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Pharm exam 5 chapters > Ch 48 highlights > Flashcards

Ch 48 highlights Flashcards

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1
Q

insulin needs increase when

A 
stress
infection
obesity
adolescent growth spurts
2nd and 3rd trimester pregnancy
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2
Q

insulin needs decrease when

A

increased exercise

1st trimester

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3
Q

insulin that can be mixed in the same syringe

A

Only NPH and short acting insulin

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4
Q

criterion for the diagnosis of DM

A 
fasting blood glucose > = 126 mg/dl
or
Random plasma glucose > = 200mg/dl  plus symptoms of D.M.
or 
oral glucose tolerance test:
2 hour plasma glucose >= 200
or 
HA1C 6.5% or higher

2 separate tests for diagnosis

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5
Q

what do you treat gestational DM with

A

Insulin

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6
Q

what type of DM management does not cause hypoglycemia and which oral agent does

A

Metformin
(sensitivity to insulin)

Sulfonylureas - does cause hypoglycemia
causes stimulation of insulin production

Meglinitinides (Glinides) - does cause hypoglycemia
works similar to Sulfonylureas

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7
Q

what pt population can you not use Metformin

A

renal impairment - blackbox warning

severe metabolic acidosis can occur with accumulation of metformin. Highest risk occurs in diabetic patients with significant renal impairment

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8
Q

Can you give someone who is Pregnant Metformin

A

yes

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9
Q

what antidiabetic causes weight loss and which causes weight gain

A

Metformin - Weight loss

Sulfonylureas - Weight Gain

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10
Q

When do you take Metformin in r/t meals

A

Metformin is not taken in r/t meals

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11
Q

Can you use Sulfonylureas in pregnancy

A

no

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12
Q

How do you take Sulfonylureas

A

Daily or BID

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13
Q

How are Glinides taken
Repaglinide
Nateglinide

A

Taken with each meal

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14
Q

what class are these meds in?
Repaglinide
Nateglinide

A

Glinides

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15
Q

Metformin decreases absorption of

A

Vit B12
folic acid

deficiencies in these vitamins can contribute to peripheral neuropathy

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16
Q

what vitamin deficiency is a diabetic taking metformin prone to that would be concerning if that pt became pregnant?

A

Folic acid

can cause neural tube defects

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17
Q

What antidiabetic holds a cardiac risk

A

Thiazolidinediones (Glitazones) - TZDs

can cause fluid retention and put a pt in heart failure or exacerbate heart failure

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18
Q 
What class is this drug?
Pioglitazone (Actos)
A

Thiazolidinediones (Glitazones) - TZDs

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19
Q

what is the indication for TZDs

A

antidiabetic for type 2 mainly as an add on to metformin

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20
Q

How do TZDs work

A

decreases insulin resistance

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21
Q

How do Alpha Glucosidase inhibitors work

A

act in intestines to delay absorption of carbs

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22
Q

what drug class is
Acarbose (Precose)
Meglitol

A

Alpha Glucosidase Inhibitors

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23
Q

how is Acarbose prescribed? monotherapy or adjunct?

A

adjunct

use with insulin, metformin or sulfonylurea

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24
Q

what is the indication for using Dipeptidyl Peptidase-4 Inhibitors (Gliptins) - DPP-4

A

optional second line therapy as an add on to metformin in the treatment of type 2 DM
can be monotherapy but usually adjunct

