DM treatment Flashcards
(166 cards)
0
Q
fasting plasma glucose OR
A
after 8hours of fasting
> or equal to 7.0 mmol/l 126 mg/dL
1
Q
Diabetes mellitus is defined as
A
elevated blood glucose
absent or inadequate pancreatic insulin secretion
without concurrent impairment of insulin action
2
Q
2 hour plasma glucose
A
75 g oral glucose load
> or equal to 11.1 mmol/l (200 mg/dl)
3
Q
uncommon criteria in WHO DM
A
elevated RBS
glycosylated hemoglobin
4
Q
signs and symptoms of DM
A
polyphagia polyuria polydipsia blurred vision fatigue nausea dry skin
5
Q
type 1 insulin dependent diabetes hallmark
A
selective Beta cell destruction
absolute insulin deficiency
6
Q
type 2 noninsulin dependent diabetes hallmark
A
insulin resistance
relative insulin deficiency
7
Q
fist diagnosis of gestational DM
A
during pregnancy
progresses to frank diabetes
8
Q
interruption of insulin replacement therapy in type 1 DM can result to
A
diabetic ketoacidosis
9
Q
type 2 DM dehydration can lead to
A
hyperketotic hyperosmolar coma
10
Q
increases in response to different stimuli especially glucose
A
INSULIN
11
Q
variability of insulin absorption is more prominent with
A
regular human insulin and NPH insulin
12
Q
half life of insulin
A
3-5 minutes
13
Q
endogenous insulin is secreted more by
A
liver 60%
14
Q
exogenous insulin is excreted more by the
A
kidney. 60%
15
Q
insulin binds with
A
alpha sub TKR
16
Q
basal insulin value
A
5-15 uu/mL (30-90 pmol/l)
17
Q
peak insulin value
A
60-90 uu/ml (369-540 pmol/l)
18
Q
human sources of insulin made from
A
recombinant DNA
19
Q
pork or beef insulin can cause
A
hyoersensitivity
not produced anymore
20
Q
different concentrations of insulin prep
A
u-100
u-500
u-40
21
Q
only concentration of insulin available in the Philippines
A
u-100
22
Q
concentration used in other countries for insulin resistance
A
u-500
23
Q
used in other countries for pedia DM
A
u-49
24
basis of classification of insulin preparations
time of onset
| duration of action
25
for basal requirements use
intermediate or long acting insulin
26
postprandial hyperglycemia use
short acting or rapid acting insulin before meals
27
only cloudy suspension among preparations
NPH
28
only insulin preparation that can be mixed with other preparations
NPH
29
mixing how to
clear soln must be injected to the cloudy suspension
30
route of general prep
SC
31
preferable regular insulin route
IV
32
pH of almost all insulin prep
neutral
33
only prep that is acidic of pH. 4 and cant be mixed with other insulin
GLARGINE
34
types used in continuous SC insulin infusion
rapid acting- LISPRO, ASPART, GLULISINE
| short acting- regular INSULIN
35
cant be mixed with other solutions
GLARGINE (Lantus)
| DETEMIR (Levemir)
36
traditional and chepest way to administer INSULIN
vial
| tuberculin syringe injection
37
mode of delivery for whose blood glucose fluctuate and is difficult to monitor and control
INSULIN pump
38
good range of blood glucose reading
80-120 fasting blood glucose early in the morning
| 140-180 after a meal
39
proline is moved from b28 to b29
| lysine is moved from b29 to b28 making it faster acting
LISPRO (humalog)
40
b28 prolone substituted with a negatively charged aspartic acid
ASPART (novolog)
41
glycine substitutes aspargine at the end of alpha chain
| 2 arginines are added to the end of the b chain
GLARGINE (lantus)
42
myristic acid is added to the alpha chain
| threonin is removed from the end of beta chain
DETERMIR (levemir)
43
lysine at b3 instead of aspargine
| glutamic acid at b29 instead of lysine
GLULISINE (apidra)
44
rapid acting insulin
LISPRO (humalog)
ASPART (novolog)
GLULISINE (apidra)
45
used for postprandial hyperglycemia
rapid acting
- LISPRO
- ASPART
- GLULISINE
46
most physiologic insulin prep
rapid acting
- LISPRO
- ASPART
- GLULISINE
47
```
onset of action of
rapid acting
-LISPRO
-ASPART
-GLULISINE
```
15 mins, not dose related
48
```
duration of action of
rapid acting
-LISPRO
-ASPART
-GLULISINE
```
3-5 hours
49
1st monomeric insulin analog to be marketed
| produced by recombinant technology
LISPRO (humalog)
50
short acting insulin
HUMULIN R
| ACTRAPID HM
51
onset of action of short acting
HUMULIN R
ACTRAPID HM
30min- 1hr
| so give 30-45 min ac
52
peak of action of short acting
HUMULIN R
ACTRAPID HM
2-3 hours
53
duration of action of short acting
HUMULIN R
ACTRAPID HM
5-8 hours
54
delayed onset of action and peak action is caused by
short acting
HUMULIN R
ACTRAPID HM
hexameric structure
55
```
NPH neutral protamine hagedorn
isophane insulin(HUMULIN N)
```
intermediate acting
56
use of protamine
added to prolong the action of insulin
57
```
onset of action of NPH neutral protamine hagedorn
isophane insulin(HUMULIN N)
```
2-5 hours
58
```
NPH neutral protamine hagedorn
isophane insulin(HUMULIN N)
duration of action
```
10-20h bid-qid
59
onset of action and duration of action of NPH are affected by the
dose
60
the only insulin used to provide for basal insulin requirements
```
NPH neutral protamine hagedorn
isophane insulin(HUMULIN N)
```
61
long acting insulin analogs
GLARGINE (lantus)
| DETEMIR
62
DETEMIR is given
2x a day
63
GLARGINE is peakless and is given
once a day
64
insulin combination's onset will depend on
```
short acting insulin
LISPRO
ASPART
GLULIGINE
regular
```
65
insulin combination duration will depend on
long acting -NPH
66
insulin regimens
basal bolus
| split mixed
67
most physiologic between two regimens
basal-bolus
68
basal bolus dose
GLARGINE - hours after supper
| +rapid acting or short acting - before meals:BLS
69
split mised dose
before breakfast: NPH + rapid or short acting
70
insulin absorption
directly into the bloodstream
71
variability of insulin absorption more prominent with
regular human - short
| NPH - intermediate
72
absorption site of insulin
abdomen>arms>thighs>buttocks
73
for px with kidney problem use
endo - liver 60%
74
complications of insulin therapy
```
hypoglycemia
insulin allergy, resistance
weight gain
lipodystrophy
increased cancer risk
```
75
immune insulin resistance prone in
use of beef insulin
obese with type 2
interrupted tx
76
rises insulin requirements in immune resistance
IgG anti insulin antibodies
77
increased cancer risk is attributed to
insulin resistance
| hyperinsulinemia- prediabetic and type 2
78
insulin indications
```
type 1 DM
pregnant diabetics
ketoacidosis, nonketotic coma
very ill patients
peri op control, patients in labor
hypersensitivity or inadequate response to oral hypoglycemic
kidney or liver disease
```
79
why is insulin the DOC for pregnant diabetics
doesnt cross the placenta
