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NAPLEX 2021 > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

how often should BG be checked in prediabetics

A

annually

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2
Q

The preferred treatment for gestational diabetes

A

insulin*

metformin and glyburide are sometimes used

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3
Q

Classic symptoms of high BG

A

polyruia
polydipsia
polyphagia

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4
Q

diagnostic criteria (A1c, FPG, 2-hr PPG)

A

a1c: >6.5 (pre: 5.7-6.4)
FPG: >126 (pre: 100-125)
2-hr PPG: >200 (pre: 140-199)

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5
Q

Treatment goals: not pregnant

A

A1c <7 or 6.5
preprandial: 80-130
2hr PPG: <180

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6
Q

Treatment goals: pregnant

A

preprandial: <95
1hr PPG: <140
2hr PPG: <120

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7
Q

what is the eAG for an A1c of 6%

A

126

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8
Q

what does 1% ^ in A1c roughly equal in eAG

A

1% increase in A1c is about 28mg/dl increase in eAG

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9
Q

statin instensity needed in diabetics

A

high if ASCVD (post-MI, PAD) or >50 with multiple risk factors
mod: no ASCVD and 40-75yo
Patients <40yo w/ ASCVD: mod
Patients <40yo w/o ASCVD: no statin

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10
Q

blood pressure goal in diabetes

A

<130/80 mmHg

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11
Q

when is an ACEi or ARB needed in diabetic patients

A

Albuminuria or HTN present

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12
Q

drugs with little/no risk of hypoglycemia

A

GLP-1
DPP4 inhibitors
SGLT2s
TZD

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13
Q

1st line in T2DM with HF

A

SGLT2: empag, canag, dapagliflozin

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14
Q

CI for SGLT2

A

eGFR <30

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15
Q

T2DM with ASCVD first line

A

GLP1: dulagluride, liraglutide, semaglutide
SGLT2: empagliflozin, canagliflozin

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16
Q

first line in diabetes

A

METFORMIN

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17
Q

cut off for metformin initiaion

A

eGFR<30

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18
Q

when can insulin be initiated initially

A

A1c>10% or BG > 300mg/dL

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19
Q

which drug classes bascially do the same thing and shouldn’t be initiated together

A

DPP4 and GLP-1s

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20
Q

What is the starting dose of basal or bedtime NPH insulin?

A

10 units daily or TDD of 0.1-0.2 units/kg/day

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21
Q

How/when to initiate prandial insulin

A

initiate if BG is not controled with basal insulin at goal. Start with once daily dose before meal with highest carb intake or highest post-prandial BG

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22
Q

What percentage of basal do we start prandial insulin at?

A

10%

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23
Q

When to pick SGLT2 over GLP-1

A

heart failure or CKD patients

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24
Q

Warnings with metformin

A

lactic acidosis with renal disease or alcohol disease
B12 deficiency
stop prior to contact media

