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PHRM844 > Final Exam Material > Flashcards

Final Exam Material Flashcards

1
Q

ideal body weight equation (males)

A

IBW = 50 kg + 2.3 (inches over 60”)

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2
Q

ideal body weight equation (females)

A

IBW = 45.5 kg + 2.3 (inches over 60”)

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3
Q

When do you use ideal body weight for fluids/electrolytes calculations?

A

If actual body weight >130% of IBW; use actual body weight otherwise

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4
Q

Where does most fluid loss occur in the body?

A

Skin, lungs, and kidneys

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5
Q

isotonic range

A

275-290 mOsm/L

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6
Q

What is the administration rate of maintenance fluids?

A

30-40 mL/kg/day

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7
Q

What tonicity can crystalloids be?

A

Isotonic, hypotonic, and hypertonic

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8
Q

Which fluids are crystalloids?

A

Normal saline (NS), 1/2 NS, D5W, lactated ringers (LR)

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9
Q

Which fluids are for resuscitation?

A

NS and LR

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10
Q

Which fluid is a maintenance fluid?

A

1/2 NS

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11
Q

Which fluid is for free water replacement and NOT a maintenance fluid by itself?

A

D5W

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12
Q

What is the most common maintenance fluid?

A

D5W + 1/2 NS + 20 mEq KCl/L

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13
Q

What tonicity can colloids be?

A

Hypertonic

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14
Q

Which fluids are colloids?

A

Albumin (5% or 25%), hetastarch, tetrastarch, blood, Plasmanate

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15
Q

What is albumin 5% used for?

A

Hypovolemia

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16
Q

What is albumin 25% used for?

A

Hypoproteinemia

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17
Q

What are signs and symptoms of dehydration?

A

Tachycardia, hypotension, <0.5 mL/kg/hr urine output, BUN/SCr ratio >20

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18
Q

normal sodium concentration range

A

135-145 mEq/L

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19
Q

What tonicity can hyponatremia be associated with?

A

Hypertonic, isotonic, hypotonic

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20
Q

How do you treat symptomatic hypovolemic hypotonic hyponatremia?

A

NaCl 3%

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21
Q

How do you treat asymptomatic hypovolemic hypotonic hyponatremia?

A

NaCl 0.9%

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22
Q

What drugs can cause SIADH, which causes isovolemic hypotonic hyponatremia?

A

Antipsychotics, carbamazepine, SSRIs

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23
Q

How do you treat symptomatic isovolemic hypotonic hyponatremia?

A

Furosemide and NaCl 3%

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24
Q

How do you treat asymptomatic isovolemic hypotonic hyponatremia?

A

NaCl 0.9% and water restriction

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25
Q

How do you treat symptomatic hypervolemic hypotonic hyponatremia?

A

Furosemide and judicious NaCl 3%

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26
Q

How do you treat asymptomatic hypervolemic hypotonic hyponatremia?

A

Furosemide

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27
Q

What is the maximum increase for serum sodium when treating hyponatremia?

A

0.5 mEq/L/hr OR 8-12 mEq/L/day

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28
Q

What is the rate of increase for serum sodium in acute hyponatremia?

A

1-2 mEq/L/hr until symptoms resolve

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29
Q

What is the goal serum sodium for acute hyponatremia?

A

120 mEq/L

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30
Q

What is the maximum increase for serum sodium when treating acute hyponatremia?

A

8-12 mEq/L in first 24 hours

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31
Q

How do you treat acute hyponatremia?

A

NaCl 0.9% (asymptomatic) OR NaCl 3% (symptomatic)

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32
Q

rule of eights

A

Replace half of sodium deficit in 8 hours, the remaining deficit in 8-16 hours

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33
Q

monitoring for acute hyponatremia

A

Measure serum sodium concentration Q2-4H until asymptomatic, then Q6-8H until WNL

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34
Q

What tonicity is hypernatremia associated with?

A

Hypertonic

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35
Q

How do you treat hypovolemic hypernatremia?

A

-Restore hemodynamic status first (if necessary), then calculate free water deficit
-Treat with D5W and/or enteral free water via feeding tube

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36
Q

hypovolemic hypernatremia monitoring

A

Check serum sodium concentration Q3-6H for first 24 hours, then check Q6-12H after symptoms resolve and serum sodium concentration <145 mEq/L

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37
Q

How do you treat isovolemic hypernatremia?

A

Desmopressin or vasopressin

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38
Q

How do you treat hypervolemic hypernatremia?

A

Stop hypertonic fluids/cause(s) and use a diuretic if needed

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39
Q

normal potassium concentration range

A

3.5-5 mEq/L

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40
Q

How do you treat hypokalemia at a range of 3-3.4 mEq/L?