| wont cause fetal hypoglycemia
80
biggest group of antihyperglycemic drugs other than insulin
sulfonylures
81
2nd generation sulfonylureas
GLIPIZIDE (minidiab)
GLIBENCLAMIDE / GLYBURIDE (daonil)
GLICAZIDE (diamicron)
GLIPERAMIDE (norizec)
82
preferred less AE and DI of sulfonylureas
2nd generation
83
short acting sulfonylureas
TOLBUTAMIDE- 2-3x a day
84
Intermediate acting sulfonylureas
1-2 per day
GLIPIZIDE (minidiab)
GLIBENCLAMIDE / GLYBURIDE (daonil)
GLICAZIDE (diamicron)
GLIPERAMIDE (norizec)
85
long acting sulfonylureas
CHLORPROPAMIDE
| 1x day
86
moa of sulfonylureas, glinides, d phenylalanine derivatives
stimulate insulin release from pancreas by interacting with ATP sensitive K channels on pancreatic beta cells
87
additional MOA of sulfonylureas
⬇️ serum glucagon secretion
| bind to extrapancreatic receptors and close K channels
88
CI of sulfonyureas
type 1 DM, ketoacidosis
renal and hepatic impairment
pregnancy
89
only sulfonylurea for pregnancy
GLYBURIDE (daonil)
90
GLIBENCAMIDE dose
5-10 mg tab OD
91
GLIBENCAMIDE is given
30 mins before breakfast
92
AE of sulfonylureas
```
hypoglycemia
GIT
weight gain
Disulfram like rxn with alcohol
agranulocytosis, thrombocytopenia
```
93
meglitinide or glinides
REPAGLINIDE (novonorm)
94
pk of REPAGLINIDE
short half life
| onset: 1hr
95
use of REPAGLINIDE
lower postprandial glucose-given at start of meals
| monotherapy or combination with Biguanides
96
SE of REPAGLINIDE
hypoglycemia
| weight gain
97
REPAGLINIDE CI
hepatic impairment
98
d phenylalanin derivatives
NATEGLINIDE (starlix)
99
NATEGLINIDE PK
short half life
| onset : 20 mins
100
use of NATEGLINIDE
lower postprandial glucose given at start of meals
101
NATEGLINIDE se
hypoglycemia-lowest
| weight gain
102
insulin secretagogue that can be given to DM px with renal impairment
D phenylalanine derivatives- NATEGLINIDE (starlix)
103
moa of biguanides
❤️ decrease hepatic glucose production by activating AMP activated protein kinase (AMPK)➡️ suppress ATP dependent processes like gluconeogenesis➡️ block glucose
increase glucose uptake in muscle and fat
lipid lowering effect
104
half life of biguanides
1.5- 3 hrs
105
duration of action of biguanides
7-12 hrs
106
extended release biguanide duration
24 hours
107
biguanide dosing
once a day
108
interesting pk of biguanide
not metabolized, excreted as an active compound
109
AE of biguanides
```
dose related GIT
anorexia
lactic acidosis
decreased b12 absorption during long term
metallic taste
```
110
uses of biguanides
first line tx of t2 DM
prevention of t2 DM in impaired glucose tolerance test
PCOS
111
the only biguanide in the market
METFORMIN (glucophage)
112
dosage form of METFORMIN
500 mg
500 mg XR
850 mg
1 g tablets
113
METFORMIN dose
500 mg to max 2.5 g per day on 3 divided doss with meals
114
METFORMIN CI
withold in conditions predisposing to renal insufficiency and or hypoxia
- CV collapse
- severe infection
- alcoholism
- renal, liver dysfxn
- ⬆️risk of lactic acidosis
115
resume METFORMIN 48 hours after the following
use of IV iodinated contrast material
| major surgical procedures
116
thiazolidinediones
PIOGLITAZONE (actos)
117
moa of PIOGLITAZONE
bind to peroxisome proliferator activated receptor PPAR y
➡️activates insuline responsive genes that reg cho and lipid metab
