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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
TZDs MOA
@nucleus: increase PPAR-gamma > increase insulin sensitivity > decreased insulin resistance
26
do TZDs require functioning beta cells?
NOPE
27
alpha-glucosidase inhibs MOA
@intestine: decrease a-glucosidase > decrease glucose absorption > slow absorption of carbs into proximal gut blood after meals
28
GLP-1 receptor agonists MOA
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
29
DPP4 - inhibs MOA
DPP4 inhib > stops DPP4 production > stops GLP1 productions > @PANCREAS > increased insulin after meal & decreased glucose made by liver
30
SGLT-2 inhibs MOA
@proximal renal tubule > SGLT-2 receptor inhib > blocks glucose reuptake from urine > increased renal glucose excretion
31
Sulfas require dose adjustments when levels of _____ or _____ intake change
activity OR caloric intake
32
TZDs may increase ______ levels
lipid levels
33
sulfas adverse reaction:
c-peptide ?? hypoglycemia weight gain
34
TZD adverse reactions
liver tox edema/hf weight gain fractures
35
alpha-glucosidase inhibitors adverse reactions
abd pain dirrhea farting elevated liver enzymes
36
GLP1 receptor agonist adverse reaction:
pancreatitis
37
DPP4 inhibitors adverse reaction
GI/URI symptoms pancreatitis nasopharyngitis
38
SGLT-2 inhibs adverse reactions
UTI, VV candidiasis, RF, hyperkalemia, dehydrations, hypotension
39
rapid acting insulin onset, peak, duration
O: 10-15 P: 1-2h D: 3-5h
40
short-acting insulin (regular)
O: 30-60 P: 2-4h D: 4-8h
41
intermediate acting insulin
O: 1-3h P: 4-10h D: 10-18h
42
long acting insulin drugs (4)
* glargine/lantus * glargine/tujeo * detemir * degludec
43
glargine/lantus onset, peak, duration
O: 2-3 P: none D: 24+h
44
glargine/toujeo onset, peak, duration
O: 5-6h P: none D: up to 30h
45
detemir onset, peak, duration
O: 1h P: none D: 18-24
46
degludec onset, peak, duration
O: 30-90m P: none D: >42h
47
long acting insulin is AKA:
basal insulin
48
long acting insulin is used to cover ______ insulin requirements
basal
49
long acting insulin can be used alone or with _______ insulin for a basal/bolus routine
rapid/short acting
50
long acting insulin is usually given _____x/day
once, usually in the morning or at bedtime
51
long acting insulin is titrated based on _______ levels
fasting blood glucose
52
long acting insulin CAN or CANNOT be mixed with other insulins
CANNOT.
53
intermediate acting insulin is used _____x/day
twice
54
intermediate acting insulin has properties of both ______ and ______ insulins
basal & prandial
55
rapid and short acting insulins are AKA
prandial insulins
56
rapid and short acting insulins are typically used _____ meals or ________
before or immediately after
57
patients taking rapid and short acting insulin must eat ________ when during the meal to prevent _______
CARBS, early in the meal to prevent hypoglycemia
58
_______ insulin is best for young children with unpredictable food intake
rapid or short
59
nemonic for fast acting insulins
no "LAG" period * lispro * aspart * glulisine
60
nemonic for intermediate insulins
"I" for inter/isophane
61
nemonic for long acting insulins
LLL * levemir (detemir) * lantus (glargine)
62
nemonic for ultra long acting insulins
"U" for ultra/deglUdec
63
pre-mixed insulins cover both _____ & _____ needs
basal & meal
64
70/30 insulin =
``` 70% = NPH 30% = regular ```
65
50/50 insulin =
50% NPH | 50% regular
66
humalog 50/50
50% Neutral protamine lispro (NPL) | 50% insulin lispro humalog
67
humalog 75/25
75% neutral protamine lispro (NPL) | 25% insulin lispro humalog
68
novolog 70/30
70% neutroal protamine aspart | 30% insulin aspart novolog
69
ALL diabetic patients need an rx for ?
GLUCAGON injection for tx of hypoglycemia
70
total daily dose of insulin range ?
0. 2 - 1.5+ units /kg | * depends on diet, exercise, degree of insulin resistance, oral meds, & beta cell funx
71
titration of insulin dose is based on ?
self BG monitoring
72
insulin should be ______ but can be left at room temp for up to _____ days
refrigerated, room temp for up to 30d
73
DM1 insulin regimens = multiple daily injections of _______ and once or twice daily of ________
* short/rapid to cover meals | * long acting for basal needs
74
best insulin regimen for DM2 = the one that 1) achieves _______ control 2) acceptable to pt & provider in terms of _____ 3) minimizes _____ episodes
1) achieves glycemic control 2) complexity, convenience, cost 3) hypoglycemic events
75
initiate basal insulin at what dose?
