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NAPLEX STUDY > diabetes > Flashcards

diabetes Flashcards

1
Q

Dx of prediabetes

A
  1. A1c: 5.7-6.4%
  2. FPG:100-125
  3. OGTT: 140-199
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2
Q

Dx of DM

A
  1. A1c >6.5
  2. FPG: >126
  3. OGTT: > 200
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3
Q

glycemic target in DM: not pregnant

A

A1c: <7
pre-prandial: 80-130
2-hr PPG: <180

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4
Q

glycemic target in DM: pregnant

A

pre-prandial: < 95
1-hr PPG: < 140
2-hr PPG: < 120

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5
Q

microvascular disease

A

retinopathy, DKD, peripheral neuropathy, autonomic neuropathy (gastroparesis, loss of bladder control, ED)

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6
Q

macrovascular disease

A

CAD, CVA, PAD`

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7
Q

ASA for ppx in DM

A

recommended for secondary prevention or in pregnancy to prevent preclampsia

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8
Q

Cholesterol control in DM

A

-high intensity statin: for those with DM + ASCVD or those 50-75 w/ multiple ASCVD risk factors
-moderate intensity statin: DM + 40-75 years (no ASCVD) and DM + <40 + ASCVD risk factors
-if on maximally tolerated statin and still not at goal can add ezetimibe

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9
Q

diabetic retinopathy

A

eye exam

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10
Q

vaccinations for patients with diabetes

A

HBV, influenza, pneumococcal

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11
Q

DKD

A

-monitor urine albumin and eGFR annually
-treat albuminuria with ACEi or ARB
-if eGFR > 25 mL/min and urine albumin > 300: SGLT2

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12
Q

neuropathy

A

-foot exams
-pregabalin, duloxetine, or gabapentin

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13
Q

blood pressure

A
  • <130/80 mmHg (if ASCVD > 15%)
  • <140/80 mmHg (if ASCVD < 15%)
    -no albuminuria: thiazide, DHP CCB, ACEi, or ARB
    -albuminuria: ACEi or ARB
    -CAD: ACEi or ARB
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14
Q

natural products

A

cinnamon, alpha lipoic acid, chromium

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15
Q

first-line treatment for T2DM

A

metformin + life style changes

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16
Q

second drug regardless to A1c

A

-ASCVD or high risk: GLP-1a or SGLT2
-HF: SGLT2
-CKD: SGLT2 or GLP-1a
-if ASCVD or high risk and still above goal: add GLP-1 or SGLT2 (if not added), TZD, basal insulin, SU, DPP-4i

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17
Q

DO NOT COMBINE

A

DPP-4i + GLP-1a
SU + Insulin

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18
Q

second drug if A1c is above goal & no ASCVD, HF, or CKD

A

-any class
-consider hypoglycemic risk, weight loss/gain potential, cost
-best for hypoglycemic risk: DPP-4i, GLP-1a, SGLT2, TZD
-best for weight loss: GLP-1a or SGLT2
-best for cost: SU or TZD

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19
Q

Biguanide

A

-decreasing hepatic glucose production, increasing insulin sensitivity, and decreasing intestinal absorption of glucose
-Metformin (Glucophage, Glucophage XR, Fortamet, Glumetza)
-lactic acidosis (risk increases with renal dysfunction)
-contraindicated in eGFR < 30 and do not start if eGFR 30-45
-diarrhea and nausea
-decrease A1c 1-2%, weight neutral, no hypoglycemia

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20
Q

SGLT2

A

-Canagliflozin (Invokana); Dapagliflozin (Farxiga); Empagloflozin (Jardiance)
-ketoacidosis
-genital mycotic infections, urosepsis, pyelonephritis, nec fasc (perineum)
-hypotension and AKI
-invokana: incr risk of leg and foot amputations - do not use in eGFR <30 unless albuminuria > 300
-farxiga: do not start in eGFR < 25
-Jardiance: do not use for glycemic control in eGFR < 30
-weight loss, incr urination, incr thirst

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21
Q

Glucagon-like peptide 1 agonists (GLP-1a)

A

-incr glucose-dependent insulin secretion, decrease glucagon secretion, slow gastric emptying, improves satiety
-liraglutide (victoza); Dulaglutide (Trulicity)
-increased risk of thyroid C cell carcinoma
-Warnings: pancreatitis, is not recommended in patients with severe GI disease
-Side effects: weight loss, nausea
-do not use with DPP4-i

