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CMN572 > unit 3: DM meds & treatment regimens > Flashcards

unit 3: DM meds & treatment regimens Flashcards

1
Q

DM1 treatment: _______ injections of both ______ & _____ insulin OR ________

A

DM1 treatment: MULTIPLE DAILY injections of PRANDIAL and BASAL insulin OR pump

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2
Q

DM1 insulin initiation dose in a metabolically stable person

A

0.5 units/kg/day

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3
Q

DM1 insulin dosing: 1st half ______ insulin to control BG after meals

A

prandial

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4
Q

DM1 insulin dosing: 2nd half ______ to control BG between meals

A

basal

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5
Q

______ insulin needs to be VERY individualized

A

prandial

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6
Q

DM2 treatment initiation med

A

metformin

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7
Q

DM2 + ASCVD pts treat with ______ or ________

A

SGLT2 inhibs
OR
GLP-1 receptor agonists

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8
Q

DM2 w high ASCVD risk OR existing HF treat w

A

SGLT2 inhibs

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9
Q

DM2 + CKD treat with _______ or ________

A

SGLT2 inhibs
OR
GLP-1 receptor agonists

*reduces risk of DKD progression, CV events or both

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10
Q

DM2. re-eval treatment every?

A

3-6m

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11
Q

what vitamin deficiency should we check for in DM2? (and maybe DM1? i dk why not?)

A

vitamin b12

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12
Q

biguanide (1)

A

metformin

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13
Q

sulfonylureas (5)

A 
nemonic: "3G Text & Call new york areas"
Tolbutamide
chlorpropamide
Glyburide
Glimepiride
Glipizide
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14
Q

thiazolidinediones (1)

A

pioglitazone

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15
Q

alpha-glucosidase inhibitors (2)

A

nemonic: “AGh I AM carb’d out”
acarbose
miglitol

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16
Q

GLP-1 receptor agonists (5)

A

nemonic: TIDE GETS LITTLE PRICKS (“tides”)(all meds are SQ)
also* “LADLE” for med names

exanatide (byetta)
liraglutide (victoza)
albiglutide (tanzeum)
dulaglutide (trulicity)
lixisesatide (adlyxin)
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17
Q

Dpp4-inhibitors (3)

A

nemonic: Diana Gliptin had 3 SAXAphones SITting in a LINe

saxagliptin
sitagliptin
linagliptin

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18
Q

SGLT-2 inhibs

A

nemonic: “CAN EMily DAte 2nd sergeant lieutenants?”

canglifozin
empagliflozin
dapagliflozin

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19
Q

metformin class & MOA

A
  1. biguanide

2. @ liver: decrease gluconeogenesis & insulin resistance

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20
Q

metformin does or does not require functional beta cells?

A

DOES NOT

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21
Q

metformin contras:

A
  • contrast dye
  • kidney/liver/HF
  • eGFR < 46
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22
Q

metformin adverse reaction

A

lactic acidosis

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23
Q

sulfonylureas MOA

A

@pancreas: mimics glucose > decrease K+ channels > increase Ca > increase insulin secretion from beta cells of pancreas

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24
Q

do sulfas require functioning beta cells?

A

YES

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25
Q

TZDs MOA

A

@nucleus: increase PPAR-gamma > increase insulin sensitivity > decreased insulin resistance

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26
Q

do TZDs require functioning beta cells?

A

NOPE

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27
Q

alpha-glucosidase inhibs MOA

A

@intestine: decrease a-glucosidase > decrease glucose absorption > slow absorption of carbs into proximal gut blood after meals

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28
Q

GLP-1 receptor agonists MOA

A

GLPA (promotes GLP-1 production > GLP -1 > @PANCREAS > increased insulin secretion > decreased glucagon secretion > delays gastric emptying > pt feels less hungy > improves post prandial hyperglycemia

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29
Q

DPP4 - inhibs MOA

A

DPP4 inhib > stops DPP4 production > stops GLP1 productions > @PANCREAS > increased insulin after meal & decreased glucose made by liver

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30
Q

SGLT-2 inhibs MOA

A

@proximal renal tubule > SGLT-2 receptor inhib > blocks glucose reuptake from urine > increased renal glucose excretion

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31
Q

Sulfas require dose adjustments when levels of _____ or _____ intake change

A

activity
OR
caloric intake

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32
Q

TZDs may increase ______ levels

A

lipid levels

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33
Q

sulfas adverse reaction:

A

c-peptide ??
hypoglycemia
weight gain

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34
Q

TZD adverse reactions

A

liver tox
edema/hf
weight gain
fractures

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35
Q

alpha-glucosidase inhibitors adverse reactions

A

abd pain
dirrhea
farting
elevated liver enzymes

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36
Q

GLP1 receptor agonist adverse reaction:

A

pancreatitis

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37
Q

DPP4 inhibitors adverse reaction

A

GI/URI symptoms
pancreatitis
nasopharyngitis

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38
Q

SGLT-2 inhibs adverse reactions

A

UTI, VV candidiasis, RF, hyperkalemia, dehydrations, hypotension

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39
Q

rapid acting insulin onset, peak, duration

A

O: 10-15
P: 1-2h
D: 3-5h

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40
Q

short-acting insulin (regular)

A

O: 30-60
P: 2-4h
D: 4-8h

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41
Q

intermediate acting insulin

A

O: 1-3h
P: 4-10h
D: 10-18h

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42
Q

long acting insulin drugs (4)

A
  • glargine/lantus
  • glargine/tujeo
  • detemir
  • degludec
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43
Q

glargine/lantus onset, peak, duration

A

O: 2-3
P: none
D: 24+h

44
Q

glargine/toujeo onset, peak, duration

A

O: 5-6h
P: none
D: up to 30h

45
Q

detemir onset, peak, duration

A

O: 1h
P: none
D: 18-24

46
Q

degludec onset, peak, duration

A

O: 30-90m
P: none
D: >42h

47
Q

long acting insulin is AKA:

A

basal insulin

48
Q

long acting insulin is used to cover ______ insulin requirements

A

basal

49
Q

long acting insulin can be used alone or with _______ insulin for a basal/bolus routine

A

rapid/short acting

50
Q

long acting insulin is usually given _____x/day

A

once, usually in the morning or at bedtime

51
Q

long acting insulin is titrated based on _______ levels

A

fasting blood glucose

52
Q

long acting insulin CAN or CANNOT be mixed with other insulins

A

CANNOT.

53
Q

intermediate acting insulin is used _____x/day

A

twice

54
Q

intermediate acting insulin has properties of both ______ and ______ insulins

A

basal & prandial

55
Q

rapid and short acting insulins are AKA

A

prandial insulins

56
Q

rapid and short acting insulins are typically used _____ meals or ________

A

before or immediately after

57
Q

patients taking rapid and short acting insulin must eat ________ when during the meal to prevent _______

A

CARBS, early in the meal to prevent hypoglycemia

58
Q

_______ insulin is best for young children with unpredictable food intake

A

rapid or short

59
Q

nemonic for fast acting insulins

A

no “LAG” period

  • lispro
  • aspart
  • glulisine
60
Q

nemonic for intermediate insulins

A

“I” for inter/isophane

61
Q

nemonic for long acting insulins

A

LLL

  • levemir (detemir)
  • lantus (glargine)
62
Q

nemonic for ultra long acting insulins

A

“U” for ultra/deglUdec

63
Q

pre-mixed insulins cover both _____ & _____ needs

A

basal & meal

64
Q

70/30 insulin =

A 
70% = NPH
30% = regular
65
Q

50/50 insulin =

A

50% NPH

50% regular

66
Q

humalog 50/50

A

50% Neutral protamine lispro (NPL)

50% insulin lispro humalog

67
Q

humalog 75/25

A

75% neutral protamine lispro (NPL)

25% insulin lispro humalog

68
Q

novolog 70/30

A

70% neutroal protamine aspart

30% insulin aspart novolog

69
Q

ALL diabetic patients need an rx for ?

A

GLUCAGON injection for tx of hypoglycemia

70
Q

total daily dose of insulin range ?

A
  1. 2 - 1.5+ units /kg

* depends on diet, exercise, degree of insulin resistance, oral meds, & beta cell funx

71
Q

titration of insulin dose is based on ?

A

self BG monitoring

72
Q

insulin should be ______ but can be left at room temp for up to _____ days

A

refrigerated, room temp for up to 30d

73
Q

DM1 insulin regimens = multiple daily injections of _______ and once or twice daily of ________

A
  • short/rapid to cover meals

* long acting for basal needs

74
Q

best insulin regimen for DM2 = the one that

1) achieves _______ control
2) acceptable to pt & provider in terms of _____
3) minimizes _____ episodes

A

1) achieves glycemic control
2) complexity, convenience, cost
3) hypoglycemic events

75
Q

initiate basal insulin at what dose?

A

10 units once per day

***this is LOW. tell pts to expect to titrate up quite a bit

76
Q

titrate basal insulin dose ____u every ____ days based on ______ until they reach their goal of ________

A

3 u every 3 days based on target fasting BG until they reach their goal of FBG 80-120 (usually)_

77
Q

it pt on basal insulin only has persistently elevated BG before lunch and dinner what do you do?