A

Oral potassium for patient with cardiac conditions

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41
Q

How do you treat hypokalemia at a range of <3 mEq/L?

A

-PO for asymptomatic patients
-IV for symptomatic patients and those who cannot tolerate PO

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42
Q

What are the appropriate rates of administration for potassium correction treatment?

A

-10 mEq/hr without cardiac monitoring
-20 mEq/hr with cardiac monitoring
-40-60 mEq/hr if emergency with severe hyperkalemia

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43
Q

How do you treat hyperkalemia?

A

-Calcium
-Albuterol, Bicarb, Insulin and Glucose
-Kayexalate/Lokelma, Diuretics (furosemide), Renal unit for dialysis Of Patient

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44
Q

normal magnesium concentration range

A

1.5-2.5 mg/dL

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45
Q

In hypomagnesemia, what should you treat before giving the patient magnesium medications?

A

Associated electrolyte disturbances (especially potassium)

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46
Q

What are the treatment options for asymptomatic patients with >1 mg/dL of magnesium presenting with hypomagnesemia?

A

-Milk of magnesia 5-10 mL PO QID
-Magnesium oxide 800 mg PO QD or 400 mg PO TID with meals

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47
Q

What are the treatment dosages for symptomatic patients or patients who cannot tolerate oral route presenting with hypomagnesemia?

A

-1-2 mg/dL –> 0.5 mEq/kg
-<1 mg/dL –> 1 mEq/kg

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48
Q

normal calcium concentration range

A

8.5-10.5 mg/dL

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49
Q

How do you treat acute hypocalcemia?

A

-100-300 mg elemental calcium IV over 5-10 minutes
-administer 1 gm/hr
-correct hypomagnesemia

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50
Q

How do you treat chronic hypocalcemia?

A

-1-3 g/day of elemental calcium (i.e., CaCO3 650 mg PO QID = 1 g elemental calcium/day)
-calcitriol 0.25 mcg PO QD/QOD (may need to increase by 0.25 mcg Q4-8W to 1 mcg PO QD)

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51
Q

normal phosphorus concentration range

A

2.5-4.5 mg/dL

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52
Q

How do you treat mild to moderate (1-2 mg/dL) hypophosphatemia?

A

-30-60 mMol/day of Phos-NaK BID/TID
-5 mL diluted Fleets Phospho-Soda BID/TID

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53
Q

How do you treat severe (<1 mg/dL) hypophosphatemia?

A

-if potassium <4 mEq/L –> KPhos
-if potassium ≥4 mEq/L –> NaPhos

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54
Q

What is the maximum rate of infusion for IV phosphorus?

A

7 mMol/hr

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55
Q

What part of the kidney is the major reabsorption site?

A

Proximal tubule

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56
Q

How do NSAIDs affect the afferent and efferent arterioles?

A

-constricts afferent arteriole (decreased vasodilatory prostaglandins)
-constricts efferent arteriole (increased angiotensin II)

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57
Q

How do ACEi/ARBs affect the afferent and efferent arterioles?

A

-slightly dilates afferent arteriole (slightly increased vasodilatory prostaglandins)
-dilates efferent arteriole (decreased angiotensin II)

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58
Q

nephritic syndrome

A

inflammation disrupting glomerular basement membrane

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59
Q

nephrotic syndrome

A

podocyte damage leading to glomerular charge-barrier disruption

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60
Q

signs and symptoms of nephritic syndrome

A

-increased hematuria
-red blood cell casts present

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61
Q

signs and symptoms of nephrotic syndrome

A

-increased edema
-increased proteinuria
-low serum albumin

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62
Q

What diuretic drug classes are potassium-wasting?

A

Carbonic anhydrase inhibitors, osmotic diuretics, sodium-potassium-chloride symport inhibitors (loop diuretics), sodium-chloride symport inhibitors (thiazides)

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63
Q

carbonic anhydrase inhibitors suffix

A

-amide

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64
Q

osmotic diuretic drugs

A

-mannitol
-isosorbide
-glucose
-glycerine

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65
Q

loop diuretic drugs

A

-bumetanide
-torsemide
-ethacrynic acid

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66
Q

What diuretic drug classes are potassium-sparing?

