Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diabetic Medications (awesome review) > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Normal blood sugar

A

80-100 fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Fasting blood sugar

A

After eating 170-200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HbA1c criteria for diagnosis

A

> or equal to 6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Random blood sugar

A

> 200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

75 g 2 hours glucose tolerance test > or =

A

200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Patient had a fasting sugar of 127, what to do next?

A

Check hgba1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Patient had a fasting blood sugar 118 and hgba1c of 6.5%, what to do next?

A

Recheck hgba1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A 35 year old patient with bp 135/80 or X year old patient with bmi of 26 and sedentary or a 40 year old patient; what will you check next?

A

Screen for diabetes, fasting blood sugar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Patient had FBS of 129, repeat 127, this patient has…

A

DM and at risk for retinopathy and nephropathy now

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

40 year old patient with vitiligo diagnosed a year ago, FBS of 140, relatives have type II DM, BMI 23; what will you do next?

A

Check islet cell antibodies and anti glutamic acid decarboxylase antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sulfonylureas

A

Glimepiride (amaryl) Glipizide (glucotrol) glyburide (diabeta, micronase); avoid in obese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Meglitinides

A

Repaglinide; excreted through bile; hence drug of choice in CKD; rapid acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Biguanides

A

Metformin (glucophage); decrease hepatic gluconeogenesis, decrease insulin resistance, decrease weight, decrease cholesterol/TG’s; Tx of choice in obese patients and increased TG’s; 5% with lactic acidosis; b12 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Alpha glucocidase inhibitors

A

Acarbose (precose); inhibits breakdown of carbohydrates and decreases absorption of glucose; mainly for post prandial hyperglycemia; avoid in low GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Thiazolidinediones ‘glitazones’

A

Pioglitazone (actos); avoid in patients with CHF NYHA II; thigh high edema, associated with bladder cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Incretin mimetics(glp-1 agonists)

A

Exenatide (bydureon), liraglutide (victoza-approved for weight loss bmi>30 and no DM), Dulaglutide (Trulicity), Semaglutide (ozempic): glp1 agonist, decreases hepatic gluconeogenesis, decreases gastric emptying, weight loss, increased cell growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Liraglutide (victoza), Semaglutide (ozempic) and dulaglutide (trulicity)

A

Have shown to decrease CV risk; good agents for obese patients failing meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

DPP4 inhibitors

A

Sitagliptin (januvia), saxagliptin (onglyza)-potential CH risk, linagliptin (tradjenta) andd alogliptin (nesina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Side effects of GLP 1 agonists

A

Nausea and pancreatitis; contraindications: pancreatitis, family hx of MEN IIA/IIB (medullary thyroid carcinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Amylin analogue

A

Pramlinitide (symlin); slows gastric emptying, decreases glucagon secreation, weight loss and early satiety; complementary to insulin; no hypoglycemia; good for obese patients failing insulin therapy with high post prandial BS and gaining weight on short acting insulin agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SGL2 Inhibitors

A

Canagliflozin (invokana), Dapagliflozin (farxiga), empaglifozin (jardiance); block reabsorption of glucose by kidney thereby increasing excretion of glucose in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Dapagliflozin (farxiga)

A

Shown to reduce heart failure hospitalizations in diabetic patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Empagliflozin (Jardiance) and Canagliflozin (invokana)

A

Reduced the incidence of end stage renal disease and hospitalizations for heart failure; there was also a trend toward decreased cardiovscular death and all cause mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Side effects of SGL2 inhibitors

A

Reduced blood pressure, genital mycotic infections, euglycemic ketoacidosis especially at times of extreme stress; necrotizing fascitis of perineum aka Fournier’s gangrene; for example; in a patient with pneumonia taking SGL2 inhibitors, stop it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

ADA blood sugar goals in DM

A

hgba1c low risk of hypoglycemia <7%
hgba1c high risk of hypoglycemia 7-8%
hgba1c with terminal or comorbid conditions >8%
Preprandial glucose between 80-130
Peak 2 hours post prandial glucose <180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Patient with a bmi of 32, FBS is 115; family hx is significant for DM; best way to prevent onset of DM?

A

Diet and exercise; aerobics and resistance training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Drugs that cause hyperglycemia

A

Statins, beta blockers except coreg, hydrochlorothiazide, niacin, olanzapine, protease inhibitors, steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Patient with type II diabetes mellitus responded well to metformin and sulfonylura previously, for several years hgba1c 7% but now has increasing blood sugars for the past year; no infections; hgba1c 8.8%, what to do next?

A

Add 24 hour glargine insulin; progressive insulin deficiency not insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

In above patient, what drug do you intend to keep with insulin?

