Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diabetes > Type 2 Diabetes Management > Flashcards

Type 2 Diabetes Management Flashcards

1
Q

Core management of T2DM consists of…

A

Self-management
Lifestyle modifications
Pharmacotherapy

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

When choosing therapy for T2DM, assess the following…

BG? other factors? lifestyle?

A

Glycemic control, CV + renal status, dietary patterns and weight changes.

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

Individualized A1C targets can be chosen using…

A

The Canadian Diabetes A1C calculator

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

There are three options when beginning therapy for T2DM:

A

Lifestyle changes; no pharmacotherapy
Starting metformin (+ second agent if A1C is 1.5% above target)
Starting insulin + metformin for symptomatic hyperglycemia

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

If A1C is not at target at 3 months, next steps include…

A

Starting metformin if not on pharmacotherapy
Adjust or advance therapy

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

The MOA of metformin involves the following…

3 components

A

Decreasing hepatic glucose production
Enhancing sensitivity to insulin + increase glucose utilization
Some anti-inflammatory, effect on gut microbiome

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

Dosing of metformin should be initiated slowly, at…

A

250-500mg once daily

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

Metformin can be titrated by ____ weekly, if there are no GI side effects.

A

500mg weekly

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

Desired dosing for metformin is…

A

850-1000mg BID

Max dose: 850mg TID

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

The XR formulation of metformin can be dosed…

A

Once or twice daily

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

Metformin’s efficacy on A1C is…

What about TG, LDL, HDL? Clinical outcomes?

A

1-1.5% (up to 2% in certain patients)

Shown to lower TG, LDL, and slightly increase HDL

Lowered MI + mortality in T2 patients with obesity

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

Metformin has a negative interaction with alcohol as it can…

A

Potentiate metformin’s effect on lactate metabolism (lactic acidosis)
Enhance hypoglycemic effect

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

Common adverse effects with metformin include:

A

GI - diarrhea, nausea, abdominal discomfort

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

If GI side effects are bothersome from metformin, we can try…

A

Taking it with food, or try the XR formulation (Glumetza)

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

Less common adverse effects that may result from metformin include:

A

Metallic taste (lasting for a few weeks)
Vitamin B12 deficiency with long-term use (>5 years)

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

Signs of B12 deficiency involve…

A

Anemia, peripheral neuropathy

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

Risk of hypoglycemia with metformin is…

A

Very low when used as monotherapy, perhaps with concomitant factors (alcohol, not eating, usage with sulfonylurea)

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

Metformin effect on weight is…

A

Weight neutral to modest weight loss

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

Metformin max effect is reached in…

A

~2 weeks

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

Lactic acidosis is a condition where…

A

Arterial pH is lowered, and accumulation of serum lactate is present

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

S/Sx’s of lactic acidosis include…

A

Weakness, malaise, myalgias, and heavy laboured breathing

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

Metformin is potentially correlated with lactic acidosis, due to…

A

Inhibiting the conversion of lactate into glucose in the liver

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

Those who are primarily at risk of lactic acidosis with metformin are those who have…

Kidney

A

Reduced eGFR - lactate is eliminated unchanged by the kidneys, so there will be reduced elimination

THEREFORE dose is reduced with impaired renal function

May be withheld or d/c depending on certain precautions

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

Renal impairment doses start when Clcr is below…

A

<60 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

eGFR between 45-59 warrants metformin dosing of…

A

1500 mg/day in divided doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

eGFR between 30-44 warrants metformin dosing of…

A

1000mg/day in divided doses

Check eGFR every 3 months

27
Q

Metformin is CI when eGFR is ____. However, new studies have shown that with eGFR of ____, metformin could be continued at 500mg od but not started.

A

CI when eGFR is <30 mL/min. eGFR of 15-30 mL/min, do not start but can continue at metformin 500mg od

28
Q

Risk factors for lactic acidosis involve the kidney or liver, such as…

A

Severe liver disease or alcohol abuse, acute illness, or severe dehydration

Also consider history of lactic acidosis

29
Q

The MOA of sulfonylureas involve…

AKA insulin secratagogues

A

Enhancing secretion of insulin via binding to SU receptors on the beta cells of the pancreas

Stimulate both basal + meal-stimulated insulin release

30
Q

2nd generation sulfonylureas include these three drugs…

A

Glyburide
Gliclazide
Glimepiride

31
Q

These two sulfonylureas ARE on the formulary:

A

Glyburide and gliclazide MR

32
Q

Usual dosing for glyburide is…

A

5mg BID, up to 10mg BID

33
Q

Usual dosing for gliclazide MR is…

A

30-120mg OD

34
Q

Are sulfonylureas CI in renal failure?