A

Renal epithelial sodium channel inhibitors, mineralocorticoid receptor antagonists, vasopressin antagonists

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67
Q

renal epithelial sodium channel inhibitor drugs

A

-amiloride
-triamterene

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68
Q

mineralocorticoid receptor antagonists suffix

A

-one

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69
Q

normal SCr (men)

A

0.74-1.35 mg/dL

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70
Q

normal SCr (women)

A

0.59-1.04 mg/dL

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71
Q

normal BUN

A

6-24 mg/dL

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72
Q

normal CrCl (men)

A

110-150 mL/min

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73
Q

normal CrCl (women)

A

100-130 mL/min

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74
Q

normal eGFR

A

≥60

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75
Q

normal vitamin D concentration

A

≥50 ng/mL

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76
Q

normal PTH concentration

A

10-55 pg/mL

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77
Q

normal hemoglobin (men)

A

14-18 g/dL

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78
Q

normal hemoglobin (women)

A

12-16 g/dL

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79
Q

normal transferrin saturation (TSAT) (men)

A

20-50%

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80
Q

normal transferrin saturation (TSAT) (women)

A

15-50%

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81
Q

normal ferritin (men)

A

24-336 mcg/L

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82
Q

normal ferritin (women)

A

11-307 mcg/L

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83
Q

normal mean corpuscular volume (MCV)

A

80-100 fl

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84
Q

normal red cell distribution width (RDW) (men)

A

11.8-14.5%

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85
Q

normal red cell distribution width (RDW) (women)

A

12.2-16.1%

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86
Q

When can you not use the Cockroft and Gault formula to estimate CrCl?

A

acute kidney injury (AKI)

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87
Q

Cockroft and Gault equation (men)

A

CrCl = ((140-age) x IBW)/(SCr x 72)

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88
Q

Cockroft and Gault equation (women)

A

CrCl = CrCl for men x 0.85

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89
Q

adjusted body weight equation

A

AjBW = IBW + 0.4(ABW - IBW)

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90
Q

calcium-containing phosphate binders

A

Calcium carbonate (Tums) and calcium acetate (PhosLo)

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91
Q

What percentage elemental calcium does calcium carbonate have?

A

40%

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92
Q

calcium carbonate dosing

A

500 mg PO TID with meals

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93
Q

calcium carbonate maximum dose

A

1500 mg/day

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94
Q

What percentage elemental calcium does calcium acetate have?

A

25%

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95
Q

calcium acetate dosing

A

2-3 tablets PO TID with meals

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96
Q

non-calcium-containing phosphate binders

A

Sevelamer carbonate (Renvela), lanthanum carbonate (Fosrenol), sucroferric oxyhydroxide (Velphoro), Auryxia (ferric citrate), aluminum hydroxide (Amphojel), magnesium carbonate (Mag-Carb), nicotinic acid, nicotinamide

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97
Q

Which non-calcium-containing phosphate binder should you NOT use?

A

aluminum hydroxide (Amphojel)

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98
Q

unactivated vitamin D medications

A

ergocalciferol (calciferol), cholecalciferol

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99
Q

activated vitamin D medications

A

calcitriol (Rocaltrol and Calcijex), paricalcitol (Zemplar), doxercalciferol (Hectorol)

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100
Q

Which vitamin D medication requires activation by the liver (prodrug)?

A

doxercalciferol (Hectorol)

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101
Q

Should hemoglobin or hematocrit be used to assess anemia?

A

hemoglobin

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102
Q

What are the KDIGO guidelines for initiation of iron supplementation?

A

TSAT <30% and ferritin <500 ng/mL

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103
Q

What is the preferred agent for intravenous iron?

A

iron sucrose (Venofer)

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104
Q

When should erythropoiesis stimulating agents (ESAs) be used in CKD patients?

A

-hemoglobin <10 g/dL and falling at rapid rate (stage 3-5 without dialysis)
-hemoglobin 9-10 g/dL (stage 5 with dialysis)

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105
Q

What are the indications for renal replacement therapy (RRT)?

A

Acid/base balance
Electrolyte balance
Intoxication
Overload of fluids
Uremia

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106
Q

What substances are not removed during hemodialysis?

A

High volume of distribution, high lipophilicity, large molecular weight, highly protein bound

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107
Q

What are the different types of peritoneal dialysis?

A

CAPD
CCPD
NIPD
TPD

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108
Q

Which type of peritoneal dialysis does not require a machine?

A

CAPD

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109
Q

What are the common manifestations of diabetes?

A

polydipsia
polyuria
polyphagia
ketoacidosis

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110
Q

What is the role of the alpha-subunit of the insulin receptor?

A

repress catalytic activity of the beta-subunit

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111
Q

How does somatostatin affect glucose secretion?

A

inhibits glucose secretion

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112
Q

What is the role of the beta-subunit of the insulin receptor?

A

cause autophosphorylation of the other beta-subunit

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113
Q

What is the molecular target of thiazolidinediones?

A

peroxisome proliferator-activated receptor gamma (PPARgamma)

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114
Q

thiazolidinedione adverse effects

A

-cardiovascular toxicities
-risk of bladder cancer (pioglitazone)
-hepatotoxicity

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115
Q

What is the molecular target of sulfonylureas?

