Brainscape's Knowledge GenomeTM

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


See full index

Pharmacology > Week 10 Diabetes > Flashcards

Week 10 Diabetes Flashcards

1
Q

Classification
Type 1 diabetes

A

Immune mediated
B-cell destruction

Pt has generic predisposition or immunologic abnormalities that cause their bodies to destroy their insulin-secreting cells (b-cells)

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

Classification
Type 1
a) age
b) body type
c) symptoms
d) Need for insulin

A

a) young (<30)/ abrupt uh. bruhpt 突然
b) Skinny
c) symptomatic

d) Immediate
MUST have in order to stay alive

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

Classification
Type 2 diabetes

A

Over time less insulin produce
Liver continue to secrete glucose and doesn’t get suppressed with food

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

Classification
Type 2
a) age
b) body type
c) symptoms
d) Need for insulin

A

a) Old (>30)) gradual
b) Obese
c) Asymptomatic

d) Years after diagnosis
Oral medication
Not need to survive since body still makes some

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

Insulin
75% of body’s glucose disposal occur in non-insulin dependent tissues
a) which one?

25% of glucose metabolism occurs require insulin
a) which one?

A

a) Brain
Liver and GI tissues

b) Muscle

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

Insulin is released from where? and what they do?

A

B-cells
suppressed hepatic glucose production
stimulates glucose uptake by peripheral tissue

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

What is the insulin resistance with type 2?

A

Liver
continue to secrete glucose with food intake
-insulin usually send message to stop secret glucose

Fat
Inc fat stores lead to insulin resistance and impaired insulin secretion

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

Diabetes
Characteristic

A

Hyperglycemia
Abnormalities carb, fat , protein metabolism
1/3 with diabetes not diagnosis
Leading causes of blindness and kidney failure
7th leading cause of death

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

Hyperglycemia symptoms

High blood sugar levels

A

3 P’s
Polyuria
Polydipsia
Polyphagia

Lethargy
Nocturia
Blurred vision
Weight loss

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

Hyperglycemia symptoms
Polyuria

Drinking lots that’s why pee a lots?
or pee lots that’s why drinking a lots?

A

Pee lots that’s why drinking a lots.

Glucose should 100% reabsorbed, but diabetic pt will pee them out.
Pee them out with water so they need to drink more.

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

What is Glycosylated A1c?

A

Glucose is bound to hemoglobin
The average serum glucose
Provides average blood glucose in 2-3 month time period

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

Diagnosis
Any one of following
a) A1c?
b) FBG

c) 2 hr plasma glucose 75 g OGTT
d) Random plasma glucose

A

a) A1c ≥6.5%
b) FBG ≥126 mg/dL
(no calorie intake >8 hours)*

c) 2 hr plasma glucose ≥200 mg/dL during a 75 g OGTT (oral glucose tolerance test)
d) Random plasma glucose ≥200 mg/dL and classic symptoms of hyperglycemia or hyperglycemic crisis

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

Complications

A

Hypoglycemia

Nephropathy
Retinopathy
Neuropathy

Diabetic foot infections

CVD
Coronary hearer disease
Peripheral vascular disease

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

Hypoglycemia
Symptoms

A

Blood glucose <70 mg/dL
More dangerous than hyperglycemia
Shaky
Sweating
Irritability

Fatigue
Dizziness
Anxious
Rapid heartbeat
Headache
Pale skin
Seizure

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

Hypoglycemia
Potential causes

A

Decreased caloric intake
Delayed or skipped meals
Too much insulin or other diabetes medications
Increased exercise

Small meal means small glucose load
= small insulin injection, but if not adjust

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

Hypoglycemia
Treatment

A

Eat 15-20g carb
½ can juice
1 cup skim milk
1 tablespoon of sugar, honey p
6-7 candy
3 glucose tablets

Once SMBG returns to normal eat meal or snack to prevent recurrence of hypoglycemia

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

Hypoglycemia
Treatment
< 50 level 2 and 3

A

Glucogan

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

Glucagon Nasal Powder

A

3 mg single use nasal application
Call 911 after use

May administer 2nd dose if no response after 15 minutes while

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

Nephropathy
a) cause
b) prevention

A

a)
Kidney damage d/t persistent hyperglycemia
Kidney’s overworking to filter blood
resulting in protein in urine

Occurs in 20-40% of patients
Single leading cause of end-stage renal disease
b)
Glycemic control
Blood pressure control

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

Retinopathy
a) cause
b) prevention

A

a)
Damages blood vessels d/t persistent hyperglycemia
Most frequent cause of new cases of blindness
b)
Glycemic control
Blood pressure control

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

Neuropathy
a) cause
b) prevention

A

a)
Damages blood vessels to the nerves d/t hyperglycemia

Peripheral neuropathy
numbness and tingling of extremities
Autonomic neuropathy
gastroparesis

b)
Glycemic control
Annually screening
Foot exams

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

Diabetic Foot Infection
a) cause
b) prevention

A

a)
Decreases sensation in extremities
Poor blood flow
Structural changes within the foot