Discussing formulary ones

A

Glyburide is CI in eGFR <60 mL/min.
Gliclazide is cautioned in 30-60 mL/min, CI in eGFR <30 mL/min

35
Q

Sulfonylurea effect on A1C is…

A

1-1.5%, (up to 2% in drug naive and elevated A1C)

36
Q

Sulfonylureas work quickly, and doses can be titrated…

A

After 2 weeks based on fasting BG, then titrate every 1-2 weeks

37
Q

The max effective dose is reached at about ____ of the maximum dosage

A

60-75%

38
Q

Long-term durability/efficacy of sulfonylureas is poor because…

A

Overtime, the pancreas will produce less insulin

Therefore, better response may be achieved if initiated early

39
Q

How do sulfonylureas compare with CV outcomes?

A

Microvascular benefit, but neutral for macrovascular benefit

40
Q

Hypoglycemia risk with sulfonylureas is…

A

High incidence, 2-30%

41
Q

Do sulfonylureas affect weight?

A

Yes, weight gain ~2kg

42
Q

Which sulfonylureas are more likely to cause hypoglycemia?

A

Glyburide > glimepiride > gliclazide

43
Q

If sulfonylureas are used in the elderly, what needs to be done with the dose to help prevent hypoglycemia?

A

Initiate at half normal dose, and titrate up

44
Q

Less freqent adverse effects that occur with sulfonylureas include…

A

Nausea
Rash, photosensitivity

Cross-sensitivity with those with a sulfa allergy is very rare

45
Q

Sulfonylureas are contraindicated in…

A

Pregnancy/breast-feeding
Severe hepatic/renal impairment

46
Q

Sulfonylureas should be held in acute illness due to…

A

Higher risk of hypoglycemia

47
Q

Drug interactions with sulfonylureas that may increase risk of hypoglycemia include…

A

Other sulfonamides, alcohol Salicylates, warfarin, NSAID’s, beta-blockers, MAOI’s

Bold = important ones

48
Q

Some drugs used with sulfonylureas may lead to lessened effects, and increased BG, such as…

A

Phenytoin
Rifampin
Colesevelam

49
Q

Repaglinide is in a group of drugs known as …

Short-acting, or non-SU insulin secretagogues

A

Meglitinides

50
Q

Repaglinide’s MOA is to…

A

Bind to site adjacent to SU receptor, resulting in stimulation of secretion of insulin from the pancreas

51
Q

Repaglinide differs from other sulfonylureas because…

PK? When is it supposed to be taken?

A

It has a faster onset and shorter duration of action; works primarily to decrease PPG

Peak levels within 1 hour, and half-life is 1 hour

52
Q

Repaglinide’s effect on A1C is…

Differs in how it affects BG !

A

1 to 1.5%; primarily decreases PPG - intended to be taken before meals to improve bolus insulin release

53
Q

Repaglinide dosing should be initiated based on…

Does it differ based on patient condition?

A

A1C: If below 8%, start at 0.5mg doses and titrate up. If above 8%, start at 1-2mg doses and titrate up.

LOW doses

54
Q

Repaglinide should be titrated every…

A

1-2 weeks until target BG is achieved

55
Q

Max dose of repaglinide should be:

A

4mg, before each meal: max dose of 16mg/day

56
Q

Due to its short duration of action, repaglinide needs to be administered…

A

Right before a meal, within 30 minutes

57
Q

Repaglinide is unique as it provides some flexibility, where a patient can…

A

Skip a meal, skip a dose; add a meal, add a dose

58
Q

Repaglinides relationship to hypoglycemia is…

A

Higher risk, especially when combined with other agents

Lesser extent compared to SU’s, and flexibility with meal dosing

59
Q

Do repaglinides affect weight?

A

Yes, weight gain ~0.3 to 1kg

Similar to SU’s but to a lesser extent

60
Q

Another common adverse effect with repaglinide are…

A

Headaches

61
Q

Repaglinide needs to be used with caution in…

Impairment

A

CrCl < 30mL/min
Caution in moderate hepatic impairment and CI in severe liver disease

Clearance significantly reduced in hepatic impairment: CYP450

62
Q

Repaglinide concentrations increase when used with:

Which CYP enzymes??

A

3A4 and 2C8 inhibitors

…Repaglinide conc. decreased with 3A4 inducers

63
Q
A

Diabetes (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions