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3152 > IC11-13 > Flashcards

IC11-13 Flashcards

1
Q

Macrovascular vs microvascular examples

A

Microvascular:
Retinopathy, nephropathy & neuropathy

Macrovascular: CVS

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2
Q

Does a drop in HbA1c correlate with drop in CV outcomes?

A

No; CV outcomes improve as A1c decreases but eventually worsens as A1c continues to drop

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3
Q

A 1% decrease in absolute HbA1c correlates to around ____ reduction in the risk for microvascular complications.

A

35%

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4
Q

Treatment goals for:
- HbA1c, FBG, PPG

A

HbA1c: ≤ 7%
More stringent: 6.0 - 6.5%
Less stringent: 7.5 – 8.0% +
(7.0% to 8.5%) if vulnerable patients

FBG: 4-7 mmol/L (in practice, 5-7)

PPG: < 10 mmol/L

To change from mmol/L to mg/dL: multiply by 18

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5
Q

Max dose for metformin

A

3g/ day

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6
Q

Adverse effects of metformin

A

▪ Common: GI, anorexia, metallic taste (usually transient; take with food to alleviate)
▪ Long-term use may ↓serum B12 concentrations
▪ Rare but fatal: lactic acidosis

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7
Q

Risk factors for hypoxemia

A

Heart failure, sepsis, liver impairment, alcoholism, ≥ 80 yo

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8
Q

How long should metformin be held after Iodinated contrast material/radiologic procedure?

A

Hold for ≥48 hrs after contrast administration; restart
when renal function returns to normal post-procedure

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9
Q

Charge for metformin

A

Positively charged

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10
Q

Use of metformin in eGFR 30-44

A

Half dose

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10
Q

At what range of eGFR is metformin contraindicated?

A

< 30

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11
Q

Benefits of metformin apart from blood glucose lowering

A

Positive effects on lipid, possible reduction in CV events (T2DM)

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12
Q

Can sulfonylurea be used in patients with no functional ß- cells?

A

No

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13
Q

When should sulfonylurea be taken?

A

15-30 mins before meal

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14
Q

Which sulfonylurea are hepatically eliminated only?

A

Tolbutamide & glipizide

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15
Q

Can sulfonylurea be taken without food?

A

No; insulin is secreted by SU hence if there is no food, this leads to hypoglycemia

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16
Q

Adverse effects of sulfonylurea

A

➢ Hypoglycemia (especially in elderly)
➢ Weight gain (~2-5 kg)
➢ Blood dyscrasias (rare)

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17
Q

MOA for thiazolidinediones

A

Peroxisome proliferator activated receptors agonist to promote glucose uptake into target cells (skeletal muscle/adipose)
▪ ↓insulin resistance; ↑ increase insulin sensitivity

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18
Q

Onset and Route of elimination for thiazolidinediones

A

Takes up to 1 month to work; eliminated by liver

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19
Q

Adverse effects of thiazolidinediones

A

➢ Hepatotoxicity
➢ Edema (caution in NYHA Class I or II HF)
➢ Fracture (increased risk; more likely in women)
➢ Weight gain
➢ Bladder cancer (Pioglitazone)
➢ Elevated LDL (Rosiglitazone)

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20
Q

Contraindication of thiazolidinediones

A

Active liver disease; NYHA Class III or IV HF

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21
Q

Benefits of thiazolidinediones apart from blood glucose lowering

A

Appears to be beneficial in patients with Fatty Liver Disease

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22
Q

Only drug approved for α-Glucosidase Inhibitors

A

Acarbose

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23
Q

Onset of metformin

A

Onset: within days; max effects take up to 2 weeks

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24
Q

Onset and Route of elimination for α-Glucosidase Inhibitors

A

Onset is rapid with each meal; Elimination: 50% via feces

25
Q

MOA for α-glucosidase inhibitor

A

➢ Delay glucose absorption and ↓PPG by competitively inhibit brush border α-
glucosidases enzyme required for breakdown of complex carbohydrates
➢ Acts locally

26
Q

Adverse effects for α-glucosidase inhibitor

A

➢ GI: flatulence, abdominal pain, diarrhea (most common cause of drug discontinuation)
➢ ↑ LFT (specific for acarbose; ↑risk at dose >100 mg TDS)

27
Q

Contraindications for α-glucosidase inhibitor

A

➢ Breast-feeding
➢ GI diseases (obstruction, irritable bowel disease)

28
Q

_______ is the #1 reason for α-glucosidase inhibitor discontinuation

A

Flatulence

29
Q

When could α-glucosidase inhibitor ideally be taken?