May result in foot ulcers which is complicated by impaired wound healing

b)
Glycemic control
Annual foot exam (podiatry)
Daily self-foot checks
Diabetic shoes

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

Macrovascular Complications
a) cause
b) prevention

A

a)
Major cause of morbidity and mortality
Largest contributor to costs related to diabetes

b)
Glycemic control
Blood pressure <130/80 mm Hg
LDL<100 mg/dL
HDL>50 mg/dL
Triglycerides<150 mg/dL

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

ADA Treatment Goals
a) A1c
b) Fasting plasma glucose
c) 2 hr post prandial glucose

d) LDL
e) BP

A

a) A1c <7%
b) Fasting plasma glucose: 70-130 mg/dL
c) 2 hour post-prandial glucose <180 mg/dL

d) LDL<100 mg/dL (70 mg/dL better)
e) <130/80 mm Hg

25
Q

Lifestyle Modifications

A

Moderate carbohydrate intake
Saturated fat <7%
Calorie restriction in Type 2 patients to promote weight loss

150 minutes/week of moderate aerobic physical activity
Resistance training twice a week

26
Q

Oral Medications
5 category

A

Insulin secretagogues
Insulin sensitizers
Alpha-glucosidase inhibitors
Sodium-glucose Co-Transporter 2 Inhibitor
Dipeptidyl Peptidase IV (DPP-4) inhibitors

27
Q

Sulfonylureas
a) Meds name
b) Characteristic

A

a)
Glyburide
Glipizide
Glimepiride

b)
Inc insulin secretion
MOST A1C reduction

28
Q

Sulfonylureas
a) ARDs
b) Clinical note

A

a)
Hypoglycemia
Weight gain
Rash
Disulfiram reaction

b)
Take in the morning
Longer the duration of diabetes, becomes less effective
Consistent meals to prevent hypoglycemia

29
Q

Meglitinides
a) Meds name
b) Characteristic

A

a)
Repaglinide Ends in “glinide”
Nateglinide

b)
Inc insulin secretion
#4 out of 6 A1C reduction
Very short duration (2-4 hr)

30
Q

Meglitinides
a) ARDs
b) Clinical note

A

a)
Hypoglycemia
Weight gain

b)
Take prior to meals
Insulin secretion increases with meal ingestion
If meals are skipped, skip medication

31
Q

Insulin sensitizers
Biguanides
a) Meds name
b) Characteristic

A

a)
Metformin
b)
Dec liver’s glucose production
MOST A1C reduction
No hypoglycemia
No weight gain

32
Q

Biguanides
a) ARDs
b) Clinical note

A

a)
GI upset
Lactic acidosis (Black Box Warning)
Very rear, but kidney disfunction pt

b)
Take with food
Contraindicated with reduced kidney function
* eGFR (CLcr) <30 ml.min
* Undergoing radiographic dye study and eGFR (CLcr) <60 ml/min

33
Q

Insulin Sensitizers
Thiazolidinediones (TZDs)
a) Meds name
b) Characteristic

A

a)
Pioglitazone
Rosiglitazone Ends in “glitazone”

b)
Inc peripheral insulin sensitivity
Dec liver’s glucose production
#3 out of 6 A1C reduction
No hypoglycemia

34
Q

Thiazolidinediones
a) ARDs
b) Clinical note

A

a)
Edema
Weight gain/ water retain
Inc risk of fracture
May induce ovulation
Bladder cancer?

b)
Contraindicated in severe heart failure (Black Box Warning)
Maximal glycemic lowering may not be seen until 3-4 months of therapy

35
Q

Alpha-glucosidase Inhibitors
a) Meds name
b) Characteristic

A

a)
Acarbose
Miglitol
b)
Slows intestinal carbohydrate digestion and absorption
LEAST A1C reduction

36
Q

Alpha-glucosidase Inhibitors
a) ARDs
b) Clinical note

A

a)
GI side effects
Flatulence, bloating, diarrhea, and abdominal discomfort
b)
Give with first bite of food
Food + med must at the same time
To treat hypoglycemia, give table sugar or milk

37
Q

Sodium Glucose Co-Transporter 2 Inhibitor
SGLT2 inhibitor

a) Meds name
b) Characteristic

A

a)
Canagliflozin
Dapagliflozin
Empagliflozin Ends in “gliflozin”

b)
Inhibits SGLT2 in proximal tubule
Reduces reabsorption of glucose
(lower glucose)
Inc urinary glucose excretion, lowers blood glucose (traps glucose in urine)
Dec CVD mortality/morbidity

38
Q

Sodium Glucose Co-Transporter 2 Inhibitor
SGLT2 inhibitor
a) ARDs
b) Clinical note

A

a)
UTI
UTI leads pyelonephritis (life threating)

Genital fungal infections
Diabetic foot ulcers and amputation (Black Box Warning)
Diabetic ketoacidosis

b)
Renal impairment
GFR <30-60 ml/minute depending on the agent

39
Q

DPP-4 Inhibitors
a) Meds name
b) Characteristic

A

a)
Alogliptin
Sitagliptin
Saxagliptin
Linagliptin Ends in “gliptin”
b)
Inhibits DPP4 activity, & in result:
inc insulin secretion
dec glucagon secretion

40
Q

a) What does GLP-1 do?
b) What does DPP-4 do?

