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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)

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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

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3
Q

Classification
Type 2 diabetes

A

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

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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

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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

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6
Q

Insulin is released from where? and what they do?

A

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

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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

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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

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9
Q

Hyperglycemia symptoms

High blood sugar levels

A

3 P’s
Polyuria
Polydipsia
Polyphagia

Lethargy
Nocturia
Blurred vision
Weight loss

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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.

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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

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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

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13
Q

Complications

A

Hypoglycemia

Nephropathy
Retinopathy
Neuropathy

Diabetic foot infections

CVD
Coronary hearer disease
Peripheral vascular disease

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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

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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

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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

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17
Q

Hypoglycemia
Treatment
< 50 level 2 and 3

A

Glucogan

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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

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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

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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

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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

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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

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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

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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
Lifestyle Modifications
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
Oral Medications 5 category
Insulin secretagogues Insulin sensitizers Alpha-glucosidase inhibitors Sodium-glucose Co-Transporter 2 Inhibitor Dipeptidyl Peptidase IV (DPP-4) inhibitors
27
Sulfonylureas a) Meds name b) Characteristic
a) Glyburide Glipizide Glimepiride b) Inc insulin secretion MOST A1C reduction
28
Sulfonylureas a) ARDs b) Clinical note
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
Meglitinides a) Meds name b) Characteristic
a) Repaglinide Ends in “glinide” Nateglinide b) Inc insulin secretion #4 out of 6 A1C reduction Very short duration (2-4 hr)
30
Meglitinides a) ARDs b) Clinical note
a) Hypoglycemia Weight gain b) Take prior to meals Insulin secretion increases with meal ingestion If meals are skipped, skip medication
31
Insulin sensitizers Biguanides a) Meds name b) Characteristic
a) Metformin b) Dec liver’s glucose production MOST A1C reduction No hypoglycemia No weight gain
32
Biguanides a) ARDs b) Clinical note
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
Insulin Sensitizers Thiazolidinediones (TZDs) a) Meds name b) Characteristic
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
Thiazolidinediones a) ARDs b) Clinical note
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
Alpha-glucosidase Inhibitors a) Meds name b) Characteristic
a) Acarbose Miglitol b) Slows intestinal carbohydrate digestion and absorption LEAST A1C reduction
36
Alpha-glucosidase Inhibitors a) ARDs b) Clinical note
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
Sodium Glucose Co-Transporter 2 Inhibitor SGLT2 inhibitor a) Meds name b) Characteristic
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
Sodium Glucose Co-Transporter 2 Inhibitor SGLT2 inhibitor a) ARDs b) Clinical note
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
DPP-4 Inhibitors a) Meds name b) Characteristic
a) Alogliptin Sitagliptin Saxagliptin Linagliptin Ends in “gliptin” b) Inhibits DPP4 activity, & in result: inc insulin secretion dec glucagon secretion
40
a) What does GLP-1 do? b) What does DPP-4 do?
a) Lower glucose in blood b) Increase glucose in blood
41
DPP-4 Inhibitors a) ARDs b) Clinical note
a) Headache Nasopharyngitis Pancreatitis Urticaria and/or facial edema b) Weight neutral No hypoglycemia as monotherapy
42
Which one is MOST A1C reduction? and which one is LEAST A1C reduction?
Most Sulfonylureas and Metformin Least Alpha-glucosidase inhibitors
43
Non-Insulin Injectable Medications GLP1 Agonists a) Meds name b) Characteristic
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
Non-Insulin Injectable Medications GLP1 Agonists a) ARDs b) Clinical note
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
Amylinomimetic a) Meds name b) Characteristic
a) Pramlintide b) Amylin analog (delays GI emptying) dec glucose spikes after meals Decreases A1c by 0.6%
46
Amylinomimetic a) ARDs b) Clinical note
a) GI: nausea, vomiting, anorexia b) GI side effects decrease over time Avoid in patients with gastroparesis (delayed gastric emptying)
47
What is amilyin?
Amylase is an enzyme Helps digest carbohydrates Most amylase made by pancreas and salivary glands.
48
What is Insulin? ADRs?
Anabolic and anticatabolic hormone w/major role in protein, carbohydrate, and fat metabolism (allows glucose to enter cells) Hypoglycemia Weight gain
49
Basal insulin? Bolus insulin?
Provide consistent insulin level to decrease blood glucose Moring to night/ long acting Administer to decrease glucose after meal Rapid or short acting
50
Insulin Characteristics: a) Onset b) Peak c) Duration
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
Insulin Dosing and Adjustment Steps #1 Check for? #2 Check for ? #3 Check for?
#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
Which insulin need to be adjust?
#1 Avoid hypoglycemia Looks good #2 Basal insulin pre-lunch and pre-dinner errors Correct earliest one which pre-breakfast
53
Administration Routes 3
Vial/syringe (cheapest) Comes in U100 and U500 Pens (easier, more expensive) Insulin pumps
54
Administer a) Sites b) note
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
Basal insulin name?
NPH Detemir Glargine Degludec
56
Bolus insulin name? 4
Lispro Aspart Glulisine Regular
57
Onset Peak duration NPH Detemir Glargine
NPH 2-4 4-8 8-12 Detemir 2 None 14-24 Glargine 4-5 None 22-24
58
Onset Peak duration Lispro Aspart Glulisine
15-30 min 1-2 3-4 Regular 30 min-1 hr 2-3 4-6

Pharmacology (34 decks)

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