A

potassium channels

116
Q

sulfonylurea adverse effects

A

-hypoglycemia
-risk of cardiovascular events
-GI side effects
-weight gain

117
Q

What drugs cause hypoglycemia?

A

-alcohol
-high dose salicylates
-beta adrenergic blockers
-ACE inhibitors
-fluoxetine
-somatostatin
-anabolic steroids
-MAO inhibitors

118
Q

What drugs cause hyperglycemia?

A

-oral contraceptives
-corticosteroids
-epinephrine
-thiazide diuretics
-catecholamines
-glucocorticoids
-thyroid hormone
-calcitonin
-somatropin
-isoniazid
-phenothiazines
-morphine

119
Q

What is the molecular target of glinides?

A

potassium channels

120
Q

What is the molecular target of metformin?

A

mitochondrial complex I

121
Q

How does metformin decrease blood glucose levels?

A

-inhibits gluconeogenesis
-increases translocation of GLUT4 to cell surface –> increased glucose uptake into cells

122
Q

What is the effect of alpha-glucosidase inhibitors?

A

decreased absorption of carbohydrates from the intestine

123
Q

What is the effect of SGLT2 inhibitors?

A

decreased reabsorption of glucose into blood –> increased excretion of glucose in urine

124
Q

What are resistin levels in patients with type 2 diabetes?

A

elevated

125
Q

What are the effects of resistin?

A

Stimulates glucose excretion by the liver and increases insulin resistance

126
Q

What are adiponectin levels in patients with type 2 diabetes?

A

lowered

127
Q

What are the effects of adiponectin?

A

Reduces blood glucose and insulin resistance

128
Q

What are TNFalpha levels in patients with type 2 diabetes?

A

elevated

129
Q

What are the effects of TNFalpha?

A

Stimulates lipolysis in white adipose tissue (WAT) and increases insulin resistance in skeletal muscle

130
Q

What is the effect of GLP-1 analogs?

A

decreased glucagon release

131
Q

What are the effects of amylin?

A

-suppresses appetite
-slows gastric emptying
-inhibits glucagon release

132
Q

What chemical change causes insulin resistance in obesity?

A

phosphorylation with serine instead of tyrosine

133
Q

What hormones cause insulin resistance in pregnancy?

A

-CRH
-cortisol
-progesterone
-placental GH
-placental lactogens

134
Q

diagnostic criteria for diabetes mellitus (need at least two)

A

-fasting blood glucose (FBG) ≥126 mg/dL OR
-A1c ≥6.5% OR
-random glucose ≥200 mg/dL with symptoms of diabetes OR
-2 hour postprandial glucose ≥200 mg/dL during oral glucose tolerance test (OGTT)

135
Q

What are the microvascular diseases resulting from diabetes?

A

-diabetic kidney disease
-ocular complications
-neuropathy

136
Q

normal urine albumin-creatinine ratio (UACR)

A

<30 mg/g

137
Q

microalbuminuria screening

A

-patients with type 1 diabetes for ≥5 years or patients with type 2 diabetes –> annually
-UACR >300 mg/g and/or eGFR <60 –> biannually
-non-pregnant patients with UACR ≥300 mg/g or eGFR <60 –> prescribe ACEi/ARB

138
Q

diabetic kidney disease treatment

A

-SGLT2 inhibitor (first-line; with type 2 diabetes with/without kidney disease)
-GLP-1RA (second-line)
-mineralocorticoid receptor antagonist (with CKD and albuminuria and at risk for cardiovascular events)

139
Q

eye exam frequency for diabetic patients

A

-initial eye exam within 5 years of diagnosis (type 1 diabetes)
-initial eye exam at diagnosis (type 2 diabetes)
-if no evidence of retinopathy for ≥1 annual exam and glycemia controlled –> assess Q1-2Y
-if retinopathy present –> assess annually (at least)

140
Q

peripheral neuropathy testing

A

-assess within 5 years of diagnosis (type 1 diabetes)
-assess at diagnosis (type 2 diabetes)
-annual monofilament testing

141
Q

neuropathy treatment

A

-pregabalin, duloxetine, or gabapentin (first-line)
-tricyclic antidepressants, venlafaxine, carbamazepine, tramadol, capsaicin, or tapentadol (second-line)

142
Q

What are the macrovascular diseases resulting from diabetes?

A

-cardiovascular disease
-stroke
-peripheral vascular disease
-periodontal disease

143
Q

treatment for patients with diabetes and atherosclerotic cardiovascular disease (ASCVD) and/or heart failure

A

-SGLT2 inhibitor OR
-GLP-1RA

144
Q

What is the blood pressure goal for pregnant patients with diabetes?

