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Advanced Pharm, Exam 2 > Diabetes > Flashcards

Diabetes Flashcards

(50 cards)

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1
Q

Typical presentation of DM1? (3)

A

DKA (d/t unaware of condition)
weight loss
Eyesight issues

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2
Q

Treatment Strategy for DM1? (2)

A

INSULIN (always)

+/- Pramlintide (symlin)

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3
Q

What is the role of Pramlintide in treatment of diabetes?

A

Reduces gastric emptying, which reduces postprandial BS peaks/spikes

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4
Q

What is a major risk of taking Pramlintide?

A

Hypoglycemia (warn patient self monitor for symptoms 3 hours after administration)

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5
Q

What medication adjustment must be made in an insulin dependent diabetic who begins taking Pramlintide?

A

Insulin dose MUST be reduced by 50%

**Pramlintide Can not be combined with insulin in the syringe

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6
Q

Side effects of Pramlintide? (3)

A

Nausea and vomiting (r/t slowed gastric emptying/overeating)
Diarrhea
Hypoglycemia

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7
Q

Contrindication for Pramlintide

A

DM related gastropheresis (already slowed emptying compounded and can cause complications

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8
Q

Defining characteristics of DM1? (2)

A

Autoimmune

Characterized by relative or absolute lack of insulin (beta cells in pancreas destroyed)

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9
Q

Defining characteristics of DM2? (3)

A

Metabolic Disorder
Body cannot make enough, or properly use insulin
Can lead to the eventual destruction of beta cells in pancreas (leading to insulin dependence)

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10
Q

What is important to know about Gestational diabetes? (3)

A

Diagnosed in 2nd or 3rd trimester
Usually seen in pts who did not have diabetes prior to pregnancy
Require TIGHT control of blood sugar

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11
Q

Diabetes treatment considerations in patients with HIV? (1)

A

Screen for pre-diabets and DM prior to starting ART (protease inhibitors)

If normal, screen yearly
If pre-diabetic, repeat every 3-6 months

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12
Q

What suffix do most Portease Inhibitors end in?

A

-VIER

Used in treatment of HIV and have implications in development of DM

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13
Q

What drugs are primarily associated with drug-induced DM? (3)

A

Glucocorticoids
Anti-retrovirals for HIV (protease inhibitors)
Anti-rejection drugs (post transplant)

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14
Q

What is the role of Insulin in the body?

A

Insulin reduces blood glucose levels in the body

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15
Q

What is the typical clinical presentation in DM2? (6)

A 
Polyuria (increased urination)
Polyphagia (increased hunger)
Polydipsia (increased thirst)
Weight changes (often weight gain in T2, weight loss T1 but not always)
Changes in vision
Changes in sensory function
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16
Q

Who should be screened for Diabetes? (2)

A 
Adults >45, regardless of weight
Overweight Adults (BMI >25) or obese with 1 or more risk factors for DM
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17
Q

Diagnostic criteria for Pre-Diabetes? (3)

A

A1C 5.7-6.4%
Fasting (8 hours) Glucose 100-125
2-hour post load glucose 140-199 during OGTT

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18
Q

Diagnostic criteria for DM? (4)

A 
A1C > 6.5%
Symptoms plus:
Random glucose >200
Fasting (8 hours) Glucose >126
2-Hour Post load glucose >200 during OGTT
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19
Q

Factors that impact A1C independent of glycemia? (4)

A

Sickle Cell (0.3% lower)
G6PD (0.7-0.8% lower)
HIV
CKD with hemodialysis

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20
Q

What is the treatment strategy for DM2? (4)

A

Medical Nutrition Therapy (MNT) + physical activity
Monotherapy or combination therapy
Addition of Insulin (basal or long-acting)
Evaluation and management of other metabolic complications.

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21
Q

Primary action of Secretagogue Medications?

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A

Increase insulin secretion from beta cells

THESE CAUSE PROGRESSION OF DM by burning out the beta cells

22
Q

What are 3 primary negative effects of secretagogue medications?

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A

THESE CAUSE PROGRESSION OF DM by burning out the beta cells

Weight Gain

Severe Hypoglycemia

23
Q

What are the 2 classes of secretagogues?

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A

Meglitinides

Sulfonylureas

24
Q

MOA of Meglitinides?

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A

Stimulate insulin release from the beta cells in the pancreas

25
What has longer duration of action, Meglitinides or Sulfonylureas?
Sulfonylureas-can be given once daily
26
Name 2 Meglitinides
Repaglinide (Prandin) | Nateglinide (Starlix)
27
What suffix do most Meglitinides end in?
-GLINIDE
28
DDI with Repaglinide (Prandin)? (5)
``` Gefibrozil Itraconazole Clopidogrel (Plavix) Cyclosporine Atazanavir (protease inhibitor for HIV treatment) ```
29
What drug is Repaglinide (Prandin) often combined with?
Metformin
30
Dosing consideration for Nateglinide (Starlix)? (1)
Must be given before meals
31
MOA Sulfonylureas?
Stimulate insulin release from pancreatic beta cells | +/- reduces hepatic glucose output
32
How are second generation Sulfonylureas dosed?
Before each meal
33
Give drug names for second 2nd Generation Sulfonylureas? (3)
Glimepiride Glipizide Glyburide
34
What drug classes are | Non-Secretagogues? (6)
``` Alpha-glucosidase Inhibitors Biguanides DDP-4 Inhibitors GLP-1 Agonists SGLT2 Inhibitors TZD ```
35
What is the primary function of non-secretagogues?
Augment pancreatic insulin
36
MOA of Alpha-glucosidase inhibitors?
Delay breakdown of complex carbs and absorption of glucose (work within GI Tract) *SLOWS carb digestion and absorption, helping to minimize post-prandial BS spikes
37
How must Alpha-glucosidase inhibitors be dosed?
MUST be given with meals (with first bite of food)
38
SE of Alpha-glucosidase inhibitors?
GI issues
39
Give drug names for Alpha-glucosidase inhibitors? (2)
Acarbose | Miglitol
40
Benefits of alpha-glucosidase inhibitors as a class? (2)
No weight gain | No hypoglycemia
41
What effect do alpha-glucosidase inhibitors have on Hbg A1C?
Modest reductions (0.5-1%)
42
MOA of Biguanides?
Reduce hepatic glucose production (reducing fasting glucose levels)
43
Side effects of biguanides? (2)
GI issues | Lactic Acidosis
44
Clinical benefits of Biguanides?
``` Weight loss No Hypoglycemia Improves Insulin Resistance Low Cost Can improve lipid-profile -decrease FA & VLDL synthesis from liver, decreasing TG ```
45
Drug names for Biguanides?
Metformin
46
What is the maximum dose for Metformin?
2g/day Can be in divided doses The higher the dose, the more side effects
47
Contraindications of Metformin? (4)
Moderate to severe liver disease Chronic/Binge ETOH Pregnancy Breast Feeding
48
If a patient is taking Metformin, when does the medication need to be held?
Renal Failure Surgery Anything that may involve IV contrast (stop day of an don't resume for 48 hours), more of an issue in AKI and risk of higher load contrast
49
What is the effect of Metformin on Hbg A1C?
Reduction of 1.5-2.0%
50
Warnings/cautions for use of Metformin? (2) Address renal dosing (yes or no)
Moderate to severe liver disease Renal Dose adjustments required Don't give metformin if GFR <30 Evaluate risk vs benefit if GFR <45

Advanced Pharm, Exam 2 (8 decks)

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