➡️ increase tissue sensitivity to insulin
118
target tissues of PIOGLOTAZONE
fat
muscle
liver
119
secondary effect of PIOGLITAZONE
decrease hepatic glucose production
120
onset of PIOGLITAZONE
4-12 weeks
121
ppar alpha effect of PIOGLITAZONE
⬇️ TAG
| slight ⬆️ HDL, LDL
122
Use of PIOGLITAZONE
add on to other insulin therapies
123
AE of PIOGLITAZONE
❤️edema and weight gain
hepatotoxic : TROGLITAZONE
risk of bone fractures
124
PIOGLITAZONE CI
pregnancy
significant liver disease
CHF
125
alpha glucosidase inhibitors
ACARBOSE (glucobay, gluconase)
VOGLIBOSE (basen)
MIGLITOL
126
moa of AG inhibitors
inhibit alpha gluconidase - no weight gain or hypoglycemia
127
alpha gluconidase fxn
breaks down polysaccharides to monosaccharides in intestinal brush border, delaying CHO absorption
128
dose of ACARBOSE (glucobay, gluconase)
50-100 mg od-tid after 1st spoonful of meal
129
VOGLIBOSE dose
0.2-0.3 mg TID AC
130
AE dose related AG inhibitors
```
malabsorption
flatulence
diarrhea
abdominal pain
bloating
reversible elevated liver fxn test
```
131
why should AG inhibitors be started at low doses
flatulence AE
132
CI AG inhibitors
IBD
intestinal conditions
renal, hepatic impairment
133
advantage of using AG inhibitors
type 1 and 2 DM
| because it is limited to the gut only
134
disadvantage of using AG inhibitor
not very effective, only a secondary drug
135
enteric hormones that segment glucose dependent insulin secretion when glucose is taken orally
INCRETIN
136
enzyme that degrades incretins
DPP4 dipeptidyl peptidase 4 inhibitor
137
moa of GLP1 analogs
stimulate b cell to release insulin in response to oral glucose load
138
GLP1 analog
EXENATIDE (byetta)
139
SC injections of EXENATIDE are absorbed
equally
| arm, ab, thigh
140
EXENATIDE peak
2 hours
141
EXENATIDE duration
til 10 hours
142
major SE of EXENATIDE
diarrhea
143
SE of EXENATIDE
GI
weight loss
headache
hemorrhagic pancreatitis
144
dosage of EXENATIDE
5 mcg BID SC to 10 mcg SC 60 mins A
| before meals
145
when should dose of EXENATIDE be adjusted?
if crea clearance is <30 ml/min
146
DPP 4 inhibitors
SITAGLIPTIN (januvia)
147
bioavailability of SITAGLIPIN
87%
148
half life of SITAGLIPIN
8-14 hours
149
preparations of SITAGLIPIN
25 mg
50 mg
100 mg
150
dosage of SITAGLIPIN
25-100 mg OD
151
unchanged SITAGLIPIN in urine
79%
152
advantage of SITAGLIPIN to EXENATIDE
oral
| relatively safe
153
adv of GLP 1 agonists
increases GLP 1 levels promoting satiety and prolonging gastric emptying time resulting in weight loss
154
DPP 4 inhibitors adv
maintains physiologic level of GLP 1 in the body
155
amylin analogs
PRAMLINTIDE
156
37 aa compound secreted with insulin from beta cells
deficient in type1,2
renal clearance
AMYLIN
157
physiologic effects of AMYLIN
inh glucagon secretion esp in postprandial state
| reduction of gastric emptying time
158
synthetic analog of AMYLIN
PRAMLINTIDE
159
an effect of PRAMLIMTIDE on appetite
anorectic
160
PRAMLINTIDE admin
SC injection
161
PRAMLINTIDE AE
hypoglycemia
nausea
vomiting
162
how is PRAMLINTIDE used with INSULIN
separate admin
preprandially
for type 1,2
163
initial therapy
1-2% lifestyle change to dec wt and inc activity
| 1.5% METFORMIN- biguanides
164
additional therapy
INSULIN
SULFONYLUREAS- Gs
TZDs - PIOGLITAZONE
165
weight neutral advantage
ACARBOSE- AG inh
