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NMT200 > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What are some types of drug that can cause dysglycemia?

A
  1. Beta-blockers (drugs ending in –olol)
  2. Corticosteroids (prednisone)
  3. HMG-CoA Reductase Inhibitors (drugs ending in statin)
  4. Thiazide or loop diuretics (hydrochlorothiazide, furosemide)
  5. Protease antiviral medications
  6. Second-generation antipsychotics (olanzapine, quetiapine)
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2
Q

What type of insulin preparation is useful for postprandial insulin injections or use with an insulin pump (continuous infusion)? Long-acting or rapid onset?

A

Rapid onset insulin preparation

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3
Q

What type of insulin preparations are useful for basal insulin infusion? Long-acting or rapid onset?

A

Long-acting insulin preparations

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4
Q

What are some adverse effects of insulin preparations?

A
  1. Hypoglycemia
    - most common
    - usually the result of a missed meal or an increase in exercise
  2. Localized fat hypertrophy
  3. Allergic reactions
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5
Q

With new and uncomplicated diagnosis of T2D, which drug is considered the first choice for patients ?

A

Metformin

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6
Q

Is metformin associated with weight gain?

A

NO

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7
Q

What is the mechanism of metformin?

A

Decreases hepatic glucose production
Lowers HbA1c by 1 – 1.5%

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8
Q

Which vitamin deficiency would be resulted from long-term use of metformin?

A

Vitamin B12

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9
Q

In patients with existing hepatic or renal disease, can we prescribe metformin? Why?

A

No. It may cause lactic acidosis.

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10
Q

Why using metformin as monotherapy, is the risk of hypoglycemia high or low?

A

LOW

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11
Q

What are the adverse effects of metformin?

A

Nausea, diarrhea, abdominal discomfort, anorexia, metallic taste.

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12
Q

Does acarbose significantly inhibit intestinal lactase? What’s its mechanism and which class does it fall into?

A

No.

Acarbose (alpha-glucosidase inhibitors) inhibits intestinal alpha-glucosidases resulting in delayed digestion of starches and disaccharides which reduces postprandial glucose levels.

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13
Q

If a patient take acarbose without a meal, is the drug still effective?

A

No. Acarbose is only effective if taken with a meal.

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14
Q

Does taking acarbose cause weight gain?

A

NO

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15
Q

Hypoglycemic patients taking acarbose should be treated with glucose or sucrose?

A

Glucose.

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16
Q

Can patient with IBS or IBD take acarbose?

A

No, acarbose is contraindicated in irritable bowel syndrome and inflammatory bowel disease.

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17
Q

How does acarbose interact with metformin?

A

Acarbose may reduce metformin bioavailability

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18
Q

What are the adverse effects of acarbose?

A

Flatulence, diarrhea, abdominal pain, cramps, nausea.

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19
Q

Does sitagliptin alter cardiovascular risk?

A

Sitagliptin does not seem to alter cardiovascular risk.

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20
Q

Does sitagliptin cause weight gain?

A

No, sitagliptin does not cause weight gain and is considered weight neutral.

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21
Q

Which class does sitagliptin fall into?

A

Dipeptidyl peptidase-4 inhibitors

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22
Q

What are the general mechanism of sitagliptin?

A

Sitagliptin inhibits the enzyme responsible for the degradation of GLP-1 and other active peptides involved in glucose homeostasis. It indirectly acts as an incretin mimetic.

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23
Q

Does sitagliptin have high or low risk of hypoglycemia?

A

Low

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24
Q

Does sitagliptin have high or low potential for drug interactions?

A

Low. Sitagliptin does not inhibit cytochrome P450 isozymes which resulting in a low potential for drug interactions.

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25
Q

What are some rare events of taking sitagliptin?

A

Pancreatitis/severe joint pain

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26
Q

What are some adverse effects of sitagliptin?

A

Nasopharyngitis
Hypersensitivity

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27
Q

Are semaglutide and liraglutide direct or indirect incretin mimetics? What is the mechanism?

A

Direct incretin mimetics by acting on GLP-1 receptors. They increases insulin secretion, suppresses postprandial glucagon secretion, slows gastric emptying, increases satiety.

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28
Q

Which drug class do semaglutide and liraglutide fall into?

A

GLP-1 receptor agonists.

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29
Q

How is semaglutide and liraglutide administrated?

A

Usually given by subcutaneous injection although there is an oral formulation of semaglutide

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30
Q

Do semaglutide and liraglutide cause weight gain or wight loss?

A

Semaglutide and liraglutide do not cause weight gain. They cause weight loss.

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31
Q

Do semaglutide and liraglutide prevent cardiovascular events?

A

Yes

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32
Q

Can semaglutide and liraglutide cause acute pancreatitis?

A

Rare

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33
Q

What are the adverse effects of semaglutide and liraglutide?

A
  1. GI adverse effects (common)
  2. Nausea upon initiation (common)
  3. Injection site reactions
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34
Q

In patients with heart rhythm disturbances and severe renal impairment, can we prescribe semaglutide and liraglutide?

A

Caution needed.

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35
Q

What are the contraindication of semaglutide and liraglutide?

A
  1. Pregnancy
  2. Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
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36
Q

Is glyburide generally considered add-on therapies to metformin or used as monotherapy?

A

Add-on.

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37
Q

Ture or False: Glyburide is considered as an insulin secretagogue which stimulates both basal and meal-stimulated insulin release.

A

Ture.

38
Q

Ture or False: Glyburide is associated with a higher risk of hypoglycemia and more weight gain.

A

True

39
Q

True or False: Significant differences exist between the available drugs in the class of sulfonylureas in terms of effectiveness, risk of hypoglycemia, and weight gain.

A

True

40
Q

What are some adverse effects of glyburide?

A
  1. Weight gain
  2. Prolonged hypoglycemia
    - especially in elderly or patients with renal impairment
    - greater compared with gliclazide and glimepiride
41
Q

Which drug can mask the hypoglycemic symptoms from glyburide?

A

Beta-blockers

42
Q

Repaglinide, a different class of insulin secretagogues, stimulates insulin release. The activity is shorter or longer than glyburide?

A

Shorter

43
Q

Which class does repaglinide fall into?

A

Meglitinides

44
Q

In the context of skipped meals, does repaglinide leads to lower or higher hypoglycemia?

A

Lower risk of hypoglycemia

45
Q

True or False: Repaglinide has less extensive metabolic drug interactions.

A

False. More extensive metabolic drug interactions

46
Q

Does canagliflozin enhance glucose excretion?

A

Yes. Canagliflozin (class of sodium-glucose cotransporter 2 inhibitor) prevents glucose reabsorption in the kidneys which leads to enhanced glucose exertion.

47
Q

Does canagliflozin cause weight gain?

A

No, canagliflozin causes weight loss

48
Q

True or False: canagliflozin reduces the risk of cardiovascular mortality, major adverse cardiovascular events and hospitalization due to heart failure.

A

True

49
Q

Does canagliflozin cause a small increase or decrease in BP?

A

Small decrease.

50
Q

What is one requirement for canagliflozin to work?

A

Require sufficient kidney function to work

  • as kidney function declines so does the antihyperglycemic effect
51
Q

What does canagliflozin slow?

A

Canagliflozin slow the progression of nephropathy

52
Q

What are some of the adverse effects of canagliflozin?

A
  1. Increased risk of genitourinary infections
  2. Reduced intravascular volume resulting in hypotension
  3. Hyperkalemia
  4. Risk of diabetic ketoacidosis
  5. Use with loop diuretics increase risk of hypotension
53
Q

True or False: pioglitazone enhances glucose reabsorption and hydrolysis of circulating triglycerides, respectively.

A

True

54
Q

Thiazolidinediones (class of pioglitazone) acts as agonists at peroxisome proliferator-activated receptor gamma (PPARG) receptors located on the cell nucleus (particularly in adipose tissue). What is the consequence of this?

A

This influences gene expression including upregulation of GLUT4 transporters and lipoprotein lipase.

55
Q

Is thiazolidinediones associated with weight gain or weight loss?

A

Weight gain

56
Q

True or False: Thiazolidinediones decrease peripheral glucose uptake.

A

False. Thiazolidinediones increased peripheral glucose uptake.

57
Q

True or False: thiazolidinediones enhanced fat cell sensitivity to insulin

A

Yes.

58
Q

True or False: thiazolidinedione increased hepatic glucose output

A

False. Thiazolidinedione decreases hepatic glucose output.

59
Q

What does thiazolidinedione do to heart?

A

Increase the incidence of heart failure due to thiazolidinedione’s ability to cause increased fluid retention and edema.

60
Q

True or False: thiazolidinedione increase the risk of fractures.

A

Yes. Especially hip and wrist

61
Q

Does thiazolidinedione worsen macular edema?

A

Yes

62
Q

True or False: Health Canada requires that physicians counsel patients and obtain their written consent for all new and renewed rosiglitazone prescriptions.

A

Yes

63
Q

What are some risk factors associated with diabetes?

A
  1. Genetics
  2. Obesity
  3. Age
  4. History of gestational diabetes
  5. Sedentary lifestyle
  6. Tobacco smoking
64
Q

What are the pre-diabetes HbA1c values?

A

5.7-6.4

65
Q

Would other medical conditions, such as PCOS, causing dysglycemia?

A

Yes

66
Q

True or False: nutrition therapy is a foundational intervention for T2D

A

Yes

67
Q

What is the HbA1c percentage reduction can be achieved with nutrition therapy ?

A

1-2%

68
Q

True or False: All nutritional recommendations to patients should take into account ethnocultural factors such as cultural foods, dining habits, lifestyles, food preparation techniques and fasting.

A

True

69
Q

In the condition of diabetes, what do we need to incorporate into a nutritional plan?

A

Caloric reduction

70
Q

True or False: In the condition of diabetes, even weight loss of 5 – 10% of initial body weight can improve glycemic control, insulin sensitivity, reduce hypertension and dyslipidemia

A

True

71
Q

Regarding meal timing, which population need to be careful?