A

Biguanide aka metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

The above patient does well on glargine insulin at bedtime and metformin for a year; hgba1c 8.5%, but FBS 115 to 130 range, what to do next?

A

Start lispro insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When is metformin contraindicated?

A

GFR <30 ml and acute or unstable CHF

32
Q

Patient started on metformin 2 days ago and complains of diarrhea after taking metformin, what to do next?

A

Continue for a week

33
Q

Patient with DM on metformin 500mg once daily and hba1c is 7.8%, what to do?

A

Increase metformin dose to twice daily (max dose is 2.4 g)

34
Q

Patient with DM on multiple medications; Cr is >1.5 and CHF with EF <35%, what to do?

A

Discontinue metformin and glitazone, start glargine or detemir and lispro or aspart

35
Q

Patient is going for cardiac catheterization or any radiocontrast study; which drug will you stop on the day of the procedure?

A

Metformin

36
Q

A 60 year old patient diagnosed with type II diabetes and bun/cr is 40/3.7; what is the best medication to start?

A

Repaglinide (linagliptin good choice too)

37
Q

A 40 year old patient with type II diabetes mellitus was treated with metformin; a year later, he starts gaining weight, as he had stopped exercising; his blood sugars go up as well; what to do?

A

Start liraglutide (victoza)

38
Q

Dawn phenomenon

A

Increased 3-7 am glucose secondary insulin resistance/ hormonal factors; treatment: increase PM NPH

39
Q

Nocturnal Hypoglycemia

A

Patient with fatigue, increased sweating and waking up with headaches +/= vivid dreams (nightmares); FBS ranges between 120-145; takes NPH at supper, what to do next? Check nocturnal BS, if low, reduce NPH or move NPH to bedtime or change to long acting (glargine or detemir)

40
Q

Palpitations, excessive sweating, nocturnal awakening, AM headaches, what to do next?

A

3 am blood sugar

41
Q

Blood sugar at 3 am is 40, what to do next?

A

Change NPH to hs or switch to long acting insulin analogue has (glargine)

42
Q

Persistently elevated FBS; 3am blood sugar 200, what to do?

A

Increase supper NPH or glargine dose

43
Q

Blood sugar 30 and patient passes out at 12 noon on 20 unit NPH and 4 units ‘R’ in AM, what to do?

A

Discontinue ‘R’ in AM

44
Q

Blood sugar at 4pm is 25 mg and at 10pm it is 210; patient is on 36 unit NPH in AM, what to do?

A

Change to 24 unit NPH in AM and 12 unit NPH in PM

45
Q

Patient with fbs of 115, hgba1c is 8.5; he takes NPH or glargine at night and metformin, what to do next?

A

Check post prandial blood sugar

46
Q

How would you start an insulin regimen of glargine and lispro in a patient who weighs 60 kg?

A

60 kg x .5 units = 30 units daily; give 1/2 or 15 units glargine with supper; give other 1/2 15 units lispro divided as tid aka 5 units b-l-s

47
Q

You want to test the above regimen in 2-3 weeks time, what to do?

A

Fructosamine test (also in pregnant patients, hemolytic anemia and hemoglobinopathies)

48
Q

An african american male diabetic patient returs for follow up; he shows his glucometer readings which show serial FBS in 115-130; hgba1c is 11% most likely etiology of the discrepancy is

A

Hemoglobinopathy

49
Q

Falsely elevated Hgba1c (decreased RBC turnover, decreased reticulocyte count)

A

Iron def anemia, folate and b12 def, ESKD, asplenia, hemoglobinopathies, sickle cell trait, thalassemia trait

50
Q

Falsely lower Hgba1c (Increased RBC turnover, increased reticulocyte count)

A

Hemolytic anemias, HIV, treating iron deficiency anemmia, folate and b12 deficiency or blood transfusions, ESKD on HD and erythropoietin

51
Q

Patient with hgba1c of 6.6%; pre prandial and post prandial blood sugars range between 90-150 except at 5pm blood sugar is 280; she has a fresh fruit snack at 4pm; what is the etiology?

A

She is most likely not washing hands after eating fruit and checking blood glucose; educate patient to wash hands before checking blood glucose

52
Q

Patient with diabetes with BS 540, TG’s 2400; is hospitalized with pancreatitis; the fastest way to control the triglycerides would be to

A

Give insulin

53
Q

If hyperglycemia and worrisome features: hypocalcemia and lactic acidosis

A

Plasma exchange

54
Q

Anion gap

A

NA- (bicar + Cl)

55
Q

DKA treatment

A

Give subq insulin 60-120 min before stopping iv insulin drip

56
Q

Patient withDKA BS 725, ketones +++, patient started on iv insulin drip and iv fluids at 10 am; at 7pm BS 200, what to do next?

