Diabetes Flashcards
(91 cards)
1
Q
Diabetes is the leading cause of
A
renal failure
Adult-onset blindness
lower limb amputation
2
Q
In the pancreas, beta cells do what
A
produce & secrete insulin
3
Q
In the pancreas, alpha cells do what
A
produce & secrete glucagon
4
Q
Insulin does what to blood glucose?
A
lowers
5
Q
Glucagon does what to blood glucose
A
increase
6
Q
Stressful conditions lead to (inc/dec) in productional cortisol by adrenal gland which stimulates liver to put out more ____?
A
increase, glucose
7
Q
In Type 1 Diabetes, what cells are being destroyed
A
Beta cells - these cells produce insulin
8
Q
Type 1 Diabetic patients have a severe or absolute deficiency of what
A
Insulin
9
Q
T1 DM is diagnosed around what age
A
30
10
Q
Mainstay of T1 DM therapy is _____ and prevention of ____
A
Insulin replacement Diabetic ketoacidosis (DKA)
11
Q
Pre-diabetic patients are prone to getting
A
Type 2 DM
12
Q
T2 DM suffer from insulin ____ or _____
A
Resistance or relative insulin deficiency
13
Q
Impaired fat metabolism is a sign of which DM?
A
T2 DM
Increased free fatty acid and triglyceride
Decreased HDL (good cholesterol)
14
Q
Uncontrolled blood glucose in T2 DM can lead to
A
Hyperosmolar Hyperglycemic Syndrome
15
Q
Insulin resistance is common in what type of DM
A
Type II
16
Q
Insulin resistance results in:
___ insulin levels
___ receptor affinity
___ plasma insulin levels
___ insulin to blood glucose ratio
A
high insulin levels
Low receptor affinity
High plasma insulin levels
High insulin to blood glucose levels
17
Q
How do you get Gestational Diabetes Mellitus (GDM)
A
Glucose intolerance during pregnancy
18
Q
What ethnicity is most likely to get GDM
A
Asian, native american, Pacific islander, Black, hispanic
19
Q
What are the adverse outcomes of GDM maternally?
A
Development of T2DM
C-Section
Pre-eclampsiav - protein in urine & high BP
Gestational HTN
20
Q
What are the adverse outcomes of GDM Fetaly
A
Shoulder dystocia/birth trauma Macrosomia Adolescent/ childhood obesity Birth defects Hypoglycemia
21
Q
These medications cause ____
Quinolone antibiotics Atypical antipsychotics Beta blockers Corticosteroids Calcinurin inhibitors Protease Inhibitors Thiazide & thiazide-like diuretics
A
Hyperglycemia
22
Q
These medications cause ____
Insulin Insulin secretagogues GLP-1 Receptor agnostis and DDP-4 Inhibitors Anti-diabetic meds Pentamidine antibiotic Anti-hypertensive (ACEi, Beta blockers) Clofibrate Disopyramide Ethanol Salicylates
A
Hypoglycemia
23
Q
Blood glucose and insulin release is stimulated by what foods?
A
Carbs and proteins
24
Q
After a meal, glucose levels should be below
A
140 mg/dL
25
For diabetics, night, morning and after a meal glucose levels can be elevated to
200 mg/dL
26
Normal blood glucose levels for overnight are
60-140 mg/dL
27
Normal blood glucose levels for after meals are
<140 mg/dL
28
Endogenous insulin is mainly cleared by
liver
29
Exogenous insulin is mainly cleared by
renal
30
Avoid giving ____ insulin to patients with renal dysfunction
exogenous insulin
31
How do you administer Rapid-acting insulin?
inject immediately before meals
| Low risk of post-meal hypoglycemia (make sure pt eats)
32
How do you administer Short-acting insulin
Inject 30-45 min before a meal, only one available in IV (make sure pt eats)
33
How do you administer Intermediate acting insulin
mixed with rapid and short acting insulin due to its unpredictability
34
How do you administer Long Acting Insulin
Detemir - BID
Glargine - daily
Degludec - daily
35
What are factors affecting insulin levels
Sit of injection
Massage of injection site
Depth of injection
Exercise
36
These symptoms suggest that a patient is experiencing ______
Tachycardia
Sweating
Nausea
Hypoglycemia effect
Patient should drink juice or eat carbs
37
Hypoglycemia can cause ___ (usually happens in the morning)
Treat it by giving less insulin
post-hypoglycemia hyperglycemia
(Somogyi Effect)
Adrenal gland notices that patient is low on insulin and will produce excessive insulin. Ask pt if they had a vivid dream
38
Diabetic patients should never be given this drug
beta blockers
39
Technosphere Insulin (Afrezza) is also known as
inhaled insulin
40
Afrezza Technosphere insulin should not be given to patients with this disease
COPD & smokers
Common side effect is cough
41
15-15-15 rule
amount of carb, protein, and fat given to diabetic patients to reverse hypoglycemia
42
Lipodystrophy is an adverse effect of what drug?
insulin - injection sites become lumpy
43
Insulin is used in what DM
Type 1 and 2 but mainly 1
44
Hb A1C should be around what range for diabetics
6-7
in double digits when uncontrolled
45
Insulin used for intensive insulin therapy is usually
basal insulin = 1/2 daily insulin requirement (long acting)
46
Insulin used for intensive insulin therapy is usually used in what DM
1 & 2
47
Conventional Insulin therapy is usually used in what type of DM
T2 DM
48
What type of insulin is used for conventional insulin therapy of T2 DM?