A

-T1D
- T2D taking insulin

72
Q

Ture or False:

  • Insulin dosing generally needs to be adjusted for periods of fasting
  • Intermittent fasting can be helpful but requires close monitoring and is generally difficult to do
  • Carbohydrate intake should be spaced throughout the day
A

All true

73
Q

True or False: General recommendation for macronutrients is:
45 – 60% carbohydrates
10 – 35% protein
20 – 35% fat

A

True

74
Q

True or False: Macronutrient distribution will vary depending on the therapeutic diet chosen and the individual needs of the patient.

A

Yes. The exact distribution of macronutrients will depend on the therapeutic diet that is being used (e.g., a low-carb diet, Mediterranean diet, etc.) and the specific needs of each patient, which might vary based on their overall health, activity level, and blood sugar management goals.

75
Q

True or False: Available evidence is insufficient to recommend any one macronutrient breakdown for patients with T2D.

A

True. There isn’t enough strong evidence to recommend one particular macronutrient distribution (the proportion of carbohydrates, proteins, and fats) for all patients with T2D. This implies that diet recommendations for people with T2D should be more personalized rather than following one standard formula.

76
Q

What is the potential consequence of reducing carbohydrate intake below 45%?

A

Reducing carbohydrate intake below 45% tends to result in an increased consumption of saturated fats.

77
Q

What is glycemic index?

A

Glycemia index is an assessment of the quality of carbohydrate-containing foods based on their ability to raise blood glucose.

*It measures how quickly and how much a carbohydrate-containing food raises blood sugar compared to a reference food, usually pure glucose or white bread.

**Low GI food: <55
**Medium GI food: 56~69
**High GI food: 70+

78
Q

True or False: a low GI diet is similar to a high-fibre diet.

A

True

79
Q

True or False: in the condition of diabetes, viscous soluble fibres can slow gastric emptying and delay the absorption of glucose in the small intestine.

A

True.
Beta-glucan from oats and barley
Mucilage from psyllium
Glucomannan from konjac mannan
Pectin from dietary pulses, eggplant, okra, and temperate climate fruits (apples, citrus fruits, berries, etc.).

80
Q

True or False: In the condition of diabetes, added sugar should be limited or eliminated, especially fructose-containing sugars and sugar sweetened beverages if they account for more than 10% of total daily energy.

A

True

81
Q

True or False: The appropriate amount of fat in a person’s diet will depend on their overall dietary goals, thus there is no recommendation for percentage of daily total energy consumption that should come from fat.

A

True

82
Q

In the condition of diabetes, we should focus on replacing saturated fats from meat with what?

A

Focus on replacing saturated fats from meat with polyunsaturated fatty acids (PUFAs).

*PUFAs are found in foods like fish, nuts, seeds, and plant oils (e.g., sunflower oil, flaxseed oil) which have been shown to be beneficial for heart health, reducing the risk of cardiovascular diseases

83
Q

True or False: Regarding protein intake, general recommendation are 0.8g per kg body weight. Intake of 1-1.5g per kg body weight representing 15~20% of total energy intake.

A

True.

84
Q

In which diet, is increasing in protein consumption recommended?

A

Energy-reduced diets unless patient has chronic kidney disease.

85
Q

What are the consideration in choice of diet?

A
  1. Patient preferences and values
  2. The presence or prevention of comorbidities.
86
Q

Which diet pattern is the best dietary approach to prevent cardiovascular disease and improve glycemic control?

A

Mediterranean diet

87
Q

When the patient is already hypertensive, what is the recommended dietary approach?

A

DASH and low-sodium diets.

  • Improvement to glycemic control

*Reduce blood pressure

*Reduce sodium and increase potassium intake through dietary emphasis on vegetables, fruits, and low-fat dairy products, and includes whole grains, poultry, fish, and nuts.

*Smaller amounts of red and processed meat, sweets, sugar-containing beverages, total saturated fat, and cholesterol

*Larger amounts of potassium, calcium, magnesium, dietary fibre, and protein

88
Q

What’s one caution of DASH and low-sodium diets?

A

Possible increased mortality risk if sodium intake is below 1500 mg per day

89
Q

True or False: Ketogenic diet is a good option for improving glycemic control and facilitating weight loss

A

True

90
Q

What are some downside of ketogenic diet?

A

It is difficult for long term engagement and there is no evidence that it improves mortality with T2D.

It is conflicting whether or not it reduces cardiovascular risk .

91
Q

Which of the following dietary recommendations is the safest and most effective for improving glycemic control in a patient with type 2 diabetes requiring insulin?
A. Engage in intermittent fasting with an 8-hour eating window
B. Follow a ketogenic diet
C. Follow a moderate-carbohydrate diet with regular meal timing
D. Follow a low sodium diet consuming no more than 1000 mg per day

A

C. Follow a moderate-carbohydrate diet with regular meal timing.

NMT200 (6 decks)

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