10 units once per day | ***this is LOW. tell pts to expect to titrate up quite a bit
76
titrate basal insulin dose ____u every ____ days based on ______ until they reach their goal of ________
3 u every 3 days based on target fasting BG until they reach their goal of FBG 80-120 (usually)_
77
it pt on basal insulin only has persistently elevated BG before lunch and dinner what do you do?
basal insulin alone is not sufficient, add twice daily mixed insulin regime or basal bolus regime
78
TZDs & basal insulin regime
may be continued but may result in increased weight gain/edema - therefore * DIET AND EXERCISE ARE IMPORTANT
79
sulfonylureas & basal insulin regime
continue at same dose or reduce by 50% esp if hypoglycemia develops
80
GLP-1 RA's & basal insulin regimen
OK for basal insulin ONLY. not prandial insulin
81
van GLP-1 RA's be used in conjunction with short acting or rapid insulin?
NOOOOO, not approved
82
split mixed insulin regimen
*2-3 injections/day of combo OR long or intermediate acting insulin AND short or rapid acting insulin
83
if using 70/30 or 75/25 what will the AM dose be?
2/3 of total daily dose
84
if using 70/30 or 75/25 what will the pre-dinner dose be?
1/3 of total daily dose
85
if using a 70/30 or 75/25 mix ____ intake needs to be fairly consistent.
carb. why? bc the pen is pre-rationed with intermediate & short acting insulin
86
pt may mix own insulin for more flexible control. AM dose? dinner dose?
* AM = 2/3 NPH + 1/3 regular or rapid | * dinner = 1/2 NPH + 1/2 regular or rapid
87
split mixed insulin titration for elevated fasting (pre-breakfast) BG?
increase evening dose of NPH (basal)
88
split mixed insulin titration for elevated pre-lunch BG?
increase AM dose of regular/rapid acting (prandial)
89
split mixed insulin titration for elevated pre-dinner glucose?
increase AM dose of NPH (basal)
90
split mixed insulin titration for elevated bedtime glucose?
increase evening dose of regular/ rapid acting (prandial)
91
when titrating any dose of mixed insulin what should you review?
peak & duration times of insulin to see which would best cover the times the pt is having BG elevations
92
basal bolus insulin regime is the most ______ but also the most _______
* physiologic | * complex
93
basal bolus insulin regime =
basal insulin + pre-meal bolus
94
basal bolus insulin dosing?
* BEDTIME (basal) = 50% of total daily dose | * Pre-meal = 50% of total daily dose split evenly between 3 meals
95
fixed dose of pre-meal basal-bolus insulin regime is only effective if pt eats meals that contain a consistent amount of _______
carbs
96
on basal -bolus regime, adjustment of _____ is necessary and can be done with a _____ and ______
* meal-time bolus dose * sliding scale * advanced carb bounting
97
sliding scale insulin is NOT the most physioloic regime bc it does not account for what?
carb content of meals
98
sliding scale can be administered in which two ways?
1) set insulin amount for set BG ranges | 2) fixed dose corrected up or down based on pre-meal BG
99
advanced carb counting is reserved for which DM?
DM 1 but allowed for a highly motivated DM2 pt
100
what does correction factor or sensitivity factor mean?
how much 1 unit of insulin will lower a pt's BG
101
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?
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
risks of insulin therapy? how do we combat these?
* hypoglycemia: educate on s/s & tx * weight gain: edu importance of diet and exercise * injection site reaction: lipohypertrophy = teach to rotate sites
103
toujeo is a _____ acting insulin (same insulin as ______) biggest difference is ______
* long acting * same as lantus * difference concentration - toujeo is 300u/ml.
104
typical insulin concentration
100u/ml
105
tresiba is _______. available in what concentrations? what is its duration? is it basal or prandial?
* degludec * U100 & U200 * duration approx 42h * basal
106
afrezza is a(n) ______ insulin. is it short or long acting? what are its risks and contraindications?
* inhaled * rapid acting * risk of bronchospasm * contra'd in pts w lung disease & smokers
107
early use of insulin in DM____ can help preserve _____
DM2, beta cells

CMN572 (13 decks)

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