A

110-135/85 mm Hg

145
Q

statin dosing for diabetic patients

A

-none to moderate intensity statin based on risk factors (for patients ages 20-39 with no ASCVD)
-moderate intensity statin (for patients ages 40-75 with no ASCVD)
-high intensity statin (for patients ages 40-75 with ≥1 risk factor)
-high intensity statin and lifestyle modifications (for patients with ASCVD)

146
Q

secondary prevention of CVD in patients with diabetes and history of CVD

A

-aspirin (first-line; 75-162 mg/day)
-clopidogrel (if aspirin allergy)

147
Q

Who can be considered for use of aspirin with primary prevention of CVD?

A

patients ≥50 years old with one major risk factor who are not at increased risk of bleeding

148
Q

fasting blood glucose goal for diabetic patients

A

80-130 mg/dL

149
Q

A1c goal for diabetic patients

A

-7% (ADA guidelines; consider 6% for some patients and pregnant women)
-≤6.5% (AACE guidelines)

150
Q

A1c monitoring

A

-biannually (if at treatment goal)
-quarterly (if therapy changed or not at treatment goal)

151
Q

What insulin is preferred for intravenous administration?

A

regular insulin

152
Q

How long are insulin vials stable at room temperature for?

A

28 days (42 days for detemir)

153
Q

How long are prefilled insulin syringes stable with refrigeration for?

A

28 days

154
Q

How long are prefilled insulin syringes stable at room temperature for?

A

10-28 days

155
Q

How long is regular/NPH mixture stable for?

A

7 days with refrigeration

156
Q

How long is ultra short-acting/NPH mixture stable for?

A

need to give ASAP

157
Q

rule of 15s

A

-start with 15 gm of fast-acting carbohydrates unless blood glucose <50 mg/dL (use 30 gm instead)
-wait 15 minutes –> check blood glucose –> if blood glucose <80 mg/dL, then repeat with another 15 gm of fast-acting carbohydrates

158
Q

What are examples of 15 gm of fast-acting carbohydrates?

A

-4 oz orange juice
-6 oz Coke
-5-6 lifesavers
-2 tsp sugar
-1 tbsp honey
-4 glucose tablets

159
Q

What should you do after treating a hypoglycemic event?

A

-if meal ≤1 hour away, eat meal
-if meal >1 hour away, eat 30 gm carbohydrate snack

160
Q

At what blood glucose level should you use glucagon?

A

<54 mg/dL

161
Q

How do you change doses from QD NPH to a(n) (ultra) long-acting insulin?

A

1:1

162
Q

How do you change doses from BID NPH to a(n) (ultra) long-acting insulin?

A

decrease dose by 20%

163
Q

How do you change doses from U-100 insulin to a concentrated insulin?

A

1:1

164
Q

How do you change doses from BID NPH to glargine U-300?

A

decrease dose by 20%

165
Q

How do you change doses from QD glargine or detemir to QD concentrated glargine?

A

may need to increase dose of QD concentrated glargine

166
Q

How do you change doses from U-100 basal-bolus regimen to U-500 regimen?

A

-if A1c ≥8% –> 1:1
-if A1c ≤8% –> decrease dose by 20%

167
Q

What is the average daily dose of insulin for type 1 diabetes?

A

0.5-0.6 units/kg/day

168
Q

What is the “honeymoon phase” dose of insulin for type 1 diabetes?

A

0.1-0.4 units/kg/day

169
Q

What is the distribution for basal-bolus regimen for type 1 diabetes?

A

-50-70% basal insulin
-30-50% bolus insulin

170
Q

What is the distribution for BID regular/NPH mixture for type 1 diabetes?

A

-40% NPH and 15% regular (morning)
-30% NPH and 15% regular (night)

171
Q

What is the starting dose of insulin for type 2 diabetes?

A

-0.1-0.2 units/kg/day OR 10 units/day (ADA guidelines)
-0.1-0.2 units/kg/day (AACE guidelines; if A1c <8%)
-0.2-0.3 units/kg/day (AACE guidelines; if A1c >8%)

172
Q

How do you adjust basal insulin dose for type 2 diabetes?

A

increase dose by 2 units Q3 days to reach fasting blood glucose goal

173
Q

bolus insulin for type 2 diabetes

A

-consider for patients taking ≥0.5 units/kg/day of basal insulin
-start with 10% of basal dose OR 4-5 units of (ultra) short-acting insulin with largest meal
-adjust dose 10-15% Q3-4 days

174
Q

rule of 500

A

500/total daily dose of insulin = gm of carbohydrates

175
Q

rule of 1800 (only for ultra short-acting insulin)

A

1800/total daily dose of insulin = # of mg/dL blood glucose will drop for every 1 unit of insulin

176
Q

rule of 1500 (only for regular insulin)

A

1500/total daily dose of insulin = # of mg/dL blood glucose will drop for every 1 unit of insulin

