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Pharmacology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes

A

Hyperglycemia cause by lack or low levels of insulin or insulin resistance

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2
Q

Type 1 DM typical age of onset

A

10-14 years

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3
Q

Type 1 DM insulin requirement or not

A

Insulin dependent. 10% population

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4
Q

Type 1 DM auto-immune origins

A

Immune mediated destruction of pancreatic B cells; insulin is absent

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5
Q

Type 1 DM treatment

A
  1. Diet
  2. Exercise
  3. Self-monitoring of BG
  4. Daily insulin injections
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6
Q

Type 2 DM insulin requirement or not

A

Non-insulin dependent. 90% population of diabetics

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7
Q

Type 2 DM age association

A

Associated with middle-aged to older adults, abdominal visceral obesity, sedentary lifestyle, genetic components

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8
Q

Treatment for type 2 DM

A
  1. Diet
  2. Exercise
  3. Oral medications if needed
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9
Q

Gestational DM

A

Diabetes that appears during pregnancy (occurs in 7% of all pregnancies)

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10
Q

Percentage of women with GDM that develop type 2 DM later in life

A

30-50%

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11
Q

GDM and baby birth weight

A

associated with large birth weight babies (> 9 lbs.)

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12
Q

GDM treatment

A
  1. Diet
  2. Self monitoring of BG
  3. Sometimes insulin injections
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13
Q

Hypoglycemia

A

BG

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14
Q

Symptoms of hypoglycemia

A
  1. Tachycarida, pounding heart, sweating
  2. Anxiety, shaking/tremor
  3. Paleness, nervousness
  4. Numbness/tingling around lips/mouth
  5. HA, confusion, mood change, irritability
  6. Slurred speech, staggering gait, double vision, and drowsiness
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15
Q

Severe hypoglycemia can lead to what

A

seizures, coma, death

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16
Q

Treatment hypoglycemia symptoms and BG >60

A

Consume 15 g carbohydrates and recheck BG in 15 min

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17
Q

Examples of 15 g of carbohydrates

A
  1. 8 oz. skim milk
  2. small box of raisins
  3. 4oz of OJ
  4. 3-6 glucose tablets
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18
Q

Treatment hypoglycemia symptoms and BG

A

Symptomatic or not consume 30g carbohydrates and recheck in 15 min

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19
Q

Treatment of hypoglycemia for unconscious patient

A

glucagon emergency kit

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20
Q

What is glucagon

A

Hormone that promotes breakdown of glycogen and increase BG

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21
Q

Amount of glucagon for adults/children

A

Adults: 1 mg
Children: 0.5 mg

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22
Q

Where do you inject glucagon

A

Into arm, thigh or buttock. Turn patient on side if vomiting

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23
Q

How long may the glucagon take to kick in

A

15 minutes

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24
Q

Hyperglycemia accounts for what percentage of diabetes related deaths

A

90%

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25
Q

What are the microvascular complications associated with hyperglycemia

A
  1. Blindness
  2. Kidney disease
  3. Peripheral neuropathy
  4. Gastroparesis
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26
Q

What are the macrovascular complications associated with hyperglycemia

A
  1. HTN
  2. Heart disease
  3. Ischemic stroke
  4. Atherosclerosis
  5. Peripheral vascular disease
27
Q

What is the number 1 reason for kidney failure and blindness in DM

A

Hyperglycemia

28
Q

What is the number 2 reason for kidney failure and blindness associated with HTN

A

Hyperglycemia

29
Q

What are the long term effects associated with DM

A
  1. CV disease
  2. High cholesterol
  3. HTN
  4. Retinopathy - blindness
  5. Nephropathy - kidney failure
  6. Neuropathy - nerve damage
  7. Foot care, gastroparesis
30
Q

What is post prandial effect?

A

increased BG level following a meal

31
Q

Insulin resistance syndrome

A
  1. hyperglycemia
  2. hyper insulinemia
  3. dyslipidemia
  4. HTN
32
Q

Hyperinsulinemia leads to what?