A

Start IV infusions D51/2 NS and continue insulin drip

57
Q

Best way to follow dka management is

A

Anion gap

58
Q

Patient with diabetes mellitus admitted for surgery in AM; he is on glargine and lispro; what to do on morning of surgery? patient recieves glargine in am

A

Give 1/2 glargine and d/c lispro

59
Q

If patient received glargine in pm, what to do?

A

Dc lispro

60
Q

A 24 year old pregnant female in 24th week; FBS 115; repeat FBS 114; refuses insulin; what to do?

A

Give metformin

61
Q

A 26 year old diabetic pregnant woman 24th week with FBS 120 and post prandial 180 on glyburide and metformin, what to do?

A

Give insulin

62
Q

Pregnancy blood sugar

A

FBS <95
1 hr PP 140
2 hr PP 120

63
Q

Elderly patient with type II diabetes mellitus brought with an episode of seizure; BS 1050, BUN 50 Cr 1.8 , ketones +

A

Hyperosmolar nonketotic coma –>IV flids –> insulin

64
Q

Patient with type I DM presents with DKA; blood sugar 725 and ketones +++; patient started on insulin drip at 10 am; by 10pm the same day, the BS is 200 and ketones negative; bicarb has gone up from 4 to 18, K dropped from 5.7 to 4.5; patient complains of difficulty breathing and muscle weakness +; CPK MM increased, JVD 3 cm; most likely cause is

A

Hypophosphatemia

65
Q

Complications of Diabetes Mellitus

A

Macrovascular: CAD, PAD: aggressive LDL control
Microvascular: Nephropathy: microalbuminuria: ACE I or ARB
Retinopathy: non proliferative –>tight glucose control
proliferative–> tight glucose control + laser therapy

66
Q

Autonomic neuropathy

A

Impotence: phosphodiesterase inhibitors
Neurogenic bladder: urinary hesitency, dribbling,incomplete evacuation; urodynamic studies with retained urine: timed bathroom visits–>bethanechol
Orthostatic hyptension–>stockings–>high salt diet–>fludrocortisone
Gastroparesis: wide fluctuations in BS 50-400 in day
Foot drop, wrist drop; 3rd nerve palsy can resolve spontaneoously

67
Q

Diabetic foot ulcers

A

Most common is staph; beta hemolytic strep; cause of ulcer is peripheral neuropathy; best way to prevent is monofilament testing

68
Q

Patient with diabetes mellitus for 15 years on metformin +sulfonylurea/insulin with hypoglycemic attacks; post prandial early satiety with vomiting; BS varies from 50-400 daily

A

Diagnosis: gastroparesis –>delayed absorption secondary to autonomic neuropathy; Best test: scintiscan of residual gastric contents; ingest isotope and scan immediately; then 2-4 hours later
Treatment: small frequent meals of liquid or pureed diet with high protein, low fat and low in non digestible fiber –>metoclopramide/Domperidone

69
Q

A nurse calls you to let you know a patients fasting blood sugar is 62; asymptomatic, what to do?

A

Adjust treatment regimen

70
Q

Symptomatic with tachycardia; what to do?

A

15 g of carbohydrate (glucose tablets, candy or sweetened fruit juice)

71
Q

Patient on insulin with loss of consciousness, BG 30; there were no premonitory symptoms

A

Hypoglycemic unawareness; Treatment: lower insulin dose to allow BG levels to increase for several weeks to restore sensitivity to hypoglycemia

72
Q

Newly diagnosed patient with BG of 350; on insulin when BG drops to 130; patient becomes tachycardic and diaphoretic; what to do

A

Keep blood glucose below 200 first

73
Q

Patient with BS of 35 and taking glipizide, metformin and acarbose; how to manage?

A

Discontinue glipizide; admit and iv dextrose; no iv line then glucagon

74
Q

A 22 year old woman with recurrent dizzy attacks in ER; mother is diabetic; blood glucose –>35; insulin 25 (5-20) c peptide .7 (<.6); patient given dextrose and symptoms resolve; patient again has similar symptoms the next day; the next diagnostic test to find the cause of hypoglycemia is

A

Urine +/- sulfonurea screen

75
Q

Best test for thyroid disease

A

TSH

76
Q

Best test to follow for hypothyroidism treatment

A

TSH

77
Q

Best test to follow for hyperthyroidism treatment

A

Free T4 and total T3; ultrasound: differentiate high risk vs low risk in cold nodules

Diabetic Medications (awesome review) (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions