Pharm > Endocrine: DM > Flashcards

Endocrine: DM Flashcards

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1
Q

T1 DM

A

cellular mediated beta cell destruction

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2
Q

T2 DM

A

insulin resistance in muscle and liver

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3
Q

maturity onset DM of the young

A

genetic disorder: impaired secretion of insulin

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4
Q

gestational DM

A

15% of pregnancies

common in 3rd tri

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5
Q

pre-diabetic

A

impaired glucose tolerance/fasting glucose

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6
Q

drug induced DM can be caused by which drugs?

A

glucocorticoids
protease inhibitors
atypical antipsychotics

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7
Q

screening for t1 DM is done why

A

if someone has relatives with T1

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8
Q

how is T1 DM screened for?

A

by measuring islet abs

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9
Q

T2 diabetes screening happens when

A

at age 45, q3 years

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10
Q

T2 Diabetes screening happens at what weight?

A

> 25kg/m2

>23kg/m2 for Asians

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11
Q

t2 dm may be seen with

A 
CVD
PCOS
HDL < 35 
TG > 250
HTN
physical inactivity
severe obesity
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12
Q

gestational DM screening

A

screen at 1st prenatal visit and again at 24-28 weeks with OGTT

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13
Q

if diagnosis of gestational DM is made,

A

screen for diabetes 4-12wks after delivery.

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14
Q

fasting plasma glucose in diabetes

A

> 126

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15
Q

random plasma glucose in diabetes

A

> 200

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16
Q

OGTT

A

administer 75g of glucose, obtain plasma glucose in 2 hours. if >200 and symptoms of hyperglycemia, diagnosis can be made.

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17
Q

A1C in diabetes

A

> 6.5%

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18
Q

one step OGTT

A

75g at 24-28 wks
fasting: >92
after 1 hr: >180
after 2 hr: >153

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19
Q

two step OGTT

A

50g at 24-28 weeks
after 1 hr if glucose < 140, no need for further workup
if >140, perform another OGTT using 100g.

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20
Q

microvascular complications of DM

A

retinopathy
neuropathy
nephropathy

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21
Q

glycemic goals of therapy:

A1C

A

<7%

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22
Q

glycemic goals of therapy:

preprandial:

A

70-130

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23
Q

glycemic goals of therapy:

postprandial

A

<180

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24
Q

BP mgmt for pt with DM

A

keep < 140/90

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25
lipid mgmt for pt c DM
no specific LDL goal, use ACC/AHA guidelines.
26
T1 DM | insulin pump
hourly basal and bolus dosing rapid acting insulins requires patient education and carb counseling.
27
neurotransmitter dysfunction in DM | meds (3)
GLP1 receptor agonists amylin bronocriptine
28
increased lipolysis and reduced glucose uptake | meds
thiazolidinediones
29
dec glucose uptake meds
metformin insulin thiazolidinediones
30
decrease incretin effect | meds
metformin alpha glucosidase inhibitors colesevelam
31
increased hepatic glucose production: | meds
metformin insulin thiazolidinediones
32
increased glucagon secretion | meds
GLP1 receptor agonists DPP 4 inhibitors Amylin
33
impaired insulin secretion | meds
sulfonylurea meglitinide GLP1 receptor agonists DPP 4 inhibitors
34
mono therapy DM
metformin -high efficacy -no risk hypoglycemia weight neutral/loss
35
AE metformin
GI | lactic acidosis
36
dual therapy: DM | metformin PLUS
either | sulfonylurea, thiazolidinedione, DPP4 inhibitor, SGL2 inhibitor, GLP1 receptor agonist, or insulin
37
metformin plus sulfonylurea
high efficacy moderate risk hypoglycemia weight: gain cost:low
38
dual therapies with highest efficacy and lowest costs
metformin+sulfo | metformin+thiazo
39
highest risk dual therapy for hypoglycemia
metformin and insulin
40
combination injectable therapy for DM
basal insulin + mealtime insulin + GLP-1RA
41
GLP1 receptor agonists
high cost | high efficacy
42
highest costing dual therapies
DPP4 inhibitor SGLT2 inhibitor GLP1 RA
43
highest efficacy dual therapy
sulfo thiazo GLP1 RA insulin*
44
T2 DM pharmacotherapy | first line
metformin
45
DPP4 inhibitors
dipeptidyl peptidase 4 inhibitor
46
SGLT2
sodium glucose cotransporter 2 inhibitors
47
GLP1 agonists
glucose like peptide 1 agonists
48
diabetic pts should be started on insulin for the following parameters
A1C > 10% | glucose >300-350
49
MoA metformin:
reduces hepatic gluconeogenesis and can inc insulin sensitivity. can also inc uptake of glucose from blood into other tissues.
50
A1c reduction c metformin
1-2%
51
blackbox warning for metformin
lactic acidosis
52
dosing for metformin is based on
GFR
53
metformin is CI in
acute or chronic metabolic acidosis | GFR <30
54
onset and full effect of metformin
onset: days | full effect: 2 weeks
55
metabolism of metformin
not hepatic
56
elimination of metformin
urine, 90% unchanged.
57
dosing of metformin
500-100mg BID
58
max dose of metformin
2550 mg/day
59
metformin and IV contrast
avoid administration within 48 hr of contrast
60
pregnancy category of metformin
B
61
sulfonylurea examples
glipizide glimepride glyburide
62
A1c reduction of sulfonylureas
1-2%
63
MoA sulfonylurea
binds to receptors on pancreatic beta cells which causes the K channel to close so that K cannot leave the cell - which causes depo of the membrane. there is then an influx of calcium which stimulates insulin secretion
64
AE sulfos
hypoglycemia | weight gain
65
CI to sulfos
hypersensitivity to sulfonamides | poor renal function
66
pt edu for sulfos
take c food
67
protein binding of sulfos
high | >95%
68
onset of sulfo
Reduces blood glucose within hours
69
elimination of sulfos
hepatic
70
monitoring for sulfos
fasting BG A1C s/s hypoglycemia
71
CI sulfos
hepatic insufficiency | renal failure
72
meglitinides A1C reduction
.5 - 1.5%
73
meglitinide meds
repaglinide | nateglinide
74
MoA of meglitinides
similar to sulfos but faster
75
AEs of meglitinides
hypoglycemia weight gain URI
76
CI c meglitinides
hypersensitivity use of gemfibrozil
77
thiazos examples
pioglitazone | rosiglitazone
78
MoA thiazos
decrease plasma glucose by increasing insulin sensitivity of adipose tissue, skeletal muscle, and the liver.
79
primary site of action of thiazos
adipose tissue
80
what receptor does thiazo bind to?
PPARy
81
thiazo A1C reduction
0.5 - 1.4 %
82
onset of thiazos
1-3 months
83
AE of thiazos
``` weight gain edema CHF exacerbation inc risk fractures in women myalgia headache macular edema inc LFT ```
84
protein binding of thiazo
high | >99%
85
Thiazo excretion
urine and feces as metabolites
86
CI c thiazos
NYHA class 3-4 of HF at initiation of therapy
87
thiazo monitoring
``` BG A1c LFT s/s HF bone health ```
88
DPP4 inhibitors examples
sitagliptin saxagliptin linagliptin alogliptin
89
DPP4 A1c reduction
0.5 - 0.8%
90
MoA DPP4
inhibits breakdown of GLP1 during meals thus increasing insulin secretion, reducing glucagon secretion, and promoting satiety.
91
DPP4 inhibitors on fasting blood glucose
low impact
92
side effect profile for DPP4 inhibitors
minimal but monitor for s/s pancreatitis
93
hypoglycemia and DPP4 as monotherapy
uncommon
94
dose adjust DPP4 inhibitors based on
GFR
95
elimination and metabolism of DPP4 inhibitors
renal elimination | minor metabolism thru CYPs
96
SGLT2 inhibitor examples
-flozins
97
MoA SGLT2 inhibitors
inc urinary glucose excretion by blocking normal reabsorption in the proximal convoluted tubule
98
AE of SGLT2 inhibitors
inc urination UTI hypotension inc risk fractures
99
SGLT2 inhibitors are CI in
renal impairment
100
alpha glucosidase inhibitor med
acarbose
101
MoA alpha glucosidase inhibitor
reduce absorption of glucose from intestine to bloodstream by slowing breakdown of large carbs into smaller, easier to absorb sugars
102
AEs of alpha glucosidase inhibitors
flatulence diarrhea abd pain inc LFTs
103
alpha glucosidase inhibitors are CI in
IBD colonic ulcerations intestinal obstruction
104
once insulin binds,
autophosphorylations occur. CAP/Cbl protein complex and PI3 kinase facilitates glucose transporter translocation. transporter gets to membrane, pulls glucose from bloodstream (BG decreases) and glucose stored as energy.
105
rapid acting insulin onset
15-30 min
106
short acting insulin onset
30-60 min
107
intermediate acting insulin onset
2-4
108
rapid acting insulin examples
lispro aspart glulisine
109
short acting insulin examples
regular (humulin)
110
intermediate acting insulin example
neutral protamine hagedorn (humulin)
111
long acting insulin examples
lantus | levemir
112
rapid acting insulin peaks
.5 - 3
113
duration of rapid onset insulins
3-5 hr
114
short acting insulin, regular, peak
2-3 hr
115
short acting insulin, regular, duration
3-6 hr
116
intermediate acting insulin peak
4-6 hr
117
duration of intermediate acting insulin
8-12
118
short acting and intermediate acting insulin are typically dosed
BID
119
long acting insulins are typically dosed
1x a day | basal
120
long acting insulin onset
3-5 hr
121
long acting insulin peak
no peak
122
duration of long acting insulin
up to 24 hr.
123
basal dosing of insulin
either 10u daily or | .1-.2 units/kg/daily
124
titration of basal dose insulin
patient can do it, 2u q3 days to target A1C.
125
for basal insulin pt, fasting plasma glucose level should be consistent with
A1c goal
126
initiation of prandial dosing
appropriate if above A1c goal but basal dose is titrated and fasting is at goal
127
prandial dosing | start with
1 dose at largest meal | either 4u/day or 10% of total basal dose
128
increasing prandial dosing
1-2 units or 10-15% twice weekly.
129
dose insulin at _ - _ units/kg/day
0.3 to 0.6 u/kg/day
130
total insulin can be divided into
2/3 NPH + 1/3 regular divided in AM and PM meal or 50% basal and 50% prandial divided in 3 meals
131
AE insulin
hypoglycemia weight gain allergy lipoatrophy or lipohypertrophy
132
GLP1 analogs end in
-tide
133
A1C reduction of GLP1 analogs
0.5-1.5%
134
MoA GLP1 analogs
increases glucose dependent insulin secretion, reduction of glucagon secretion, and reduced gastric emptying
135
AE GLP1
N/V/D hypoglycemia AKI
136
CI GLP1
impaired renal function
137
monitoring for GLP1
``` bg a1c s/s pancreatitis hypogly weight loss ```
138
tx hypoglycemia
treat at < 70 | admin 15-20 glucose, reassess in 15. if glucose still <70, admin another 15-20.
139
tx hypoglycemia c bg <54
admin glucagon 1mg IM or IV dextrose if no response.
140
DKA is more common in
T1
141
tx DKA
fluid replacement c 1/2NS or NS bolus and infusion of insulin potassium sodium bicarb
142
bolus and infusion insulin rates for DKA
bolus: 0.1unit/kg infusion: 0.1u/kg/hr
143
when to reduce insulin infusion in DKA
reduce by .02-.05 u/kg/hr when serum glu reaches 200
144
when do we give bicarb in dka?
if serum pH is <6.9
145
when is DKA considered resolved?
venous pH > 7.3 bicarb >15 anion gap <12
146
tx nephropathy in DM
screen yearly for urine album/creat ratio (normal is < 30) - if >30, use ace/arb. obtain CrCl yearly reduce dietary protein
147
retinopathy in DM
screen annually | treat extreme cases c IV steroids
148
neuropathy tx DM
TCAs - amitriptyline SNRIs - duloxetine or anticonvulsants - gapapentin/pregabalin

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