177
Q

Somogyi effect

A

nocturnal hypoglycemia with rebound hyperglycemia

178
Q

metformin cautions for use/contraindications

A

-renal dysfunction (use eGFR for dosing)
-acute decompensated hospitalized, unstable, or severe renal/hepatic disease heart failure patients
-alcoholics
-post myocardial infarction
-hepatic failure
-surgery/radiologic procedure with contrast dye (hold 1-2 days before and ~2 days after depending on patient status)
-COPD
-shock

179
Q

metformin dosing

A

-start with 500 mg PO BID or 850 mg QD with meals
-titrate Q1-2W by 250-500 mg/day
-maximum dose: 2 gm/day

180
Q

How often should you monitor serum creatinine if a patient’s eGFR is ≥60?

A

annually

181
Q

How often should you monitor serum creatinine if a patient’s eGFR is 45 ≤ x < 60?

A

every 3-6 months

182
Q

Can you start metformin if a patient’s eGFR is 30 ≤ x < 45?

A

No

183
Q

How do you adjust the dose of metformin if a patient’s eGFR is 30 ≤ x < 45?

A

decrease dose by 50%

184
Q

How often should you monitor serum creatinine if a patient’s eGFR is 30 ≤ x < 45?

A

every 3 months

185
Q

Can you take metformin if a patient’s eGFR <30?

A

No

186
Q

SGLT2 inhibitor adverse effects

A

-urinary tract infections
-genital fungal infections
-increased urination
-hypotension
-increased cholesterol
-diabetic ketoacidosis
-bone fractures and decreased bone mineral density (canagliflozin)
-acute kidney injury (canagliflozin and dapagliflozin)
-increased risk of foot and leg amputations (canagliflozin)

187
Q

What patients cannot take SGLT2 inhibitors?

A

patients with end-stage renal disease (ESRD) on hemodialysis

188
Q

How should SGLT2 inhibitors be managed if a patient is undergoing surgery?

A

-hold 3 days before surgery (4 days for ertugliflozin)
-restart once oral intake is back to baseline and other factors have resolved

189
Q

GLP-1 agonist contraindications

A

-chronic pancreatitis
-personal/family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
-pre-existing gallbladder disease
-gastroparesis
-proliferative diabetic retinopathy

190
Q

Rybelsus dosing

A

3 mg PO QD for 30 days, then 7 mg PO QD

191
Q

maximum dose of Rybelsus

A

14 mg/day (7 mg/day if on Ozempic 0.5 mg SQ QW)

192
Q

DPP-4 inhibitor adverse effects

A

-nasopharyngitis
-upper respiratory tract infections
-headache
-acute pancreatitis
-joint pain
-heart failure (except for sitagliptin)

193
Q

When should you start dual therapy for diabetes?

A

A1c >9%

194
Q

What is the insulin dosing for pregnancy patients with gestational diabetes?

A

0.7-1.0 units/kg/day

195
Q

What is the second-line treatment for pregnancy patients with gestational diabetes?

A

metformin

196
Q

What diabetes medication should be avoided for pregnancy patients with gestational diabetes?

A

sulfonylureas

197
Q

A1c goal for elderly patients

A

<8.0%

198
Q

fasting blood glucose goal for elderly patients

A

90-150 mg/dL

199
Q

bedtime glucose goal for elderly patients

A

100-180 mg/dL

200
Q

How should basal insulin be adjusted before a patient’s surgery?

A

-decrease dinnertime basal insulin dose by ~25%
-give 75-80% of dose the morning of surgery

201
Q

How should metformin be adjusted before a patient’s surgery?

A

hold day of surgery

202
Q

How should oral glucose lowering medications be adjusted before a patient’s surgery?

A

hold the morning of surgery

203
Q

How should NPH insulin be adjusted before a patient’s surgery?

A

give 50% of dose the morning of surgery

204
Q

Who does diabetic ketoacidosis usually occur in?

A

type 1 diabetes patients

205
Q

What commonly causes diabetic ketoacidosis?

A

-poor adherence to treatment regimen
-infection (most commonly UTIs)

206
Q

diabetic ketoacidosis symptoms

A

-nausea/vomiting
-abdominal pain
-changes in mental status
-fruity breath
-Kussmaul respirations
-coma

207
Q

What is the diabetic ketoacidosis triad?

A

hyperglycemia
hyperketonemia
metabolic acidosis

208
Q

What are the goals of treatment for diabetic ketoacidosis?

A

-restore circulatory volume
-inhibit ketogenesis and return of normal glucose metabolism
-correct electrolyte imbalances

209
Q

How should you administer fluids to a patient with diabetic ketoacidosis?