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25
``` What class is Sitagliptin (Januvia) ```
Dipeptidyl Peptidase-4 Inhibitors (Gliptins) - DPP-4
26
Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor) could cause weight gain or weight loss?
weight loss
27
``` what drug class Canagliflozin (invokana) ```
Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor)
28
common side effect for Canagliflozin (Invokana)
female genital fungal infections, urinary tract infections, and increased urination
29
A diabetic on Beta blockers
dangerous bc it can mask the signs of hypoglycemia\ | avoid placing diabetics on beta blockers
30
Glucagon-like Peptide -1 (GLP-1) Receptor Agonists therapeutic goal
improvement of glucose control for patients with DM type 2
31
What drug class is Exenatide (Byetta))
Glucagon-like Peptide -1 (GLP-1) Receptor Agonists
32
What baseline data do you need to prescribe an antidiabetic
Random plasma glucose, fasting plasma glucose, Hemoglobin A1C, Serum electrolytes, urinary glucose and ketones
33
What hypersensitivity reactions have been seen for Glucagon-like Peptide -1 (GLP-1) Receptor Agonists
anaphylaxis | angioedema
34
Can you use Glucagon-like Peptide -1 (GLP-1) Receptor Agonists in pregnancy
use in caution with pregnancy
35
what patient population do you need to avoid when prescribing Glucagon-like Peptide -1 (GLP-1) Receptor Agonists
renal dysfunction renal transplant patients history of pancreatitis
36
what class is Pramlintide (symlin)
Amylin Mimetic
37
What is Pramlintide (symlin) approved for
DM type 1 or 2 adjunct therapy to use at mealtime in patients who have failed to achieve glucose control despite optimal insulin therapy hypoglycemia is the biggest concern esp in type 1
38
what type of DM is Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor) used for
type 2
39
What is the therapeutic goal for Dipeptidyl Peptidase-4 inhibitors (Gliptins)
management of glucose control as an adjunct treatment for type 2 DM
40
what pt population is high risk for Dipeptidyl Peptidase-4 inhibitors (Gliptins)
pt with history of pancreatitis
41
Therapeutic goal for Meglinitinides (Glinides)
glycemic control with type 2 dm in combination with diet and exercise
42
High risk pt population for Glinides
use with caution with patients in liver impairment and those taking gemfibrozil
43
Therapeutic goal for Sulfonylureas
Maintain glycemic control in patients with Type 2 dm in conjunction with diet and exercise
44
High risk pt population for Sulfonylureas
Do not use in pregnancy or breastfeeding Use with caution in patients with renal or hepatic dysfunction
45
what medications can raise glucose
sympathomimetics | glucocorticoids
46
What medications can lower glucose
sulfonylureas
47
for a fasting blood glucose, how many hours do you fast
8
48
Name the short duration: Rapid acting insulin
``` Insulin lispro (Humalog) Insulin aspart (Novolog) Insulin glulisine (Apidra) ```
49
Name the Short Duration: Short Acting insulin
Regular Insulin (Humulin R, Novolin R)
50
Name the Intermediate duration insulin
Humulin N, Novolin N
51
Name the long duration inuslins
``` Insulin glargine (U-100) - lantus Insulin detemir -Levemir ```
52
Name the Ultralong Duration inusulins
``` Insulin Glargine (U-300) - Toujeo Insulin degludec - Tresiba ```
53
what insulin can be inhaled at mealtime for type 1 or type 2
Afrezza
54
Insulin lispro Humalog onset
15-30 min
55
Insulin aspart Novolog onset
10-20 min
56
Insulin glulisine (Apidra) onset
10-15 min
57
Regular Insulin (Humulin R, Novolin R) onset
30-60 min
58
Humulin N, Novolin N onset
60-120 min
59
Lantus onset
70 min
60
Levemir onset
60-120 min
61
INsulin glargine (U-300) onset
360 min
62
Insulin degludec onset
30-90 min
63
postprandial insulin control
humalog novolog apidra
64
How often is NPH given (humulin N, Novolin N)
2-3 times/day
65
how often is lantus given
1-2 /day
66
How often is U-300 given
once per day in place of lantus
67
what do you give if hypoglycemia develops while taking Acarbose
IM or IV glucose | You cannot use oral glucose bc receptors are blocked. It will not work
68
Acarbose Miglitol Which is associated with hepatic dysfunction
Acarbose
69
Which antidiabetic is more effective in African American population
Miglitol
70
What common Side Effects does Miglitol and Acarbose have | alpha -glucosidase inhibitors
GI (slows motility) - delays absorption of dietary carbs and thereby reduces the rise in blood glucose after a meal
71
Acarbose increases the risk for
anemia (can decrease the absorption of iron)
72
what drug class Glucotrol Glucotrol XL
Sulfonylureas
73
what dietary item must be avoided when taking a sulfonylurea
Alcohol will cause a disulfiram like reaction
74
How is Glucotrol taken
once daily with breakfast
75
what is a glycosylated hemoglobin level
HA1C
76
what anti-hypertensives can you give a diabetic
Aces | Arbs
77
what patient population can you not use metformin
Heart failure liver impairment renal impairment due to being at high risk for lactic acidosis liver and renal - build up heart failure - when not pumping efficiently, anaroebic byproduct is lactic acid
78
Glipizide (Glucotrol) | Glyburide (Diabeta)
Sulfonylureas
79
when are glinides taken
with every meal
80
When are sulfonylureas taken
Daily or BID
81
which antidiabetic will you have weight loss
metformin
82
Which antidiabetic will you have weight gain
sulfonylureas and glinides
83
sitagliptin | is what class
Gliptins
84
adverse effects of sitagliptin
stevens-johnson anaphylaxis angioedema pancreatitis
85
pt with severe hypoglycemia with limited life expectancy or advanced macro microvascular complications where should your target A1C sit
below 8
86
when is insulin glargine given (lantus)
once daily at bedtime

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