A

May consider taking with the largest meal of the day or with the meal that
consists the most carbs; as it is mainly used to control postprandial blood glucose

30
Q

What does GLP-1 stand for?

A

Glucagon-like peptide 1

31
Q

What does DPP-4 stand for?

A

Dipeptidyl-peptidase 4

32
Q

Dosing for liraglutide & Max dose

A

Initiate at 0.6mg then titrate to 1.2mg after 1 week. Can increase to 1.8mg

33
Q

Long acting agents of GLP-1 are a/w lesser ____ but more ____

A

N/V; diarrhoea

34
Q

Which drug is recommended over insulin as first-line injectable? (for greater glucose lowering)

A

GLP-1 receptor agonist

35
Q

2 Examples of DPP-4 i

A

Sitagliptin/ Linagliptin

36
Q

Which DPP-4i does not need dose adj?

A

Linagliptin

37
Q

Dose adj for sitagliptin

A

CrCl (30-49): 50mg OD
CrCl < 30: 35mg OD

Original dose: 100mg OD

38
Q

Signs and symptoms of pancreatitis

A

N/V, abdominal pain, fever

39
Q

Advantages of DPP-4 i over GLP-1 agonists

A

Lower incidences of GI adverse events

40
Q

Disadvantages of DPP-4 i over GLP-1 agonists

A

weight neutral, smaller HbA1c reduction, no “big 3” benefits (ASCVD, HF, CKD)

41
Q

3 examples of SGLT2i

A

Canagliflozin, Dapagliflozin, Empagliflozin

42
Q

Mode of elimination for endogenous vs exogenous insulin

A

Endogenous: Liver;
Exogenous: Kidney

43
Q

More muscular region results in ____ insulin absorption

A

Faster

44
Q

Higher gauge, ____ needle -> ___ pain but ____ needle weakness & ____ speed of injection

A

finer; decr; incr; decr

45
Q

– Unopened insulin vials: good until _____ only if stored in
refrigerator
* if not refrigerated, good for _____
– Opened insulin vials: good for ____ regardless of refrigeration
– Other insulin containing devices (e.g. pen, refill cartridges): vary, see package insert.

A

expiration date; 28 days; 28 days

46
Q

Which length of needles do not need pinch?

A

4 or 5 mm (only for pens) EXCEPT patient with lesser SC fat using arms or thighs for injection

47
Q

Which ppl inject at 45 degrees?

A

frail elderly or cachexic adults or children

48
Q

Which insulins are usually not mixed?

A

Long-acting -> detemir & glargine

49
Q

Significance of anion gap

A

Represents acidosis

50
Q

beta- hydroxybutyrate, acetoacetic acid, and acetone are examples of ____

A

ketones

51
Q

Dawn phenomenon

A

release of cortisol in the waking hours causes BG levels to rise sharply

52
Q

Somogyi effect

A

BG levels drop sharping at night (miss bedtime snack/ too much insulin, etc), body responds by releasing glucagon, BG level incr

53
Q

How to differentiate btw dawn phenomenon and somogyi effect?

A

Wake up at 2-3am to test BG

54
Q

How does insulin cause lipoatrophy?

A

due to immune response due to pork and beef insulin

55
Q

How does insulin cause lipohypertrophy?

A

due to not rotating injection sites

56
Q

Adverse effects of insulin

A
  1. Weight gain
  2. Lipodystrophy
  3. Local allergic rxn (redness, swelling & itch at injection site -> more for beef and pork insulin)
57
Q

When is insulin considered?

A

➢Ongoing catabolism (weight loss)
➢Symptoms of hyperglycemia
➢A1c > 10%
➢BG > 16.7 mmol/L

58
Q

In which age group should you NOT start aspirin?

A

> 70 y/o

59
Q

ASCVD risk factors

A
  1. LDL ≥ 2.6 mmol/L,
  2. high blood pressure,
  3. smoking,
  4. chronic kidney disease,
  5. albuminuria,
  6. family history of premature ASCVD.

3152 (18 decks)

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