A

-administer NS at 500-1000 mL/hr for first 1-4 hours
-evaluate corrected sodium at 2-4 hours
-if corrected sodium is normal/high –> change to 1/2 NS and decrease rate by 50%
-if corrected sodium is low –> continue NS and decrease rate by 50%
-when blood glucose approaches 200 mg/dL, change to D5W and 1/2 NS at 150-200 mL/hr until ketoacidosis resolved

210
Q

How should you administer insulin to a patient with diabetic ketoacidosis?

A

-start 0.1 units/kg/hour with/without bolus of 0.1 units/kg
-if glucose does not fall by ≥10% in the first hour, give, repeat, or increase bolus dose

211
Q

When can you switch a patient from IV to SQ insulin in diabetic ketoacidosis?

A

-blood glucose <200 mg/dL AND (at least two of the following criteria)
-anion gap closes ≤12 mEq/L
-bicarbonate level ≥15 mEq/L
-venous pH >7.3

212
Q

How do you dose a patient on SQ insulin for diabetic ketoacidosis?

A

-0.5-0.8 units/kg/day (50/50 basal/bolus; insulin naïve patients)
-total amount of IV insulin and convert to daily requirement using basal/bolus OR Q6H NPH insulin

213
Q

How long should IV and SQ insulin be overlapped in patients with diabetic ketoacidosis to prevent rebound ketoacidosis or hyperglycemia?

A

2-4 hours

214
Q

anion gap equation

A

anion gap = sodium - (chloride + bicarbonate)

215
Q

At what potassium level should insulin NOT be started for patients with diabetic ketoacidosis?

A

<3.3 mmol/L

216
Q

When should bicarbonate be repleted in patients with diabetic ketoacidosis?

A

pH <6.9

217
Q

What are the goals of treatment for HHS?

A

-restore circulatory volume
-restore urine output to ≥50 mL/hour
-return blood glucose to normal

218
Q

How should you administer fluids to a patient with HHS?

A

-administer 1/2 NS OR NS at 500-1000 mL/hr for first 1-4 hours
-evaluate corrected sodium at 2-4 hours
-if corrected sodium is normal/high –> reduce rate
-if corrected sodium is low –> consider NS
-when blood glucose is 300 mg/dL, change to D5W and 1/2 NS at 150-200 mL/hr until resolution of HHS

219
Q

What type of insulin is available in insulin cartridges?

A

rapid-acting insulin

220
Q

What does a higher gauge needle indicate?

A

thinner needle

221
Q

How many units should you prime an insulin pen with?

A

2 units

222
Q

How many units should you prime Humulin R U-500 KiwkPen with?

A

5 units

223
Q

How many units should you prime Toujeo Max SoloStar U-300 with?

A

4 units

224
Q

How many units should you prime Toujeo SoloStar U-300 with?

A

3 units

225
Q

What devices are available for patients with a fear of needles?

A

-TickleFLEX
-NovoFine Autocover pen needles
-Autoshield Duo pen needles

226
Q

What are adverse reactions of Afrezza?

A

-hypoglycemia
-cough
-throat pain or irritation

227
Q

What are contraindications for Afrezza?

A

asthma and/or COPD

228
Q

What GLP-1 agonists are dosed QD/BID?

A

-Byetta (BID; exenatide IR)
-Victoza (QD; liraglutide)

229
Q

Which non-insulin injectables are auto-injectors?

A

-Trulicity
-Bydureon BCise
-Mounjaro

230
Q

Which non-insulin injectable has pen needles included?

A

Ozempic

231
Q

Is reconstitution required for glucagon injections?

A

Yes

232
Q

Is inhalation required for Baqsimi?

A

No

233
Q

What medications may result in more adverse events than benefits in older adults?

A

-sedative/hypnotics
-neuroleptics/antipsychotics
-antidepressants
-opioids (especially long-acting)
-loop diuretics
-alpha blockers

234
Q

What is the most common type of urinary incontinence in both men and women?

A

urge

235
Q

Is stress urinary incontinence more common in men or women?

A

women

236
Q

What causes urge urinary incontinence?

A

hyperactivity of detrusor muscle

237
Q

What causes stress urinary incontinence?

A

outlet incompetence with abdominal pressure

238
Q

What causes overflow urinary incontinence?

A

outlet obstruction, inability to urinate, or uncoordinated detrusor constriction

239
Q

Is aging a barrier to medication nonadherence?

A

No

240
Q

What are physiologic changes in elderly patients?

A

-decreased total body water
-decreased lean body mass
-increased body fat
-decreased baroreceptor response/activity
-reduced heart rate variability
-decreased hepatic blood flow
-decreased renal blood flow
-decreased neurotransmitter volume

241
Q

How does aging affect the volume of distribution of water-soluble drugs?

