Martin pharm DM part II Flashcards Preview

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Flashcards in Martin pharm DM part II Deck (50):
1

what are adverse effects to insulin therapy

hypoglycemia
insuline allergy and resistance
lipoatrophy and lipohypertrophy

2

biggest risk factor hypoglycemia

the more rigorous attempt to achieve euglycemia

3

causes of hypoglycemia with Tx

inappropriate dose
mismatch of time of injection vs food intake
exercise induced increase glucose utilization

4

what is the dominant counter regulatory hormone for hypoglycemia in DM I patients and why

epinephrine because glucagon secretion becomres deficient

5

most frequent allergic reaction to insulin

IgE mediated local cutaneous reactions
occasionally anaphylactic reaction or insulin R due to circulating IgG Ab

6

what causes the lipohypertrophy/atrophy from insulin

site of constant injection

7

what are conditions that require IV insulin

ketoacidosis
perioperative control and childbirth

8

msot common drug induced ypoglycemic states are those caused by

ethanol, beta-adrenergic antagonists and salicylates

9

why can beta antagonists cause hypoglycemia

inhibit the effects of catecholamines on gluconeogensis and glycogenolysis
also mask the sympathetically mediated Sx assoc with fall in blood glucose (tremors and palpiataions)

10

what drugs either have direct hyperglycemic effect ot indirect

epi, glucocorticoids, oral contraceptions (direct)
phenytoin, clonidine, Ca Ch blockers (inhibit insulin secretion
some diuretics deplete K and indirectly inhibit insulin secretion

11

Initial monotherapy for DM II

metformin

12

effects of metformin

reduce haptic glucose output by inhibiting gluconeogenesis
increase insulin action in peripheral tissues
increase glucose uptake dna utilization by muscle
reduce intestinal absorption of glucose

13

why is metformin preferred over sulfonylureas

does not cause weight gain or provoke hypoglycemia
has lipid lowering effect

14

side effects metformin

abdominal discomfort, anorexia, nausea, metallic taste, diarrhea

15

CI to metformin

lactic acidosis, hepatic disease, renal impairment, cardiac failure, chronic hypoxic lung disease

16

what clears metformin

kidneys

17

what type of sulfonylureas are used now

the second generations
glipizide
glyburide
glimepiride

18

glyburide should be used cautiously in what patients

elderly with renal failure and otheres predisposed to hypoglycemia

19

how do sulfonylureas work

lower blood glucose by stimulating insulin release from pancreatic beta cells
bind to and bloc ATP sensitive K channel
extrapancreatic effects like increased # receprtors for insulin and LGUT transporters

20

what metabolizes sulfonylureas

liver

21

patients most likley to respond to sulfonlyureas

older than 30 recently Dx
not overtly obese
some beta cell function
<300 fasting level glucose

22

drug of choice if CI for sulfonlyureas

insulin

23

adverse reactions sulfonlyureas

hypoglycemic reactions like a coma
nausea, vomiting, cholestatic jaundice, hypoNa, agranulocytosis, aplastic anemia, HS reactions

24

drug drug interactions with sulfonylureas

many transiently increase hypoglycemic effects

25

CI to sulfonlyureas

type I DM, sulfa allergies, pregnant or nursing mothers and significant hepatic or renal insufficiency

26

what are the non sulfonylure secretagogues

repaglinide and natedlinide

27

what type of patient adheres better to repaglinide and nateflinide

those whoe are erratic eaters because rapid action if taken right before a meal

28

can repaglinide and nateflinide be combined with metformin

yes

29

how do acarbose and miglitol work

alpha glucosidase inhibitors
competitive inhibition of sugar digestion delaying absorption of carbs and limits postprandial rise in glucose

30

drugs most useful in newly diagnosed DM II patients with mild hyperglycemia

alpha glucosidase inhibitors

31

if combined with what drugs will the alpha glucosidase inhibitors cause hypoglycemia

insulin or sulfonlyureas

32

side effects alpha glucosidase inhibitors

flatulence, diarrhea and GI upset from undigested carbohydrate

33

CI for alpha glucosidase inhibitors

diabetic ketoacidosis, cirrhosis, IBD, colonic ulcers, partial intestinal obstruction

34

what are TZDs used for (thiazolidinediones)

poorly controlled DM II

35

what must you do if Tx patient with TZD

liver function tests every 3 mo

36

how do TZDs work

bind nuclear transcription factors PPAR-gamma site that resensitize target tissue to insulin

37

effects of pioglitazone TZD

reduce insulin R
improve peripheral action insulin
reduce hyperglycemia by inc glucose uptake
reduce hepatic glucose production
take several weeks to produce a clinical effect

38

pioglitazone is approved for regimen with what

monotherapy
insulin
sulfonylureas or metformin

39

side effects pioglitazone

moderate weight gain, edema, mild anemia
(fluid retention)

40

risk with rosiglitazone

MI

41

What is pramlintide

maylin analog

42

how is pramlinitide administered

SQ injection before meals

43

advserse effects pramlinitide

increased risk hypoglycemia, nausea
decreased appetite, comiting, stomach pain, tiredness, dizziness or indigestion

44

what secretes glucagon like peptide

intestinal L cells

45

what is the GLP analog

exenatide

46

effects of GLP-1 agonists

glucose dependent enhancement of endogenous insulin secretion
inhbition of endogenous glucagon secretion
appetite suppression
reduction in speed of gastric emptying
stimualte islet growth

47

most common adverse effects GLP-1 agonists

nausea, vomiting, diarrhea and upper resp Sx

48

biggest drawback to GLP-1 agonists

need 2x SQ injection

49

adverse effects of the Na glucose co transporter 2 inhibitors

genital mycotic infections and UTIs
diuretic effects sometimes
bladder cancer

50

which drug class in DM causes increased risk for acute pancreatitis and severe HS reactions

DPP-4 inhibitors