A

a) Lower glucose in blood
b) Increase glucose in blood

41
Q

DPP-4 Inhibitors
a) ARDs
b) Clinical note

A

a)
Headache
Nasopharyngitis
Pancreatitis
Urticaria and/or facial edema

b)
Weight neutral
No hypoglycemia as monotherapy

42
Q

Which one is MOST A1C reduction?
and which one is LEAST A1C reduction?

A

Most
Sulfonylureas and Metformin

Least
Alpha-glucosidase inhibitors

43
Q

Non-Insulin Injectable Medications
GLP1 Agonists
a) Meds name
b) Characteristic

A

a)
Exenatide
Long acting exenatide
Liraglutide
Albiglutide
Lixisenatide
Dulaglutide Ends in “natide” or “glutide”

b)
GLP1 Receptor Agonist:
inc insulin secretion
dec glucagon secretion
slows GI absorption
inc satiety

Decrease A1c by 1-1.6%

44
Q

Non-Insulin Injectable Medications
GLP1 Agonists
a) ARDs
b) Clinical note

A

a)
GI (nausea, diarrhea, vomiting)
Acute pancreatitis
Thyroid tumors in rats

b)
Black box warning for Long acting exenatide & Liraglutide Thyroid tumors
Causes weight loss
Improves B cell functioning

Exenatide must be administered w/in 60 min prior to a meal
Liraglutide and Exenatide extended release may be given regardless of meals

45
Q

Amylinomimetic
a) Meds name
b) Characteristic

A

a)
Pramlintide
b)
Amylin analog (delays GI emptying)
dec glucose spikes after meals
Decreases A1c by 0.6%

46
Q

Amylinomimetic
a) ARDs
b) Clinical note

A

a)
GI: nausea, vomiting, anorexia

b)
GI side effects decrease over time
Avoid in patients with gastroparesis
(delayed gastric emptying)

47
Q

What is amilyin?

A

Amylase is an enzyme
Helps digest carbohydrates

Most amylase made by pancreas and salivary glands.

48
Q

What is Insulin?

ADRs?

A

Anabolic and anticatabolic hormone w/major role in protein, carbohydrate, and fat metabolism (allows glucose to enter cells)

Hypoglycemia
Weight gain

49
Q

Basal insulin?
Bolus insulin?

A

Provide consistent insulin level to decrease
blood glucose
Moring to night/ long acting

Administer to decrease glucose after meal
Rapid or short acting

50
Q

Insulin Characteristics:
a) Onset
b) Peak
c) Duration

A

a) Length of time insulin enters blood stream and begins lowering blood glucose

b)Time insulin is at maximum strength in terms of lowering blood glucose

c) How long insulin lowers blood glucose

51
Q

Insulin Dosing and Adjustment
Steps
#1 Check for?
#2 Check for ?
#3 Check for?

A

1 hypoglycemia <70

#2 fasting blood glucose 70-130 mg/dL
#3 2 hour post-prandial glucose <180 mg/dL

Correct earliest abnormal value (NOT the highest value)

52
Q

Which insulin need to be adjust?

A

1 Avoid hypoglycemia

   Looks good #2   Basal insulin
   pre-lunch and pre-dinner errors

Correct earliest one which pre-breakfast

53
Q

Administration
Routes 3

A

Vial/syringe (cheapest)
Comes in U100 and U500
Pens (easier, more expensive)
Insulin pumps

54
Q

Administer
a) Sites
b) note

A

a)
Upper arm, upper back/shoulder blade area, lower back, anterior thigh, abdomen (most common)
b)
Rotate injections around the same site (don’t change body area, just rotate within the site)
Prevents skin thickening/lipohypertrophy
Inject in subcutaneous fat

55
Q

Basal insulin
name?

A

NPH
Detemir
Glargine
Degludec

56
Q

Bolus insulin
name? 4

A

Lispro
Aspart
Glulisine
Regular

57
Q

Onset Peak duration
NPH
Detemir
Glargine

A

NPH 2-4 4-8 8-12
Detemir 2 None 14-24
Glargine 4-5 None 22-24

58
Q

Onset Peak duration
Lispro
Aspart
Glulisine

A

15-30 min 1-2 3-4
Regular 30 min-1 hr 2-3 4-6

Pharmacology (34 decks)

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