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Pharm Exam 4 > Wk 12 DM > Flashcards

Wk 12 DM Flashcards

1
Q

DM

A

hyperglycemia
impaired metab
impaired insulin sec, insulin resistance

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2
Q

Type I

A

5-10% of class, age of onset <30, weak genetic link, absolutely no insulin prod, autoimmune

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3
Q

Type II

A

90+% of class, >30, strong genetic link, either insulin resistance or defective insulin release or excess glu prod or all the above

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4
Q

diagnosis of DM

A

confirmed by repeat

HgbA1c >6.5%, FBG >126, S/S’s + RPG >200 and OGTT >200

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5
Q

4 main ft’s of type I DM

A

long pre-clinical period
hyperglycemia when 80-90% of beta cells are destroyed
transient remission (“honeymoon period”)
established dx

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6
Q

Type I DM tx

A

individualized to each pt
goal is to mimic normal physiologic levels
basal, bolus or basal-bolus (long acting insulin and short acting insulin)

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7
Q

Insulin types

A 
human insulin (regular, short acting, 100 units/mL, 500 units/mL (U-500) which is error prone) 
insulin analogs (rapid acting/ultra short and long acting) 
NPH (intermediate acting) 
mixtures
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8
Q

insulin route of administration

A

PO destroys protein, but be given parenterally
usually by SC injection (slow abs)
regular insulin may be given IV

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9
Q

Insulin Requirement 1

A

total daily dose required - 0.4-1 units/kg/day of actual body weight
dec during “honeymoon period” to 0.2-0.5 units/kg/day

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10
Q

Insulin Requirement 2

A

basal insulin 24 hr coverage
approximately half total daily insulin dose
may use any intermediate/long acting insulin
NPH usually preferred as it can be mixed
Detemir may req q12 hr/BID dosing

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11
Q

Insulin Requirement 3

A

other 50% of total daily dose (meal time insulin)
divided between meals based on type of meal, pt characteristics
rapid acting or regular insulin

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12
Q

non-intensive insulin therapy - 2 injections

A

“split mixed” dosing
2 daily injections (2/3 TDD in morning, 1/3 TDD in evening)
basal insulin should be the 2/3 in am, 1/3 in evening if using NPH

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13
Q

non-intensive insulin therapy - 3 injections

A

3 daily injections: same dosing as split mixed but moves NPH to bedtime
dec nocturnal hypoglycemia
inc effect at dawn

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14
Q

intensive insulin therapy

A

multiple self monitored blood glucose (SMBG) checks each day

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15
Q

sliding scale insulin

A

“tight” control vs “regular” control

institutional specific

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16
Q

SMBG

A

blood glucose levels evaluate impact of insulin on meals

determined by FBG and PPG (post prandial glucose)

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17
Q

HbA1c

A 
glycosylated Hgb 
assesses glycemic control over 2-3 mo's 
4-6% in non-diabetics 
AACE recommends <6/5% 
ADA recommends <7%
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18
Q

interpreting HgbA1c

A

process is irreversible
lasts the life of the RBC (120 days)
reflects av glu over 3 months

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19
Q

type II DM tx

A

individualized based on age and comorbidities
lifestyle changes and simultaneously initiate pharm tx
no single algorithm is ideal, consider other factors
most pt’s will require multiple meds eventually

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20
Q

therapeutic lifestyle changes in type II DM

A

weight reduction through diet and exercise (target >/= 7 kg loss for all, may dec A1c by 1-2%)
tobacco cessation
minimize alc intake
nut counseling

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21
Q

summary of therapy for type II DM

A

TLCs and mono therapy with metformin at dx
start dual therapy if not at target A1c after 3 mo’s of mono therapy or if baseline A1c >/= 9%
start triple therapy if not at target A1c after 3 mo’s of dual
start combo injections if not at target A1c after 3 mo’s of triple therapy, blood glucose is >/= 300-350 and/or A1c >/= 10-12%

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22
Q

insulin in type II

A

insulin now used earlier in pharm to minimize micro and microvascular complications
multiple drugs are being used earlier

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23
Q

when to start insulin in type II

A

not at A1c goal after >/= 2 non-insulin hypoglycemics, severe FBG levels, A1c >10%
DO NOT use as a threat for not reaching A1c goals

24
Q

starting with basal (long acting) insulin in type II

A

guidelines recommend long acting because it causes less hypoglycemia
both NPH and LA - analogs are =’ly effective
NPH is available OTC and is much cheaper

25
Q

starting insulin in type II

A

start basal qd
adjust once or twice weekly
if not at goal (or dose >0.5 units/kg/day) begin prandial rapid insulin b4 largest meal
if still not controlled, begin basal-bolus insulin

26
Q

hypoglycemia S/S’s

A

shakiness, nervous, anxiety
palpitations, tachycardia, sweating (absent or diminished if on B-blockers)
hunger, N/V, HA
impaired judgement, mentation, fatigue, lethargy, ataxia (mistaken for drunk), stupor, coma, seizures

27
Q

mild hypoglycemia tx

A

glu tabs, fruit juice, hard candy (no artificial sweeteners), glucose gel

28
Q

severe hypoglycemia tx

A

glucagon injection

50% dextrose

29
Q

highly affective hypoglycemic agents

A

insulin
biguanides
sulfonylureas
rapid-acting secretagogues

30
Q

moderately affective hypoglycemic agents

A

TCDs
DPP4Is
SGLT2Is

31
Q

incretin hormones

A

inc insulin sec in response to meals

GLP-1 and GIP

32
Q

minimally effective hypoglycemic agents

A

a-glucosidase inhibitors (AGIs)
pramlintide
glucagon-like peptide-1 rec agonists (GLP-1-RAgs)

33
Q

AGIs

A

inhibits enzymes pancreatic alpha amylase and GI brush border a-glucosidase
delays hydrolysis of ing’ed CHO’s
reduces postprandial insulin and glu peaks
both agents =’ly efficacious

34
Q

Pramlintide

A

synthetic analog of human amylin

dec’s post-prandial glu levels, doesn’t affect B cells

35
Q

DKA

A

mainly seen in type I DM

caused by: omission of tx (med non-adherence), info (hyperthermic) or alcohol abuse

36
Q

DKA S/S’s

A

poly’s, weakness, fruity odor to breath, N/V and dehydration

37
Q

DKA tx

A

output - mild DKA
input - mod-severe DKA, if severe need to admit to ICU
needs fluids, insulin, K, bicarb and Na

38
Q

thyroid hormone

A

20% of T3 produced in thyroid, 80% produced peripherally by breakdown of T4 (extra thyroidal conversion)
steady state: 4-5 half lives (long)

39
Q

thyroid gland

A

regulation of hor prod

hypothalamic-pituitary-thyroid axis

40
Q

subclinical hypothyroidism labs

A

inc TSH, free T4 normal

41
Q

classic triad of Graves

A

hyperthyroidism
opthalmopathy
dermopathy

42
Q

rapid acting insulin

A

rapid abs due to reduced self-association

43
Q

long acting insulin

A

reduced solubility, slowing abs

adv: cont coverage without injections

44
Q

Glargine

A

long acting insulin, duration 22-36 h
can be given at any time, but needs to be same time each day
Toujeo is a type that is error prone (300 dose)

45
Q

Detemir

A

long acting insulin, duration: 12-20 hrs

46
Q

Degludec

A

long acting insulin, duration: >42 hrs
may take without regard to meal, doesn’t have to be dosed same time each day
less nocturnal hypoglycemia
Tresiba is a type that is error prone (200 dose, not 100)

47
Q

NPH

A

suspension of crystalline zinc insulin and positively charged polypeptide, protamine
absorbed slower after subQ inc
duration of action longer than regular insulin, shorter than long acting
cloudy appearance

48
Q

Metformin MOA

A

red hepatic glu prod
red intestinal glu abs
inc insulin sensitivity
improve peripheral flu uptake and utilization

49
Q

Metformin other

A

first biguanide was phenformin
DONT use if CrCl <30 (CKD stage 4 and 5)
monitor closely for CrCl 30-59 (CKD stage 3)

50
Q

Sulfonylureas

A

second line to metformi
qd dosing (possible BID for glypizide and glyburide)
all equally effective in class
moderately effective, efficacy dec over time
stimulates release of insulin
requires presence of insulin (fxning pancreas)

51
Q

rapid acting secretagogues

A

stimulates insulin release from pancreas
similar to SU but shorter 1/2 life
faster onset than SUs
may cause hypoglycemia (less than SUs) and weight gain

52
Q

DPP4Is

A

prolongs incretin levels to stimulate insulin syn/release and dec glucagon sec from pancreatic alpha cells
“incretin enhancers”
results: prolonged basal insulin sec

53
Q

SGLT2I

A

SGLT2 recovers filtered flu from urine, so inhibition inc’s urine glu loss

54
Q

GLP-1 mech

A

incretin mimetic
enhances glu dependent insulin secretion
inhibits release of glucagon
found not to inc HF risk

55
Q

T3/T4 mixtures (Liotrix)

A

expensive, lacks therapeutic rationale

56
Q

Methimazole

A

blocks oxidation of iodine in thyroid

no effect on circulating T3 or T4

57
Q

antithyroid SEs

A

agranulocytosis, aplastic anemia, thrombocytopenia

Pharm Exam 4 (3 decks)

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