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22
Q

Insulin secretagogues: SU

A

-Glipizide (Glucotrol, Glucotrol XL); Glimepiride (Amaryl); Glyburide
-do not use in those with sulfa allergy
-highest risk of hypoglycemia
-decreases A1c by 1-2%
-Glucotrol XL produces a ghost tablet

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23
Q

Insulin secretagogues: meglitinides

A

-repaglinide and nateglinide
-hypoglycemia
-weight gain

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24
Q

Dipeptidyl Peptidase 4 inhibitors (DPP4-i)

A

-prevent DPP4 from breaking down incretin hormones
-sitagliptin (Januvia); Linagliptin (Tradjenta)
-sitagliptin requires renal adjustment for eGR 30 and less
-warnings: pancreatitis, arthralgias, renal failure
-DO NOT USE WITH GLP1-a

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25
Q

TZDs

A

-PPARy agonists that increase peripheral insulin sensitivity
-pioglitazone (Actos); Rosiglitazone (Avandia)
-exacerbate HF (DO NOT USE WITH NYHA III/IV), edema, risk of fractures

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26
Q

Alpha-Glucosidase inhibitors

A

-Acarbose (Precose)
-inhibit metabolism of intestinal sucrose
-each dose should be taken with first bite of each meal

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27
Q

Metformin/pioglitazone (Actoplus)

A

metformin + TZD

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28
Q

Metformin/sitagliptin (Janumet)

A

metformin + DPP-4 inhibitor

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29
Q

Metformin/Canagliflozin (Invokamet)

A

metformin + SGLT2

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30
Q

Basal insulin

A

glargine (Lantus, Toujeo), detemir (levemir), degludec (Tresiba - extra long acting)
-peakless
-onset of 3-4 hrs and duration > 24 hrs
-impact fasting glucose
-Lantus is 100 IU, toujeo is concentrated at 300 IU/mL

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31
Q

intermediate-acting insulin

A

-insulin NPH
-can be used as basal insulin
-onset of 1-2 hrs and peaks at 4-12 hrs
-dosed BID

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32
Q

rapid-acting insulin

A

-aspart (Novolog), lispro (Humalog), and glulisine
-provide bolus dose
-fast onset of 15 min, peak 1-2 hrs, and duration of 3-5 hrs

33
Q

short acting insulin

A

-insulin regular (Humulin R, Novolin R)
-onset of 30 min, peaks at 2 hours, and lasts 6-10 hrs
-preferred for IV infusions (should be prepared in non-PVC container)

34
Q

concentrated insulin

A

for those that require > 200 IU/day

35
Q

Mixed insulin

A

-70 NPH/ 30 R (Humulin 70/30, Novolin 70/30)
-75/25 mix (lispro protamine/lispro)
-50/50 (lispro protamine/lispro)

36
Q

starting insulin in T2DM

A
  1. add basal insulin: 10 IU SC QD or 0.1-0.2 SC/kg/day and titrate base on FPG
  2. if not at goal: add prandial insulin - 4 IU or 10% of basal dose SC once daily prior to largest meal
    3a: if not at goal: full basal/bolus reigmen
    3b: if not at goal: mixed insulin regimen
37
Q

starting insulin in T1DM

A
  1. 0.5 IU kg/day
  2. insulin dosed on TBW
  3. 50% of the TDD is administered as basal insulin and 50% a prandial (bolus) insulin
    -calculate TDD (0.5 IU/kg/day, using TBW)
    -divide TDD into 50% basal insulin and 50% bolus (rapid-acting) insulin
    -divide the bolus insulin evenly among 3 meals
38
Q

starting regimen with NPH and Regular insulin

A

-not preferred as it does not mimic natural insulin
-2/3 of the TDD is given as NPH and 1/3 is given as regular insulin

39
Q

adjusting basal insulin

A

low BG trend: decrease the basal or NPH insulin dose
high BG trend: incr basal or NPH insulin dose

40
Q

postprandial BG high or low

A

-if following same meal on most days - regular or rapid-acting insulin dose taken prior should be increased/decreased

41
Q

preprandial BG high or low

A

-if high or low before the same meal on most days - regular or rapid-acting insulin dose taken before the previous meal should be increased/decreased

42
Q

mealtime dosing

A
  1. use the same insulin dose every time
  2. calculate an insulin dose at each meal
    -bolus dose calculated with the insulin-to-carbohydrate ratio (ICR)
    -ICR indicates the grams of carbs covered by 1 IU of insulin
43
Q

ICR: Rule of 450 FOR REGULAR

A

450/TDD of insulin = g of carbohydrates covered by 1 IU of regular insulin

44
Q

ICR: Rule of 500 FOR RAPID-ACTING

A

500/TDD of insulin = g of carbohydrates covered by 1 IU of rapid-acting insulin

45
Q

Correction factor: 1500 Rule FOR REGULAR

A

1500/TDD of insulin = correction factor for 1 IU of regular insulin

46
Q

Correction factor: 1800 Rule FOR RAPID-ACTING

A

1800/TDD of insulin = correction factor of 1 IU of rapid-acting insulin

47
Q

correction dose

A

(BG now) - (target blood glucose) / correction factor = correction dose

48
Q

converting between insulin

A

-most insulin conversions are 1:1
-except NPH dosed BID > insulin glargine dosed daily –use 80% of the NPH dose
-except toujeo -> insulin glargine or levemir–use 80% of the toujeo

49
Q

Room temperature stability: 10 days

A

humalog mix 50/50 and 75/25 pens
humulin 70/30 pen

50
Q

Room temperature stability: 14 days

A

humulin N pen
novolog mix 70/30 pen

51
Q

Room temperature stability: 31 days

A

Humulin R U-100, N and 70/30 vials

52
Q

Room temperature stability: 40 days

A

humulin R U-500 vial

53
Q

Room temperature stability: 42 days

A

Novolin R U-100, N, and 70/30 vials, levemir vial and pen

54
Q

Room temperature stability: 56 days

A

tresiba, toujeo

55
Q

needle gauge

A

-higher the gauge, the thinner the needle
-32G thinnest
-28G thickest
-shorter needles and higher gauge needles cause less pain
-shortest needles are 4 mm and 5 mm
-8 mm needles are long enough

56
Q

hypoglycemia

A

dizziness, anxiety/irritability, shakiness, headache, diaphoresis, hunger, cofnusion
-severe hypoglycemia can cause seziures, coma, and death

57
Q

hypoglycemia tx: Rule 15

A

-pure glucose or gel is preferred
1. take 15-20 g of glucose or simple carbs
2. recheck BG after 15 min
3. if hypoglycemia continues repeat steps 1 and 2
4. once BG is normal, eat a small meal or snack

58
Q

hypoglycemia tx for those unconcious

A

dextrose or glucagon

59
Q

drugs that cause hypoglycemia

A

insulin, SU, meglitinides, alcohol, beta blockers

60
Q

drugs that increase BG

A

BB, thiazide, loop diuretics, tacrolimus, cyclosporine, protease inhibitor, quinolones, antipsychotics, statins, steroids, cough syrups, niacin

61
Q

drugs that decrease BG

A

BB, quinolones, tramadol

62
Q

Diabetic Ketoacidosis

A

-high BG, ketoacidosis, and ketonuria
-BG > 250, ketones, abdominal pain, nausea, vomiting, dehydration
-anion gap

63
Q

Hyperosmolar hyperglycemic state

A

-severe dehydration with altered consciousness
-confusion, delirium
-BG > 600
-extreme dehydration

64
Q

DKA and HHS tx

A

-aggressive fluids (first) and insulin
1. fluids: start with NS and when glu reaches 200 mg/dL change to D5W1/2NS
2. R insulin infusion: 0.1IU/kg bolus then 0.1 IU/kg/hr continuous infusion OR 0.14 IU/kg/hr continuous
3.prevent hypokalemia
4. treat acidosis if pH < 6.9; acidosis may be corrected by fluids - give sodium bicarb

65
Q

if presents with: cancer

A

avoid GLP-1a

66
Q

if presents with: gastroproesis, GI disorder

A

Avoid GLP-1a and pramlintide

67
Q

if presents with: genital infection/UTI

A

avoid SGLT2

68
Q

if presents with: HF

A

avoid TZDs, alogliptin, saxagliptin

69
Q

if presents with: hypoglycemia

A

avoid insulin, SU, meglitinides, and pramlintide

70
Q

if presents with: hypotension/dehydration

A

avoid SGLT2

71
Q

if presents with: hypokalemia

A

avoid insulin

72
Q

if presents with: ketoacidosis

A

avoid SGLT2

73
Q

if presents with: lactic acidosis

A

avoid metformin

74
Q

if presents with: osteopenia/osteoprosis

A

avoid canagliflozin and SU

75
Q

if presents with: pancreatitis

A

avoid DPP-4 i, GLP-1a

76
Q

if presents with: peripheral neuropathy, PAD, foot ulcers

A

avoid canagliflozin

77
Q

if presents with: sulfa allergy

A

avoid SU

78
Q

if presents with: renal insufficiency

A

avoid metformin, SGLT2 inhibitors, exenatide, glyburide

NAPLEX STUDY (25 decks)

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