A

increased VLDL, triglycerides, and atherosclerosis

33
Q

Dyslipidemia leads to what

A

high triglycerides (300-400), low HDL (

34
Q

Benefits of tight glucose control

A
  1. less microvascular complications
  2. Less macrovascular complications
  3. reduce long-term health care costs
35
Q

Drawbacks of tight glucose control

A
  1. more injections/medications/higher dosage
  2. Increased cost of meds and supplies
  3. increased risk of hypoglycemic events
  4. Compliance is harder and require more education
  5. increased self monitoring
36
Q

Beneficial medications in diabetics

A
  1. Antiplatelet drugs
  2. ACE or ARB - protect kidneys
  3. Statins - LDL worse with DM
  4. Antihypertensives (
37
Q

Problematic medications in DM

A
  1. beta blockers (mask s/s hypoglycemia)
  2. Corticosteroids
  3. oral decongestants
  4. Antipsycotics
  5. Some herbals
38
Q

Typical preprandial BG goal

A

70-130 mg/dL

39
Q

Typical postprandial BG goal

A
40
Q

Goal for A1c

A
41
Q

Oral hypoglycemic metformin (MOA)

A
  1. decrease hepatic glucose production (glyconeogenesis) by interfering with lactate oxidation
  2. enhances insulin sensitivity in hepatic and peripheral muscle tissue
    - – Treatment for type II diabetes lowers A1c and reduce M/M
42
Q

Oral hypoglycemic metformin (therapeutic use)

A

Only oral DM medicaiton proven to reduce M/M. Drug of choice for initial therapy along with lifestyle modifications

43
Q

Metformin adverse effects

A
  1. decreased appetite, metallic taste, N/V and diarrhea

2. decreased absorption of vitamin B12 and folic acid

44
Q

Sulfonylureas

A

glipizide
glimepiride
glyburide
—treatment for type II DM

45
Q

sulfonylureas MOA

A
  1. stimulates pancreas to release more insulin

2. decresaed hepatic glucose production

46
Q

ADR sulfonylureas

A

hypoglycemia and weight gain

47
Q

Meglitinides

A

Repaglinide

Nateglinide

48
Q

MOA meglitinides

A

Similar to sulfonylurease

49
Q

DPP4 inhibitors

A

sitagliptin
linagliptin
saxagliptin

50
Q

MOA DPP4 inhibitors

A

inhibits enzyme DPP4 (normally breaks down glucagon-like peptide 1). These drugs increase GLP-1 levels (inhibits livers production of glucose)

51
Q

Thiazolidinediones

A

pioglitazone

rosiglitazone

52
Q

Very rapid acting/short acting insulin

A

lispro
Aspart
Glusiline
all are 15-30 min onset

53
Q

Rapid acting/short acting insulin

A

regular 30-60 min

54
Q

Intermediate-acting insulin

A

NPH 2-4 hr

55
Q

Long-acting/Basal insulin

A

Insulin Detemir 2hr

Glargine insulin 4-5 hr

56
Q

Premixed insulin combo

A

NPH/regular 30-60 min
NPA/aspart 15-20 min
NPL/lispro - 15-20 min

57
Q

Insulin is produced by what cells in what organ

A

beta cells of the pancreas

58
Q

What type of insulin do you take for postprandial spike

A

rapid or very rapid acting

59
Q

If patient has taken insulin and has not eaten yet what is exercise prescription?

A

do not begin exercise

60
Q

Adverse effects of insulin

A

Hypoglycemia - serious risk
weight gain
injection site reactions

61
Q

When should rapid and intermediate acting insulins be taken

A

30 minutes before a meal or snack

62
Q

When should very rapid acting insulin be taken

A

15 min before meal or snack

63
Q

What drug is taken with the first bite of each meal three times daily?

A

Alpha-glucosidase inhibitors
acarbose
miglitol

64
Q

Fermentation associated with what drug

A

alpha-glucosidease inhibitors
acarbose
miglitol

Pharmacology (6 decks)

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