what is localized fat hypertrophy

A

result of frequent use of same injection site resulting in low or unpredictable absorption of insulin from that site

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19
Q

when should you aim to reach target a1c in newly diagnosed diabetes patients

A

3-6 months

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20
Q

MOA of SU and meglitinides

A

insulin secretagogues- squeeze pancreas to release more insulin

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21
Q

MOA of metformin and thiazolidinediones

A

decrease hepatic glucose production (shut off leaky liver) and increase tissue sensitivity to insulin

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22
Q

MOA of DPP4 inhibitors and GLP1 agonists

A

mimic or enhance incretin hormones. DPP4 augments the action on GLP1 by preventing its breakdown, while glp1 agonists increase insulin, suppress glucagon, and increase satiety by slowing gastric emptying

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23
Q

MOA acarbose

A

delay or prevents digestion of complex carbs

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24
Q

which antidiabetics are associated with weight gain?

A

SUs/insulin secretagogues, insulin, TZDs

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25
Q

which antidiabetics are associated with weight loss?

A

glp1 agonists, and modest with SGLT2 inhbitors. -almost all are weight neutral. Weight gain ones are SU/insulin secretagogues, insulin, TZDs

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26
Q

strongest evidence for antidiabetic agent with reducing mortality and macrovascular endpoints

A

metformin

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27
Q

SU with most risk of hypoglycemia

A

glyburide -also associated with most weight gain

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28
Q

which diabetic medications should be skipped if you skip a meal

A

meglitinides- repaglinide, etc- take them just prior to meal

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29
Q

TZD MOA in diabetes

A

PPAR gamma agonists- influence gene expression in cell leading ot enhaned insulin sensitivity and lower levels of blood glucose and circulating insulin

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30
Q

which antidiabetic meds are CI in bladder cancer (current or past)

A

pioglitazone, dapigliflozin

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31
Q

which groups of antidiabetic meds are associated with rare risk of pancreatitis

A

GLP1agonists and DPP4 inhibitors

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32
Q

diabetes meds CI in those with hx or fam hx of medullary thyroid cancer or multiple endocrine neoplasia syndrome

A

GLP1agonists

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33
Q

which antidiabetic agents have potential for hypotension

A

sglt2 inhibitors

34
Q

which antidiabetic meds have rare SE of diabetic ketoacidosis-what are sx?

A

sglt2 inhibitors -N/V, abdominal pain, fruity acetone breath, decreased LOC, seizure, stroke

35
Q

appropriate empiric dose of basal insulin HS for type 2 needing to start insulin

A

5-10 units HS. Or 0.1-0.2Ukg

36
Q

target A1C is ___; this is based on benefit seen in

A

less than or equal to 7. reduced microvascular and neuropathic complications. less than or equal to 6.5 may be suggested if benefits thought to outweigh risks of hypogly (prevent nephro and retinopathy). A1C target up to 8.5% may be suggested in frail elderly, limited life expectancy or recurrent hypogly

37
Q

target for FPG or preprandial

A

4-7 mmol/L

38
Q

target for 2 hour PPG

A

5-10, or 5-8 if a1c goal not met

39
Q

when might fibrates be useful in cholesterol treatment

A

TG remain a problem

40
Q

BP target in diabetes

A

less than 130/80

41
Q

folic acid during pregnancy in diabetic patients:

A

5mg daily at least 3 months prior to conception, continued until 3 months gestation, then reduced to 0.4-1mg daily and continue through preg and a min of 6 months post partum or until breastfeeding is complete

42
Q

diabetes in pregnancy- drugs

A

d/c teratogens like ace, arb, statin, and start insulin. Of can’t take insulin, start glyburide or metformin

43
Q

What is diabetic ketoacidosis

A

from severe insulin def

44
Q

SE with metformin

A

metallic taste, N (take with food), diarrhea

45
Q

SE with DPP4 inh

A

nasopharyngitis

46
Q

SE GLP 1 inh

A

N, V, D

47
Q

SE insulin secretagogues

A

weight gain, hypoglycemia more common,

48
Q

SE SGLT2 inh

A

GU infections, hypotension, hyperkalemia (caution with loop diuretics and volume depletion),

49
Q

when should ketone testing be performed

A

BG 14 or more, presence of sx of ketoacidosis or when acutely ill and have high BG

50
Q

major risk factor for AMD

A

smoking- advise patients to quit and maintain balanced diet

51
Q

treatment for wet AMD

A

VEG-F inhibitors- effective for decreasing vision loss. Injected directly into eye.