A

basal insulin alone is not sufficient, add twice daily mixed insulin regime or basal bolus regime

78
Q

TZDs & basal insulin regime

A

may be continued but may result in increased weight gain/edema

  • therefore
  • DIET AND EXERCISE ARE IMPORTANT
79
Q

sulfonylureas & basal insulin regime

A

continue at same dose or reduce by 50% esp if hypoglycemia develops

80
Q

GLP-1 RA’s & basal insulin regimen

A

OK for basal insulin ONLY. not prandial insulin

81
Q

van GLP-1 RA’s be used in conjunction with short acting or rapid insulin?

A

NOOOOO, not approved

82
Q

split mixed insulin regimen

A

*2-3 injections/day of combo
OR
long or intermediate acting insulin AND short or rapid acting insulin

83
Q

if using 70/30 or 75/25 what will the AM dose be?

A

2/3 of total daily dose

84
Q

if using 70/30 or 75/25 what will the pre-dinner dose be?

A

1/3 of total daily dose

85
Q

if using a 70/30 or 75/25 mix ____ intake needs to be fairly consistent.

A

carb. why? bc the pen is pre-rationed with intermediate & short acting insulin

86
Q

pt may mix own insulin for more flexible control. AM dose? dinner dose?

A
  • AM = 2/3 NPH + 1/3 regular or rapid

* dinner = 1/2 NPH + 1/2 regular or rapid

87
Q

split mixed insulin titration for elevated fasting (pre-breakfast) BG?

A

increase evening dose of NPH (basal)

88
Q

split mixed insulin titration for elevated pre-lunch BG?

A

increase AM dose of regular/rapid acting (prandial)

89
Q

split mixed insulin titration for elevated pre-dinner glucose?

A

increase AM dose of NPH (basal)

90
Q

split mixed insulin titration for elevated bedtime glucose?

A

increase evening dose of regular/ rapid acting (prandial)

91
Q

when titrating any dose of mixed insulin what should you review?

A

peak & duration times of insulin to see which would best cover the times the pt is having BG elevations

92
Q

basal bolus insulin regime is the most ______ but also the most _______

A
  • physiologic

* complex

93
Q

basal bolus insulin regime =

A

basal insulin + pre-meal bolus

94
Q

basal bolus insulin dosing?

A
  • BEDTIME (basal) = 50% of total daily dose

* Pre-meal = 50% of total daily dose split evenly between 3 meals

95
Q

fixed dose of pre-meal basal-bolus insulin regime is only effective if pt eats meals that contain a consistent amount of _______

A

carbs

96
Q

on basal -bolus regime, adjustment of _____ is necessary and can be done with a _____ and ______

A
  • meal-time bolus dose
  • sliding scale
  • advanced carb bounting
97
Q

sliding scale insulin is NOT the most physioloic regime bc it does not account for what?

A

carb content of meals

98
Q

sliding scale can be administered in which two ways?

A

1) set insulin amount for set BG ranges

2) fixed dose corrected up or down based on pre-meal BG

99
Q

advanced carb counting is reserved for which DM?

A

DM 1 but allowed for a highly motivated DM2 pt

100
Q

what does correction factor or sensitivity factor mean?

A

how much 1 unit of insulin will lower a pt’s BG

101
Q

example insulin calculation:
your pt insulin to carb ratio is 1:15. Correction factor is 40. Pre-meal glucose goal is 100.

Their dinner contains 75g carbs. Their pre-dinner BG is 140.

What is their insulin dose for this meal?

A

SIX UNITS

  • 5 units to cover carbs
  • 1 unit to cover elevated BG
  • 75g/15g = 5 units insulin
  • 1 unit for BG elevated 40 pts over goal (ex. would have been 2 unit if BG 180 bc corrective factor is 40units drop per 1u insulin)
102
Q

risks of insulin therapy? how do we combat these?

A
  • hypoglycemia: educate on s/s & tx
  • weight gain: edu importance of diet and exercise
  • injection site reaction: lipohypertrophy = teach to rotate sites
103
Q

toujeo is a _____ acting insulin (same insulin as ______) biggest difference is ______

A
  • long acting
  • same as lantus
  • difference concentration
  • toujeo is 300u/ml.
104
Q

typical insulin concentration

A

100u/ml

105
Q

tresiba is _______. available in what concentrations? what is its duration? is it basal or prandial?

A
  • degludec
  • U100 & U200
  • duration approx 42h
  • basal
106
Q

afrezza is a(n) ______ insulin. is it short or long acting? what are its risks and contraindications?

A
  • inhaled
  • rapid acting
  • risk of bronchospasm
  • contra’d in pts w lung disease & smokers
107
Q

early use of insulin in DM____ can help preserve _____

A

DM2, beta cells

CMN572 (13 decks)

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