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25
What eGFR indicates to not initiate metformin
30-45
26
Side effects of thiazolidinediones
"-glitazones" edema weight gain bone fractures
27
Because of certain side effects, which patients would we not want to start a thiazolidinedione on?
Heart failure (edema)
28
What is a unique warning with thiazolidinediones?
"glitazones" | can stimulate ovulation!
29
Which sglt2s provide renal benefit
canagliflozoin (invokanna) | empagliflozin (jardiance)
30
which sglt2s provide hf benefit
canagliflozoin (invokanna) empagliflozin (jardiance) dapagliflozin (Farxiga)
31
when do sglt2s need to be d/c acutely
3 days prior to surgery to decrease risk of ketoacidosis
32
Boxed warning of amputation with _____
canagliflozin (invokanna) | do not use in neuropathy
33
eGFR of ____ = SGLT2s CI
eGFR <30
34
Which DPP4 does not need adjusted for renal impairment
linagliptin (Tradjenta)
35
which DPP4 can cause hepatotoxicity?
Alogliptin (Nesina)
36
which DPP4s should not be used in HF
aloglpitin (Nesina) | saxagliptin (Onglyza)
37
Which drug class should not be used with insulin
``` sulfonyureas (-ide) glipizide, glimepiride, glyburide AND meglitinides (glinide) repaglinide, nateglinide ```
38
What is a unique thing about sulfonyureas having to do with prolonged use
efficacy will decrease due to decreased beta cell function
39
MOA of sulfonyureas
increase insulin secretion by beta cells
40
Which drug class has a Beers Criteria warning against use
sulfonyureas
41
MOA of DPP4 inhibitors
increases incretin causing less glucagon production therefore lowering blood glucose
42
thiazolidinediones MOA
(actos/avandia) | increase muscle uptake of blood glucose due to increased sensitivity
43
Meglitinides MOA
-glinide | incease mealtime insulin secreation
44
risk of hypoglycemia with meglitinides?
YES! Especially if patient skips meals`
45
Which drug class can cause weight gain?
meglitinides, insulin, sulfonylureas, tzds
46
GLP1 that can be used in type 1 DM
pramlintide (symlin)
47
Which GLP1s come with pen needles?
weekly injections: Trulicity, Bydureon, Ozempic
48
which diabetic drug should be avoided in hyperkalemia?
canagliflozin
49
____ cells produce glucagon
alpha
50
____ cells produce insulin
beta
51
What is the glucose reverse in the liver/muscle stored stored as?
glycogen
52
MOA glucagon
pulls glucose into blood stream from glycogen stores
53
When are ketones made?
When glycogen stores in liver are low, glucagon signals fat cells to create ketones
54
List of basal insulins
glargine detemir degludec
55
which basal insulin is ultra-long acting
degludec
56
what is Regular insulin's role
bolus, but is slower acting than a rapid acting insulin
57
NPH facts
intermediate acting p = protamine hypoglycemia risk due to peaks that don't coincide with food intake variable, duration of action (14-24 hours)
58
onset and duration: rapid acting
15 min onset | 3-5 hour duration
59
onset and duration: regular insulin
30 min onset | 6-10 hours duration
60
onset and duration- NPH
1-2 hour onset | 14-24 hour duration
61
onset and duration- detemir
3-4 hour | 1 day
62
pros of basal insulin
NO PEAKS!
63
onset and duration - glargine
3-4 hour | 1 day
64
onset and duration - degludec
1 hour onset | 42+ hour duration
65
which diabetic drug should not be used with insulin due to risk of heart failure
rosiglitazone
66
which is rapid acting, humalog or humulin?
humalog and novolog! | think, diabetics need to LOG their meals and these are used at meal time
67
How is NPH given? `
twice daily before breakfaast and supper
68
how to start basal/bolus regime
if doing TID, start with 0.5u/kg/day then split 50:50 among basal and bolus dosing. bolus dosing should be spread out tid
69
how to convert between insulins
typically 1:1 except NPH ->lantus or Toujeo ->lantus - use 80% of current dosing
70
what is the ICR
insulin to carb ratio - how many grams of carbs are covered by 1 unit insulin
71
how to calculate icr
regular: rule of 450 = 450/TDD insulin Rapid: rule of 500 = 500/TDD = g of carbs covered by 1 unit insulin
72
what is the correction factor?
indicates how much the BG will be lowered by 1 unit of insulin
73
How to calculate the correction factor
regular: 1500 rule 1500/TDD rapid: 1800 rule 1800/tdd
74
how to calculate correction dose
(BG now - target BG)/correction factor
75
how to use correction dose
add it to the normal number of units of insulin before meals
76
If a patients BG readings before dinner are consistently high and they are on basal/bolus regime, what dose needs changed?
increase lunch time bolus
77
which insulins have a room temp stability other than 28 days?
10: humalog mix pen 14: humulin N and N/R pens 31: humulin R vial 40: Humulin R U-500 vial 41: Novolin N, R, N/R, 70/30 vials, levemir 56: Tresiba, Toujeo pen
78
goal BG in hospitalized patients
140-180
79
Lab values of DKA
bg >250 ketones in urine and serum anion gap acidosis (pH<7.35, gap >12)
80
Treating DKA and HHS
aggressive fluid resuscitation with NS, once BG 200 switch to D5W 1/2 NS Watch K+ and replace as needed insulin infusion 0.1 u/kg/hr give sodium bicarb with pH is <6.9
81
what is HHS
``` hyperosmolar hyperglycemic state: confusion/delirium BG>600 with osmolarlity of >320 dehydration pH>7.3 ```

NAPLEX 2021 (28 decks)

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