52
Q

beta carotene in AREDs formulas

A

no longer recommended due to increased risk of lung cancer therefore no forms contain it anymore

53
Q

how long should you wait between different eye drop medications

A

five minutes

54
Q

side effects of all eye drops

A

local irritation, blurred vision temp

55
Q

prostaglandin eyedrops examples, what they do and common SE

A

“prosts” lower pressure of eye- brown pigmentation of iris, elongation of eyelashes

56
Q

only modifiable risk factor for glaucoma

A

elevated intraocular pressure

57
Q

drug that can commonly worsen glaucoma

A

corticosteroids

58
Q

drugs used to treat open angle glaucoma initially, and then after

A

beta blocker or prostaglandin analogue first,then add or substitute carbonic anhydrase inhibitor, adrenergic agonist, or whatever hasn’t been used in first line

59
Q

how do beta blockers work in glaucoma

A

decrease formation of aqueous humour and therfore pressure. CI in certain pulmonary and cardiac diseases

60
Q

examples of carbonic anhydrase inibitors and how they work in glaucoma- what line are they and why

A

dorzolamide, brinzolamide, decrease aqueous humor. Not first line because not as effective to lower IOP, but can be used as adjunct or in patients CI to BB. Bitter or unusual taste on instillation normal

61
Q

how do prostaglandins work in glaucoma

A

lower IOP by increasing outflow

62
Q

cholinergic agonists in glaucoma

A

pilocarpine- directly stimulate muscarinic receptors to contract muscle and increase outflow. SE= miosis (reduced night vision), spasm, brow ache

63
Q

combination products in glaucoma

A

all more effective than either agent on their own, all contain timolol

64
Q

what products OTC are cautioned in angle closure glaucoma

A

antihistamines/decongestants- rarely a problem in open angle glaucoma (most common), but can provoke angle closure glaucoma in those predisposed

65
Q

what is there cross reactivity with for carbonic anhydrase inhibitors

A

sulfonamides

66
Q

what happens when vasoconstricting or decongestant eye drops are used too often

A

rebound hyperemia

67
Q

first line choice for absense seizures

A

ethosuximide- not first line or even second for anything else

68
Q

first line anti seizure for generalized tonic clonic and focal/partial

A

both: carbamaz, lamotrigine, pheny. Tonic also had valproic/divalproex. Partial also has levitiracetam

69
Q

avoid these seizure meds in absense

A

gaba for sure, carba (may worsen absense seizures) and pheny use with caution

70
Q

avoid these seizure meds in myoclonic

A

carb (caution), pheny

71
Q

avoid these seizure meds in pregnancy, and give what

A

valproic acid/divalproex, in child bearing age females give folic acid at least 1mg daily some say 5mg

72
Q

general principles in AED therapy

A

single AED started at fraction of target dose to minimize AE (expect phenytoin and phenobarb), add second if max tolerated dose isn’t satisfactory and gradually withdraw first agent after maintenance dose of 2nd drug has been achieved. Polytherapy reserved for when 2-3 drugs have failed

73
Q

what suggests impending status epilepticus, and what is SE

A

SE= over 30 minutes and associated with high morbidity and mortality ie brain injury, if over 5 treat as impending

74
Q

name enzyme inducing AEDs that are a problem with COC and may lower efficacy. What else may they be a problem with?

A

carbamazepine, phenobarb, phenytoin, topiramate, primidone. Use barrier method as well in these patients or other methods (IUD, depot etc) but still use barrier. Also problem with other DI- reduce levels of other drugs

75
Q

AEDS in pregnancy- general principles of choosing therapy

A

use montherapy if possible, don’t change AEDs as risk of malformation is highest during first tri anyway when may not know preg yet and switching puts at risk of seiures, AED levels may drop due to increased clearance so watch, vitamin K given to all newborns at delivery to prevent hemorrhagic diseases. Breastfeeding? ensure watch levels as they may now increase! all appear okay, but barbituates may sedate baby

76
Q

name the epilepsy barbituates

A

primidone and phenobarb

77
Q

common SE with valproic /divalproex

A

N, weight gain, tremor, hair loss, blood dyscrasias, hepatotox; cognitive effects less than older AEDs

78
Q

common carbamaz SE

A

rash (rarely very serious-steen johnson- skin peels off), transient neutropenia, N, dizzy/drowsy (not as much as others)

79
Q

lamotrigine AE and DI

A

rash (can be serious), insomnia. Must have very slow titration. Valproic acid inhibits metabolism, increased met with enzyme inducing AEDs, hormonal contraceptives reduce serum levels of it up to 50%

80
Q

levetiracetam SE

A

sleepy, decreased energy, HA, irritable, depression

PEBC- OTC (21 decks)

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