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OU Practice Spring 2018 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

(124 cards)

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1
Q

DM

A

disease in which the body’s ability to produce and/or respond to insulin is impaired

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2
Q

Type 1 DM

A
  • Absolute deficiency of insulin production
  • Onset is usually during childhood
  • Etiology is mostly autoimmune in nature
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3
Q

Type 2 DM

A
  • Relative deficiency of insulin production associated with tissue insulin resistance
  • Most common
  • Usually occurs during adulthood
  • Etiology mostly due to genetics / lifestyle
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4
Q

hypoglycemia symptoms (< 70)

A
  • Tremors
  • Tachycardia
  • Diaphoresis
  • Dizziness
  • Anxiousness
  • Increased appetite
  • Impaired vision
  • Weakness
  • Headache
  • Irritability
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5
Q

hyperglycemia symptoms (fasting > 130, non-fasting > 180)

A
  • Frequent urination (polyuria)
  • Extreme thirst (polydipsia)
  • Sweet / Fruity breath
  • Somnolence
  • Increased appetite
  • Blurred vision
  • Nausea / Vomiting
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6
Q

non-DM drugs that cause glucose dysregulation: increase blood glucose

A
  • Systemic corticosteroids
  • Protease inhibitors (ritonavir)
  • Oral contraceptives (estrogens)
  • Diuretics (furosemide, HCTZ)
  • Atypical antipsychotics (olanzapine, clozapine)
  • Beta-agonists
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7
Q

non-DM drugs that cause glucose dysregulation: decrease blood glucose

A
  • Alcohol
  • Pentamidine
  • Fluoroquinolones
  • Beta-blockers
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8
Q

Metformin

A
  • Glucophage®, Glucophage XR®, Glumetza®
  • DM II
  • Decreases hepatic glucose production and intestinal glucose absorption
  • Improves insulin sensitivity by increasing glucose uptake and utilization in skeletal muscle and adipose tissue
  • drug interaction w/ ranolazine (increase metformin) and alcohol (can cause hypoglycemia)
  • d/c if pt is getting contrast dye b/c it can increase risk of metabolic acidosis
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9
Q

Metformin adverse effects

A
  • GI upset: N/D; try to avoid by starting low go slow, take with food, ER formulation
  • Vit B-12 deficiency
  • Lactic acidosis
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10
Q

Metformin precautions

A
  • Black box warning: lactic acidosis
  • Hepatic impairment
  • Renal impairment (eGFR 30-45 mL/min/1.73m2)
  • CV disease
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11
Q

Metformin contraindications

A
  • eGFR < 30 mL/min/1.73m2

- acute or chronic metabolic acidosis

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12
Q

Metformin counseling

A
  • take with food
  • shell of ER formulation may be visible in stool
  • weight neutral
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13
Q

Metformin dosing

A
  • 500mg po BID initially

- titrate up to max 2550mg/day

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14
Q

Sulfonylureas

A
  • DM II
  • Stimulates insulin secretion from functioning beta cells in the pancreas
  • Increase insulin sensitivity and lower hepatic glucose production
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15
Q

Sulfonylureas adverse effects

A
  • Hypoglycemia

- Weight gain

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16
Q

Sulfonylureas precautions

A
  • Renal / hepatic impairment
  • Sulfa allergy
  • G6PD deficiency
  • Do not use concomitantly with meglitinide class
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17
Q

Sulfonylureas contraindications

A
  • Ketoacidosis

- DM I

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18
Q

Sulfonylureas counseling

A
  • Maintain consistent diet; Take with breakfast
  • Weight gain (glyburide the most)
  • Decrease efficacy over time
  • Can cause hypoglycemia
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19
Q

What are the drugs in the Sulfonylureas class?

