Chapter 44

Question 1

ACE inhibitors and insulin

Answer 1

increase sensitivity to insulin

Question 2

Drugs that cause hyperglycemia

Answer 2

Phenytoin
Steroids
Diuretics

Question 3

Drugs that cause hypoglycemia

Answer 3

Lithium
ACE inhibitors (lisinopril)

Question 4

A1C level in diabetes

Answer 4

> 6.5%

Question 5

Insulin adverse effects

Answer 5

hypoglycemia

WT gain

Question 6

Basal insulin (Long-acting)

Answer 6

given to all Type 1 and most Type 2 DM patients

ok if eating or not (Lantus/Glargine or NPH).

Question 7

Nutritional or Pre-meal insulin or Prandial insulin

Answer 7

given with meals in anticipation of increased glucose load (scheduled Aspart or Lispro)

Question 8

Correction or Supplemental insulin

Answer 8

Short acting insulin (Aspart or Lispro) given to cover high glucose level prior to meals

Question 9

Insulin and contraceptives

Answer 9

↓FBS and insulin resistance

Question 10

Humalog KwikPen

Answer 10

containing 3 mL (300 units) of U-100 insulin

prime with 2 units to a stream of insulin before each injection

Question 11

DM common complications

Answer 11

neuropathy, nephropathy, retinopathy, vascular disease

Question 12

sudden onset Hypoglycemia sx

Answer 12

Pale, cool skin
Tachycardia, palpitations,
Confusion, dizziness, shakiness
Sweating, moist skin

Question 13

slow onset Hypoglycemia sx

Answer 13

Fatigue, weakness, HA, tremors

Causes: ↑ exercise ↑insulin, ↓ food intake

Question 14

Hypoglycemia tx

Answer 14

15gm sugar
wait 15 min
15gm sugar

Question 15

glucagon administration

Answer 15

can only give 1x/24 hours

do not give in liver disease as there are no glucose stores

Question 16

Oral Antidiabetic Agents

Answer 16

Sulfonylureas
Meglitinides (similar to sulfonyureas)
Biguanides
Thiazolidinediones (TZD)
Alpha-glucosidase Inhibitors

Question 17

Sulfonylureas functions/teaching

Answer 17

Stimulate insulin from pancreas beta cells

Take same time each day

Question 18

Sulfonylureas adverse effects

Answer 18

weight gain, hypoglycemia, heartburn, dizziness, HA, drowsiness, tremors, palpitations, sweating
drink ETOH =flushing, ↑ HR, nausea, blood dyscrasias, jaundice

Question 19

Sulfonylureas ex

Answer 19

chlorpropamide (Diabinese), glyburide (Micronase, Diabeta), glimepiride (Amaryl), glipizide (Glucotrol)

Question 20

Drug Interactions with Sulfonylureas causing hyperglycemia

Answer 20

Steroids
Estrogen
Thiazides
Epinephrine

Question 21

Drug Interactions with Sulfonylureas causing hypoglycemia

Answer 21

ETOH
Coumadin
ASA
Zantac (GERD)

Question 22

Meglitinides (Prandin) function

Answer 22

Stimulates mealtime insulin from pancreatic islet cells (similar to Sulfonylureas)

Question 23

Meglitinides (Prandin) teaching

Answer 23

take at the same time
must eat before taking
2-4 hour duration

Question 24

Meglitinides (Prandin) ending

Answer 24

ide

Ide rather have my pancreas secrete insulin

Question 25

Biguanide function

Answer 25

Prevents the liver from breaking down glycogen into glucose, ↑ tissue sensitivity to insulin ↑ glucose absorption in cells & lowers total & LDL cholesterol

Question 26

Biguanide example

Answer 26

Metformin (Glucophage) 1000 mg/day

Question 27

Biguanide adverse effects

Answer 27

flatulence, weakness, upset stomach

Question 28

Biguanide teaching

Answer 28

Ø wt gain or hypoglycemia, lactate = lactic acidosis in patients with impaired liver (or elderly)

Question 29

Thiazolidinediones (glitazones) function

Answer 29

Inhibit hepatic gluconeogenesis & ↓ insulin resistance

Question 30

Thiazolidinediones (glitazones) adverse effects

Answer 30

may cause cardiovascular event HA, myalgia, anorexia, jaundice, dark urine fluid retention, weight gain, Ø hypoglycemia- only with insulin/Sulfonylureas

Question 31

Thiazolidinediones (glitazones) dosing

Answer 31

Optimal ↓ing of blood glucose may take 3-4 months

Question 32

Thiazolidinediones (glitazones) contraindications

Answer 32

``` liver failure (monitor LFT's) HF ```

Question 33

Thiazolidinediones (glitazones) middle

Answer 33

azo

Question 34

Alpha-Glucosidase Inhibitors mechanism of action

Answer 34

delays CHO digestion

Question 35

Alpha-Glucosidase Inhibitors adverse effects

Answer 35

GI issues, liver impairment, hypoglycemia only with insulin/Sulfonylureas, tremors, palpitations, sweating

Question 36

Alpha-Glucosidase Inhibitors teaching

Answer 36

Garlic & ginseng may cause hypoglycemia

Question 37

Alpha-Glucosidase Inhibitors examples

Answer 37

Acarbose (Precose) & Miglitol (Glyset)

Question 38

Pramlintide (Symlin)

Answer 38

Amylin Analog amylin missing in type 1 can be used in type 1 or 2

Question 39

Pramlintide (Symlin) mechanism of action

Answer 39

slows food absorption | decreases glucagon

Question 40

Pramlintide (Symlin) adverse effects

Answer 40

hypoglycemia, GI (N&V, abdominal pain, anorexia), dizziness, fatigue, HA

Question 41

Exenatide (Byetta)

Answer 41

Incretin Mimetic (GLP-1 Agonist)

Question 42

Exenatide (Byetta) mechanism of action

Answer 42

Enhance insulin secretion after release from the gut into the systemic circulation

Question 43

Exenatide (Byetta) adverse effects

Answer 43

hypoglycemia (↑ incidence with other agents), GI (N/V/D, anorexia), pancreatitis, dizziness HA, injection site reactions, antibody formation do not give if hx of pancreatitis

Question 44

Exenatide (Byetta) dosing

Answer 44

Combine Metformin or Metformin & a sulfonylurea (↓ A1c by 0.4—0.9%)

Question 45

Exenatide (Byetta) beneficial effects

Answer 45

no appetite, wt loss

Question 46

Sitagliptin Phosphate (Januvia) mechanism of action

Answer 46

Blocks DPP-4 which wants to inactivate incretins (GLP-1)

Question 47

Sitagliptin Phosphate (Januvia) route

Answer 47

PO | 1x daily

Question 48

Sitagliptin Phosphate (Januvia) adverse effects

Answer 48

nasopharyngitis, URI, HA, hypoglycemia with sulfonylurea & metformin, GI (abdominal pain, diarrhea), serious allergic reactions (anaphylactoid reactions, angioedema Stevens-Johnson syndrome)