Brainscape's Knowledge GenomeTM

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


See full index

Fam Med: Diabetes > Type 2 DM > Flashcards

Type 2 DM Flashcards

1
Q

Discuss the pathophysiology of T2DM

A
  • Results from defective insulin secretion followed by loss of B-cell mass in response to increased demand as a result of insulin resistance
  • Loss of pancreatic cells is progressive; however, insulin secretion is usually sufficient to prevent ketosis under basal conditions
  • Mechanism of B-cell loss is unknown but programmed cell death in response to genetic and environmental factors demonstrated in animals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the A1c goal for T2 diabetics?

A

<7% or as low as can be achieved safely

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

What is first line treatment for T2DM?

A

Metformin if tolerated

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

How long does it take to see results from each class of medications?

A

Metformin, insulin secretagogues, DPP-IV inhibiors and glucagon-like-peptide-1 analogs: within days to weeks

Thiazolidinedione: several weeks to months

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

When is it necessary to start combo therapy in T2 diabetics?

A

May be needed at the time of diagnosis to achieve A1c and glucose targets in patients presenting with significant hyperglycemia and will likely be needed as B-cell function deteriorates over time

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

When is it necessary to start insulin therapy in T2 diabetics?

A

Considered in patients presenting in DKA or with very high glucose levels (A1c >10%)

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

Insulin secretatagogues (sulfonylureas): give examples of medications in this class

A

Glyburide

Glipizide

Glimepiride

Gliclazide

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

MOA of Insulin secretatagogues (sulfonylureas)

A

Increase insulin secretion by binding specific receptors in B-cells

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

What is the frequency of Insulin secretatagogues (sulfonylureas) dosing?

A

30-60 mins before food and should never be administered to fasting patients

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

Which of the SFUs should be avoided in patients with renal failure and why?

A

Glyburide because it has an active metabolite with significant renal excretion

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

Which of the SFU’s has the longest duration of action?

A

Glimepiride (administered once per day)

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

Which populations tend to do well with SFUs?

A

Newly diagnosed T2DM with mild-moderate fasting hyperglycemia

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

List the most common adverse effects of SFUs

A

Hypoglycemia (MC with glyburide)

Weight gain

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

Biguanide

List the only medication in this class

A

Metformin

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

What is the MOA of the Biguanide

A

Inhibits hepatic glucose output and stimulates glucose uptake by peripheral tissues

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

How is the Biguanide dosed?

A

Taken with food beginning with a single 500 or 850mg tablet, and the dose is increased every few days to weeks until optimal glycemic effect is achieved or 2,000mg/d is reached

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

What are the most common side effects of the Biguanide?

A

GI sx

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

What is the most serious adverse effect of the Biguanide? What are risk factors for this condition?

A

Lactic acidosis (incidence of 3/100,000 patient-years and significant mortality rate)

RF: renal dysfunction, hypovolemia, tissue hypoxia, infection, alcoholism, cardiopulmonary disease

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

What are contraindications for the Biguanides?

A
  • Serum creatinine level of >1.5 mg/dL in men and >1.4 mg/dL in women
  • eGFR of <60 mL/min
  • Other situations: cardiogenic or septic shock, CHF requiring pharm therapy, severe liver dx, pulm insufficiency with hypoxemia, severe tissue hypo perfusion
20
Q

How do you dose Metformin if the patient needs radioactive dye for imaging?

A

Discontinued at time of contrast procedure and not restarted for 48 hours

21
Q

Thiazolidinediones

What medication is in this class?

A

Pioglitazone

22
Q

What is the MOA of TZDs?

A

Increase insulin sensitivity in muscle, adipose tissue, and liver

23
Q

How are TZDs dosed?

A
  • Initial dose is 15 or 30mg PO daily taken with or without food and can be increased after several weeks to 45mg PO daily
  • Max dose approved with insulin is 30mg daily
24
Q

What other insulin therapies can TZDs be combined with?

A

SFU, metformin, sitagliptin, exanatide, insulin

25
Q

What is the most common adverse effect of TZDs?

A

Edema (ranging from none to mild peripheral edema)

26
Q

Which populations of patients should not receive TZDs?

A

Patients with compromised cardiac function

27
Q

What do you need to monitor (lab wise) with this TZDs?

A

Periodic monitoring of liver function (LFTs): risk of drug induced hepatotoxicity

28
Q

What hematologic effects does TZDs have on the body?

A

Mild decrements in hemoglobin and/or pancytopenia due to an increased plasma volume but also subclinical bone marrow suppression

29
Q

What are the MSK risks with TZDs?

A

Increase the risk of fracture in women, particularly smaller bones due to inhibition of osteoblast activity

30
Q

What do you need to advise women of child bearing age who are taking this medication?

A

Resumption of ovulation may occur during TZD therapy in premenopausal women with anovulatory cycles, so contraceptive practice should be reviews to prevent unintended pregnancy

31
Q

DPP-IV inhibitors

Give examples of medications in this class

A

Sitagliptin

Vildagliptin

Saxaglitpin

Linagliptin

32
Q

What is the MOA of DPP-IV inhibitors?

A

Inhibitors of DPP-IV, the enzyme that breaks down endogenous GLP, which is an incretin secreted from the intestinal L cells. Increased levels of GLP reduce BG concentration by inhibiting glucagon secretion from pancreatic alpha cells and stimulating insulin secretion

33
Q

How is sitagliptin dosed? What populations need to avoid this medication? What are ADRs?

A

Once daily at 100mg

Elimination pathway is predominately renal so dose reduction recommended in patients with reduced renal function (50mg if eGFR <50 or 25mg if <30)

34
Q

How is saxagliptan dosed?

What are the main SE?

A

Once daily in doses of 2.5 or 5 mg with lower dose used in patients with creatinine clearance <50mL/min

SE: uticaria and facial edema

35
Q

How is linagliptan dosed?

Why is this medication better for patients with renal disease?

A

Once daily 5mg

Due to its fecal route of excretion

36
Q

GLP agonists/mimetics

Give examples of medications in this class

A

Exenatide

Liraglutide

37
Q

What is the MOA of GLP agonists?

A

Structurally similar to endogenous GLP1 but resist breakdown by DPP enzymes à longer half-life and reach higher blood and tissue levels

38
Q

How is exanatide dosed?

A

SC injection in doses of 5 or 10 micrograms twice daily before meals

39
Q

How much can exanatide lower an A1c by?

A

0.6% to 1.2%

40
Q

What are ADRs of exanatide?

A

Pancreatitis and acute renal failure

41
Q

How is liraglutide dosed?

A

SC injection once daily at any time in doses of 0.6, 1.2 or 1.8 mg

42
Q

What are the main SE of liraglutide?

A

N/V, dizziness, and HA

43
Q

What are the two main ADR found in rodents in liraglutide?

A

Increased calcitonin levels and medullary thyroid cancer

44
Q

When is insulin therapy indicated in a T2DM patient?

A
  • Patients whom oral or injectable agents have failed to achieve or sustain glycemic control
  • Metabolic decompensation: DKA and nonketotic hyperosmolar crisis
  • New diagnosed pt with severe hyperglycemia
  • Pregnancy and other situations in which oral agents are contraindicated
45
Q

List common combination therapies

What is the most common?

A

SFU plus metformin

46
Q

What is a good regimen for combo therapy if weight loss is the goal?

A

Metformin plus DPP-IV inhibitor or GLP analog

47
Q

Why are TZDs avoided with insulin?

A

Higher incidence of CHF exacerbations

Fam Med: Diabetes (4 decks)

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