A

decreases

242
Q

How does aging affect the concentration of water-soluble drugs?

A

increases

243
Q

How does aging affect the volume of distribution of lipid-soluble drugs?

A

increases

244
Q

How does aging affect the half-life of lipid-soluble drugs?

A

increases

245
Q

How does aging affect the clearance of hepatically cleared drugs?

A

decreases

246
Q

How does aging affect the half-life of hepatically cleared drugs?

A

increases

247
Q

How does aging affect the clearance of renally cleared drugs?

A

decreases

248
Q

How does aging affect the half-life of renally cleared drugs?

A

increases

249
Q

Who is involved in the decision-making process of the BEERS criteria?

A

Interprofessional panel of 12 experts in geriatric care and pharmacotherapy

250
Q

How does the committee describe the quality of evidence for the BEERS criteria?

A

GRADE-based approach

251
Q

What are the three phases of platelet activation?

A

platelet adhesion
platelet secretion
platelet aggregation

252
Q

What chemical inhibits thrombogenesis?

A

PGI2 (prostacyclin)

253
Q

What chemicals are released from platelet granules to bind to ADP receptors?

A

ADP
TXA2
5-HT (serotonin)

254
Q

What chemical are platelets cross-linked by?

A

fibrinogen

255
Q

What is the molecular target of clopidogrel, prasugrel, and ticagrelor?

A

P2Y12 receptor

256
Q

What drugs bind irreversibly to the P2Y12 receptor?

A

clopidogrel and prasugrel

257
Q

What drug binds reversibly to the P2Y12 receptor?

A

ticagrelor

257
Q

What is the molecular target of abciximab and eptifibatide?

A

GP IIb/IIIa receptor

258
Q

What is the molecular target of dipyridamole and cilostazol?

A

cAMP phosphodiesterase

259
Q

What converts prothrombin to thrombin?

A

factor Xa (prothrombin activator)

260
Q

What does prothrombin time measure?

A

How long it takes for clot to form in blood sample

261
Q

What does bleeding time evaluate?

A

Platelet function

262
Q

What does activated thromboplastin time measure?

A

How long it takes for blood to form clot

263
Q

What is the normal INR value for patients not taking anticoagulants?

A

1.0

264
Q

What is the INR therapeutic range for patients taking anticoagulants?

A

2.5-3.5

265
Q

What is the difference between the mechanism of actions of heparin and low molecular weight heparins?

A

Low molecular weight heparins can only bind factor Xa, whereas heparin can bind thrombin and factor Xa

266
Q

What is the molecular target of warfarin?

A

vitamin K epoxide reductase (VKORC1)

267
Q

What is plasminogen?

A

Anticoagulant protein that circulates in inactive form

268
Q

What is plasmin?

A

Proteolytic enzyme that digests fibrin and fibrinogen

269
Q

Which drug lacks the fibrin binding domain?

A

reteplase

270
Q

Is alteplase or tenecteplase more selective?

A

tenecteplase

271
Q

What is the molecular target of tranexamic acid and lysine?

A

lysine binding sites on plasminogen molecules

272
Q

What is the molecular target of aminocaproic acid?

A

Kringle domain of plasminogen

273
Q

Does all deep vein thrombosis lead to pulmonary embolisms?

A

No

274
Q

Do all pulmonary embolisms lead to deep vein thrombosis?

A

Yes

275
Q

indirect thrombin inhibitor drugs

A

-heparin
-low molecular weight heparin (enoxaparin)

276
Q

heparin dosing

A

80 units/kg (IV bolus) followed by 18 units/kg/hr (infusion)

277
Q

heparin monitoring

A

activated partial thromboplastin time (aPTT)

278
Q

characteristics of heparin associated thrombocytopenia (HAT)

A

-HIT type I
-non-immune mediated
-mild decrease in platelets
-occurs around 48-72 hours after administration of heparin
-transient
-do not need to discontinue heparin

279
Q

characteristics of heparin induced thrombocytopenia (HIT)

A

-immune mediated
-thrombotic complications
-occurs between 7-14 days after administration of heparin
-platelets drop >50% from baseline or <100,000/mm
-need to discontinue heparin

280
Q

Is monitoring required for low molecular weight heparins?

A

No

281
Q

What is the enoxaparin dosing for prophylaxis?

A

-30 mg SQ Q12H (surgery)
-40 mg SQ QD (medical)

282
Q

What is the enoxaparin dosing for treatment?

A

-1 mg/kg SQ Q12H
-1.5 mg/kg SQ QD

283
Q

indirect factor Xa inhibitor drug

A

fondaparinux

284
Q

direct factor Xa inhibitor drugs

A

-lepirudin
-bivalirudin
-argatroban

285
Q
A

PHRM844 (4 decks)

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