A
  • Glipizide (Glucotrol®, Glucotrol XL®)
  • Glyburide (Diabeta®, Micronase®)
  • Glimepiride (Amaryl®)
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20
Q

Glipizide

A
  • Glucotrol®, Glucotrol XL®

- Take 30 min before meals

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21
Q

Metformin dosage forms

A
  • Tablets: 500mg, 850mg, 1000mg
  • Extended Release tab: 500mg, 750mg
  • Osmotic release tab: 500mg, 750mg
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22
Q

Glipizide dosage forms

A
  • Tablets: 5mg, 10mg

- Extended Release tablets: 2.5mg, 5mg, 10mg (avoid in pts with GI obstruction)

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23
Q

Glipizide dosing

A

5-20mg per day (once daily or BID)

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24
Q

Glyburide

A
  • Diabeta®
  • Micronase®
    -Take with breakfast / first meal
  • not recommended in
    patients with chronic kidney disease (CKD)
  • Concomitant use with bosentan
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25
Glyburide dosing forms
Tablets: 1.25mg, 2.5mg, 5mg
26
Glyburide dosing
2.5-5mg by mouth once or twice daily
27
Glimepiride
- Amaryl® | - Take with breakfast / first main meal
28
Glimepiride dosage forms
Tablets: 1mg, 2mg, 4mg
29
Glimepiride dosing
1-4mg by mouth daily
30
Meglitinides
- DM II - lowers blood glucose levels by stimulating release of insulin - interacts with ATP sensitive potassium channel on beta cells in pancreas - short half life - effective on postprandial glucose level - can have variable meal schedule - reduced hypoglycemia compared to sulfonylurea
31
Meglitinides adverse effects
- Hypoglycemia | - Weight gain
32
Meglitinides precautions
- Do not use with sulfonylureas | - Use with caution in renal / hepatic impairment
33
Which drugs are in the Meglitinides class?
- Repaglinide (Prandin®) | - Nateglinide (Starlix®)
34
Repaglinide
- Prandin® - If meal is skipped, skip dose -Take 30 min or less before meal - Contraindicated with concurrent gemfibrozil therapy
35
Repaglinide dosage forms
Tablets 0.5mg, 1mg, 2mg
36
Repaglinide dosing
0.5mg by mouth TID with meals
37
Nateglinide
- Starlix® - If meal is skipped, skip dose -Take 30 min or less before meal
38
Nateglinide dosage forms
Tablets: 60mg, 120mg
39
Nateglinide dosing
60-120mg by mouth TID with meals
40
Alpha-glucosidase inhibitors
- Lowers postprandial glucose by competitive, reversible inhibition of pancreatic alpha-amylase and membrane bound intestinal alpha-glucoside hydrolysis - Inhibits hydrolysis of complex starches; decrease glucose absorption - Does not enhance insulin secretion
41
Alpha-glucosidase inhibitors adverse effects
- GI: flatulence, diarrhea, abdominal pain | - Elevated AST / ALT
42
Alpha-glucosidase inhibitors contraindications
- Ketoacidosis - Chronic intestinal diseases associated with marked disorders of digestion or absorption conditions that may deteriorate as a result of increased gas formation in the intestine (ex. IBD, bowel obstruction, colonic ulceration) - Precaution: SCr > 2mg/dL or CrCl < 25mL/min
43
What drugs are in the Alpha-glucosidase inhibitors class?
- Acarbose (Precose®) | - Miglitol (Glyset®)
44
Acarbose
- Precose® | - Take with first bite of food
45
Miglitol
- Glyset® - Take with first bite of food - Contraindicated in patients with cirrhosis
46
Acarbose dosage forms
Tablets: 25mg, 50mg, 100mg
47
Acarbose dosing
25mg by mouth TID
48
Miglitol dosage forms
Tablets: 25mg, 50mg, 100mg
49
Miglitol dosing
25mg by mouth TID
50
GLP-1
