Diabetes

Question 1

T/F: The goal for types of nutrition is a balanced intake with most carbohydrates from non-starchy vegetables

Answer 1

True

Question 2

What is the equation for net carbs

Answer 2

Take total carbohydrate grams and

SUBTRACT the grams of fiber

Question 3

What type of weight loss goals should be determined for patients with diabetes and prediabetes

Answer 3

Diabetes: At least 5% of weight loss
Prediabetes: 7 to 10%

Question 4

How much exercise is needed for a patient is needed per week

Answer 4

150 minutes per week (no more than two days without exercise/ 2 to 3 days of resistance training)

Question 5

What is the drug of choice for type 2 diabetes

Answer 5

Metformin

Question 6

What is the MOA of metformin

Answer 6

Decreases hepatic glucose production, decreases intestinal glucose absorption, increase insulin sensitivity

Question 7

What are the clinical effects of metformin

Answer 7

A1C: decrease by 1 to 2 percent, FBG: 50-70 mg/dL

Question 8

How is metformin excreted

Answer 8

Urine (kidneys)

Question 9

What are the most common adverse effects of metformin

Answer 9

Diarrhea. N/V, abdominal bloating/flatulence. malabsorption, and heartburn

Question 10

What are the rare adverse effects of metformin

Answer 10

LACTIC ACIDOSIS. headache, taste disturbances, and loss of energy

Question 11

What is the starting dose for metformin

Answer 11

500 mg once a day with food in order to reduce gastrointestinal adverse effects

Question 12

What is the maximum clinically effective dose

Answer 12

2000 mg per day

Question 13

What patients are contraindicated for using metformin

Answer 13

eGFR is less than 30/ml/min/1.73m2 (if eGFR later falls below 45/ml/min/1.73m2 then asssess benefits and risks of treatment

Question 14

What are drug interactions with metformin

Answer 14

Amiloride, digoxin, morphine, procainimide, alcohol

Question 15

What are the thiazolidinediones (TZDs)

Answer 15

PIOGLITAZONE and Rosiglitazone

Question 16

What is the MOA of TZDs

Answer 16

Improve insulin sensitivity, enhance glucose in muscle and adipose tissue, inhibit gluconeogenisis,

Question 17

T/F: TZDs have a delayed onset of action of 2-4 weeks with full effect not seen until 12 weeks

Answer 17

True

Question 18

What are the clinical effects of TZDs

Answer 18

A1C: 0.5-1.5%
FBG: 30 to 60%

Question 19

What are the liver enzymes used in TZDs

Answer 19

CYP2C8 and CYP3A4

Question 20

What patients cannot receive TZDs

Answer 20

Patients with congestive heart failure (Class 3 or 4)/ Monitor weight gain dyspnea (shortness of breath) and edema

Question 21

What must be monitored for using TZDs

Answer 21

Liver enzymes (Do not initiate if ALTis greater than 2.5 times the ULN

Question 22

What are the adverse effects of TZDs

Answer 22

edema, weight gain, change in lipids, upper respiratory infection

Question 23

What patients are not recommended to get TZDs

Answer 23

Patients with heart disease and liver disease

Question 24

What is the mechanism of SGLT2 inhibitors

Answer 24

Block the reabsorption of filtered glucose leading to glucosuria

Question 25

What are the sodium glucose co-transporter 2 inhibitors

Answer 25

Canagliflozin (Invonaka), Dapaglifozin (Farxiga), Empaglifozin (Jardiance), Ertuglifozin (Steglatro)

Question 26

How are the SGLT2 inhibitors excreted

Answer 26

Urine and Feces

Question 27

Which SGLT2 is known for increased of amputation

Answer 27

Canagliflozin

Question 28

Which patients are contraindicated in SGLT2 inhibitors

Answer 28

End Stage Renal disease

Question 29

What are the adverse effects of SGLT2 inhibitors

Answer 29

KETOACIDOSIS, genital mycotic infections, UTIs, dehydration and increased urination,

Question 30

Which SGLT2-inhibtor is has an additional indication to reduce Cardiovascular death

Answer 30

Empaglifozin

Question 31

What is MOA of DDP-4 inhibitors

Answer 31

increase increntin (GLP-1 and GIP) inhibiting glucagon release and increasing insulin secretion

Question 32

What are the DDP-4 inhibitors

Answer 32

Sitaglipitin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)

Question 33

What are the advantages of giving DDP-4 inhibitors

Answer 33

They can be given in patients with renal insufficiency

Question 34

Which DDP-4 inhibitors have an FDA alert, what for

Answer 34

Saxagliptin and Aloglipitin/ may increase risk of heart failure

Question 35

What are the DDP-4 side effects

Answer 35

Headache, nasopharyngitis, hypoglycemia, edema (Saxagliptin)

Question 36

What is the MOA of sulfonylurea

Answer 36

Stimulate insulin secretion from pancreatic beta cells, improves insulin sensitivity

Question 37

What are the sulfonylureas

Answer 37

Glyburide: once-twice daily with breakfast Glipizide: once-twice daily (immediate release formulation should be taken 30 minutes before food) Glimepride: once daily with breakfast or first main meal

Question 38

What are the adverse effects of sulfonylurea

Answer 38

Hypoglycemia, dizziness, gastrointestinal disturbances, allergic skin reactions