Fixed dose of long acting insulin
49
Sulfonylureas (SFUs) MOA
insulin secreatagogues
Stimulate insulin release
Decrease glucose output from liver
50
Name that the class
Glyburide
Glipizide
Glimepiride
Gliclazide
SFUs
51
What are adverse effects of SFUs
Hypoglycemia
Weight gain
Blurry vision
52
What is the first line agent for T2 DM
SFUs
53
SFU should only be used on patient who have a working...
pancreas
54
SFU and Meglitinide are known as
Insulin secretagogues
55
MOA: Meglitinide
Stimulate release of insulin by closing ATP-sensitive K+ channels
56
What class of drugs are these?
Repaglinide
Nateglinide
Meglitinide
57
Almost all anti-diabetic medications cause these adverse effects
Hypoglycemia
| Weight gain
58
T/F Meglitinide, TZD & metformin (biguanides), GLP-1can be used as monotherapy or add-on to metformin in T2 DM
true
59
What drug can be used to lower postprandial blood glucose?
Meglitidine, Alpha-glucosidase inhibitor
| GLP-1
60
Metformin fits under what class of drugs?
Biguanides
61
For a patient who is experiencing abdominal pain you would give them metformin _____
extended release daily
62
Vitamin B12 should be prescribed to patients who are also taking
metformin/ biguanides
63
Lactic acid risk in patients with renal, cardio, or hepatic disease can be increased with
metformin, biguanides
64
When should you take metformin?
With meals
65
A patient with reduced renal function should not take? (eGFR <30 mL/min/1.73 m^2)
METFORMIN, biguanides
66
Off-label use of this drug can be used to treat
Gestational Diabetes
Polycystic Ovary Syndrome
Pre-Diabetes (A1C 5.7-6.4% or impaired fasting glucose)
Metformin, biguanides
67
What is the method of action for Thiazolidinediones (TZD)
ligands of the peroxisome proliferator-activated receptor (PPAR receptors)
Decrease insulin resistance in muscles and fat
Increase HDL & decrease triglycerides
68
What class do these drugs belong to?
Pioglitazone
Rosiglitazone
Thiazolidinediones
69
This class of drugs is contraindicated for NYHA Class III/IV heart failure
Thiazolidinediones (TZD)
Pioglitazone
Rosiglitazone
70
Name the adverse effects of Thiazolidinediones
Pioglitazone
Rosiglitazone
```
Weight gain
Volume retention: CHF
Increases fracture risks
Increases LDL (rosi)
Increases risks for bladded cancer (pio)
```
71
MOA of Alpha-Glucosidase Inhibitors
Competitively inhibit alpha glucosidase enzymes --> slows intestinal carbohydrate digestion/absorption
72
Do not give this medication to patients who have renal failure
Miglitol (Apha-glucosidase inhibitor)
Metformin/biguanides
Exogenous insulin
73
Flatulence is an adverse effect of which drug?
Alpha-glucosidase inhibitor
74
Alpha-glucosidase should not be used on patients with
GI disorders, and renal dysfunction
75
Glucagon-Like Peptide-1 (GLP-1) Receptor agonist MOA
stimulates GLP-1 receptor --> increased insulin release, decreased glucagon secretion, slowed gastric emptying, and increased satiety
76
This drug lowers the risk for hypoglycemia
Glucose-like Peptide-1 receptor agonists
77
Glucode-like Peptide-1 receptor agonists are administered in what fashion
injectable
78
Name the class of drugs
Albiglutide
Dulaglutide
Exenatide
Liraglutide
Glucose-like Peptide-1 receptor agonists
79
Increased risk for pancreatitis can be induced by
GLP-1
80
Gallbladder diseased patients should not take
GLP-1
81
Liraglutide has been approved to be used off label as - GLP1
Chronic weight gain
82
Severe joint pain, renal impairment, new or worsening heart failure are symptoms of
DPP-4 gliptins
83
MOA DPP-4
Inhibits degradation if incretins --> increased insulin secretion, decreased glucagon secretion, slowed gastric emptying, and increased satiety
84
Anxiety can be caused by
GLP-1
85
MOA of Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor ("Flozin")
Blocks reabsorption in kidneys --> increase glucosuria secretion, slowed gastric emptying and increased satiety
86
What class do these drugs belong to?
Alogliptin
Linagliptin
Saxogliptin
Sitagliptin
DPP-4
87
The dosing of these gliptins (DPP-4) should be reduced in order to prevent renal impairment and new/worsening heart failure
Saxogliptin & alogliptin
88
MOA of Sodium-Glucose Co-Transporter 2 (AGLT2) Inhibitors (Flozins)
Blocks glucose reabsorption in kidneys --> increases glucosuria
89
What class do these drugs belong to?
Canagliflozin
Dapaglifliozin
Empagliflozin * Jardiance
Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors ("Flozin")
90
What class of drugs do these adverse effects belong to
Genital fungal infection, urinary tract infection, Hypotension, increased LDL
SGLT2 Flozins
91
What are the warning and precautions of Flozins
Renal impairment
Bladder Cancer (dapagliflozin)
Fractures & decreased bone mineral density (Canagliflozin)