- DMII - increase insulin in presence of elevated glucose concentration - decrease glucagon secretion in glucose-dependent manner - delays gastric emptying - regulates appetite
51
GLP-1 adverse effects
- N/V/D - headache - Pancreatitis
52
GLP-1 precautions
- boxed warning: thyroid cancer | - Pancreatitis
53
GLP-1 counseling
- injection technique | - weight loss
54
Liraglutide dosage forms
- Victoza® | - Prefilled pen: 0.6mg, 1.2mg, 1.8mg
55
Liraglutide dosing
- Victoza® | - 1.8mg SQ once daily
56
Exenatide
- Byetta®, Bydureon® - Byetta: INR increase (monitor warfarin) - CI with CrCl <30ml/min (both) - Bydureon need to assemble
57
Exenatide dosage forms
- Byetta: Prefilled pen (5mcg, 10mcg) | - Bydureon: 2mg
58
Exenatide dosing
- Byetta: 5-10mcg SQ once daily | - Bydureon: 2mg SQ every week
59
Albiglutide
- Tanzeum® | - Must dissolve first (15min for 30mg, 30min for 50mg)
60
Dulaglutide dosage forms
- Trulicity® | - Prefilled pen: 0.75mg, 1.5mg
61
Dulaglutide dosing
- Trulicity® | - SQ every week
62
DPP-4 inhibitors
- DM II - inhibit break down of GLP-6 - used in combination with other products
63
DPP-4 inhibitors precautions
- renal insufficiency | - use with agents that cause hypoglycemia
64
DPP-4 inhibitors adverse effects
- Nasopharyngitis - Pancreatitis - Arthralgia - Angioedema - Urticaria
65
DPP-4 inhibitors counseling
- may take with or without food | - weight neutral
66
What drugs are in the DPP-4 inhibitors class?
- Sitagliptin (Januvia®) - Linagliptin (Tradjenta®) - Saxagliptin (Onglyza®) - Alogliptin (Nesina®)
67
Sitagliptin
- Januvia® - renal adjustment - May increase digoxin levels
68
Sitagliptin dosage forms
Tablets 25mg, 50mg, 100mg
69
Sitagliptin dosing
100mg by mouth once daily
70
Linagliptin
- Tradjenta® | - CYP3A4 interactions
71
Linagliptin dosage forms
5mg tablets
72
Linagliptin dosing
5mg by mouth once daily
73
Saxagliptin
- Onglyza® - renal adjustment - CYP3A4 interactions - New/worsening heart failure
74
Saxagliptin dosage forms
Tablets 2.5mg, 5mg
75
Saxagliptin dosing
2.5mg or 5mg by mouth once daily
76
Alogliptin
- Nesina® - renal adjustment - New/worsening heart failure
77
Alogliptin dosage forms
25mg tablets
78
Alogliptin dosing
25mg by mouth once daily
79
SGLT2 inhibitors
- DM II - reduce renal threshold - reduce glucose reabsorption - increase loss ofcluose in urine - reduce plasma glucose levels
80
SGLT2 inhibitors precautions
- Ketoacidosis - Hypotension - Fractures - Hyperkalemia - Renal impairment - CONTRAINDICATED in pts with CrCl < 30mL/min
81
SGLT2 inhibitors adverse effects
- UTI / gential fungal infections - increased urination - increased LDL - dizziness
82
SGLT2 inhibitors counseling
- weight loss | - signs / symptoms of decreased blood pressure
83
What drugs are in the SGLT2 inhibitors class?
- Cangliflozin (Invokana®) - Dapagliflozin (Farxiga®) - Empagliflozin (Jardiance®)
84
Cangliflozin
- Invokana® - Take with first meal of the day - 3A4 substrate - Only use 300mg with eGFR ≥60ml/min/1.73 m2) - increased risk of leg and foot amputations
85
Cangliflozin dosage forms
Tablets 100mg, 300mg
86
Cangliflozin dosing
100mg by mouth once daily
87
Dapagliflozin dosage forms
- Farxiga® | - Tablets 5mg, 10mg
88
Dapagliflozin dosing
- Farxiga® | - 5mg by mouth once daily
89
Empagliflozin
- Jardiance® - decrease CV mortality and hospitalization due to HF in Type II DM with CVD - Dose adjust with eGFR < 45 mL/min/1.73 m2
90
Empagliflozin dosage forms
Tablets 10mg, 25mg
91
Empagliflozin dosing
10mg by mouth once daily
92
Thiazolidinediones (TZDs)
- DM II - increased sensitivity of skeletal muscle - decreasing fatty acid at adipose tissue -> less ketoacidosis - increase lipogenesis - has drug interactions; 2C9, 3A4
