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1. Pharm II > Diabetes > Flashcards

Diabetes Flashcards

(54 cards)

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1
Q

What is the purpose of fasting blood sugar?

A

Measure the effectiveness of basal insulin or agents that decrease gluconeogenesis overnight

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2
Q

What is the purpose of premeal blood sugar?

A

To calculate bolus dose or agents given to improve insulin secretion

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3
Q

What is the purpose of postmeal blood sugar (2hr post prandial)?

A

Measure the effectiveness of bolus or agents given to increase insulin

Determines needed food changes

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4
Q

What is the purpose of bedtime blood sugar?

A

To avoid early AM lows from insulin or oral agents

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5
Q

What is a glucose meter? What does it do?

A

An experimental tool

Determines patterns

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6
Q

Who should receive high vs moderate intensity statin?

A

Moderate: > 40yo w/ no CV RFs

High: Anyone w/ CV RFs (all ages)

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7
Q

What 2 meds are “high intensity” statins?

A

Atorvastatin

Rosuvastatin

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8
Q

What are A1c recommendations according to ADA vs AACE/ACE? Which is more stringent?

A

ADA = < 7.0%

AACE/ACE = ≤ 6.5% (more stringent)

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9
Q

What is the hypoglycemia alert value?

A

≤ 70

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10
Q

What value is considered clinically significant hypoglycemia?

A

< 54

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11
Q

If hypoglycemia occurs, what should the pt do?

A

Consume 15g of simple carbs:

  • OJ, milk OR
  • 4 glucose tabs OR
  • 1 tube glucose gel

Retest BG 15 mins later

If BG < 70, repeat rule of 15

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12
Q

What slows the absorption of sugar?

A

Fat!

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13
Q

What are sx of hypoglycemia?

A 
Shaking
Sweating 
Fast HR
Impaired vision
Weakness, fatigue
HA, irritable, anxious, dizzy
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14
Q

What are sx of hyperglycemia?

A 
Thirst
Frequent urination
Dry skin
Blurred vision
Drowsiness
Nausea
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15
Q

What 2 things can cause BG to rise quickly?

A

Infections

Corticosteroids

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16
Q

What med class decreases glucose absorption?

A

alpha-glucosidase inhibitors

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17
Q

What 2 meds decrease glucose production?

A

metformin & insulin

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18
Q

What med class increases glucose secretion?

A

SGLT2 inhibitors

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19
Q

What 4 med classes increase insulin secretion?

A

Sulphonylureas
Meglitinides
GLP1 activators
DPP4 inhibitors

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20
Q

What % of A1c should you consider dual therapy?

A

A1c > 9%

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21
Q

What % of A1c should you consider combination injectable therapy?

A

A1c > 10%

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22
Q

How often should you monitor A1c?

Study These Flashcards
A

Every 3-6 mos

23
Q

What are 5 major concerns when initiating hyperglycemic tx?

Study These Flashcards
A 
Hypoglycemia 
Wt change
CV effects
Renal adjustments
FDA warnings
24
Q

What are ADEs of metformin?

Study These Flashcards
A

GI sx

B12 deficiency

25
What is the black box warning for SGLT2 inhibitors?
Risk of amputation
26
What are other risks associated w/ SGLT2 inhibitors?
``` Bone fx DKA GU infections Volume depletion, hypotension Increased LDL ```
27
What is the black box warning for GLP1 activators?
Risk of thyroid c-cell tumors
28
What are other ADEs of GLP1 activators?
GI sx Injection site reactions ? Acute pancreatitis
29
What are ADEs of DPP4 inhibitors?
Acute pancreatitis Joint pain Rare: urticaria, facial edema, Steven Johnson syndrome
30
What is the black box warning for thiazolidinediones?
CHF
31
What are other ADEs of thiazolidinediones?
``` Fluid retention Fat accumulation Bone fx Bladder CA Increased LDL ```
32
What is the FDA special warning for sulfonylureas?
Increased risk of CV mortality based on studies of tolbutamide
33
What is an ADE of insulin?
Injection site reactions
34
What 2 drugs are known to be weight-neutral?
Metformin | DPP4 inhibitors
35
What 2 drugs cause wt loss?
SGLT2 inhibitors | GPP1 activators
36
Which sulfonylurea should not be used?
Glyburide
37
Which GLP1 agonist shows benefit in reducing CV mortality?
Liraglutide
38
Metformin enhances insulin sensitivity in....
hepatic & peripheral tissues
39
TZDs enhance insulin sensitivity in....
muscle, liver, & fat
40
Which TZD can potentially decrease TGs?
Pioglitazone
41
What drugs have increased risk of hypoglycemia?
Insulin Sulfonylureas Metaglinides
42
What drugs cause wt gain?
Insulin TZDs Sulfonylureas Metaglinides
43
SGLT2 inhibitors + diuretics can cause....
Orthostatic hypotension | Electrolyte abnormalities
44
What are 4 ADEs of alpha-glucosidase inhibitors?
Flatulence Bloating Abd discomfort Diarrhea
45
What drug class can potentially reduce LDL levels by 12-16%?
Bile acid sequestrants | ex. Colesevelam
46
How should bromocriptine be administered?
Daily w/ food within 2hrs of waking from sleep *If morning administration is missed, then skip the dose!
47
How many units of insulin should you start w/?
10U/day OR .1-.2U/kg/day
48
How should you adjust one's dose of insulin?
Increase 10-15% or 2-4U once or twice weekly until FBG goal met
49
Reduction in caloric intake helps w/ _______, whereas exercise helps w/ ______
Wt loss Wt maintenance
50
What are ADEs of phentermine (short-term tx for obesity)?
``` HA Elevated BP & HR Insomnia Dry mouth Constipation Anxiety, palpitations ```
51
What are the ADEs of orlistat (lipase inhibitor, long-term tx for obesity) ?
``` Abd pain/discomfort Oily spotting/stool Fecal urgency Flatulence Malabsorption of fat soluble vitamins & meds ```
52
What is the dawn phenomenon?
Surge of hormones produced daily by the body, hours before waking
53
When is the somogyi effect most likely to occur?
Following an episode of untreated nighttime hypoglycemia --> high blood sugar in AM
54
How do you correct the somogyi effect?
Check glucose in the middle of the night Increase food intake or lower insulin in PM

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