93
Thiazolidinediones (TZDs) adverse effects
- edema - macular degeneration - weight fain - muscle pain - headache
94
Thiazolidinediones (TZDs) precautions
- edema - macular degeneration - bladder cancer - fractures
95
Thiazolidinediones (TZDs) contraindication
heart failure (initiation of therapy)
96
What drugs are in the Thiazolidinediones (TZDs) class?
- Pioglitazone (Actos®) | - Rosiglitazone (Avandia®)
97
Pioglitazone
- Actos® - Decreased triglycerides - May reduce CVD
98
Pioglitazone dosage forms
Tablets 15mg, 30mg, 45mg
99
Pioglitazone dosing
15mg by mouth once daily
100
Rosiglitazone
- Avandia® - Increased LDL - Do not initiate in patients with stable IHD.
101
Rosiglitazone dosage forms
Tablets 4mg, 8mg
102
Rosiglitazone dosing
4mg by mouth once daily
103
Glyburide- Metformin brand name
- Glucovance® | - Sulfonylurea + Metformin
104
Sitagliptan-Metformin brand name
- Janumet®, Janumet XR® | - DPP-4 Inhibitor + Metformin
105
Linagliptan-Metformin brand name
- Jentadueto®, Jentadueto XR® | - DPP-4 Inhibitor + Metformin
106
Saxagliptan-Metformin brand name
- Kombiglyze®, Kombiglyze XR® | - DPP-4 Inhibitor + Metformin
107
Canagliflozin-Metformin brand name
- Invokamet® | - SGLT-2 Inhibitor + Metformin
108
Empagliflozin-Linagliptin brand name
- Glyxambi® | - SGLT-2 Inhibitor + DPP-4 Inhibitor
109
PioglitazoleGlimepiride brand name
- Duetact® | - TZD + Sulfonylurea
110
insulin adverse effects
- hypoglycemia - injection site reaction - weight gain
111
insulin precautions
hypoglycemia
112
insulin patient counseling
- watch for signs/symptoms of hypoglycemia - alternate injection technique - when to administer - expiration date - blood glucose testing - sliding scale if applicable
113
adverse effects associated with hypoglycemia
- precipitation of acute cerebrovascular disease - MI - neurocognitive dysfunction - retinal cell death / vision loss - counter regulatory response - hypoglycemia unawareness - decreased psychological well-being and quality of life
114
Insulin Asapart
- Novolog®, Novolog Flexpen® - rapid acting - give 5-10 minutes before meal
115
Insulin Lispro
- Humalog®, Humalog Kwikpen® - rapid acting - give within 15 min of meal or immediately after
116
Insulin Glulisine
- Apidra®, Apidra Solostar® - rapid acting - give within 15 min before or within 20 min after starting meal
117
What are the rapid acting insulin?
- apart - lipro - glulisine
118
Regular Insulin
- Humulin R®, Novolin R® - intermediate acting - OTC - give 30 min prior to meal - Humulin R: Expires 28 days after opening - Novolin R: Expires 42 days after opening
119
NPH
- Humulin N, Novolin N - intermediate acting - OTC - cloudy appearance - Humulin N: Vials expires 28 days after opening, Pens 14 days - Novolin N: Expires 42 days after opening
120
What are the intermediate acting insulin?
- regular | - NPH
121
Insulin Degludec
- Tresiba Flextouch® - basal / long acting - dosed once daily, can be dosed anytime (not within 8 hours of last dose) - Expires 56 days after opening
122
Insulin Detemir
- Levemir®, Levemir Flextouch® - basal / long acting - can be given once or twice daily (12 hours apart) - Expires 42 days after opening
123
Insulin Glargine
- Lantus (U100®) vial and Solostar, Toujeo® (U-300) Solostar - basal / long acting - acidic pH -cloudy appearance - Toujeo® is more concentrated than Lantus® - Expires 28 days after opening
124
What are the basal / long acting insulin?
- Degludec - Detemir - Glargine

OU Practice Spring 2018 (9 decks)

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