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Flashcards in Pharm - Diabetes Deck (32)
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1
Q

3 Techinques for measuring glycemic control

A
  1. Patient self-monitoring of blood glucose (SMBG) = finger stick
  2. Continuous glucose monitoring systems (CGMS) = machine thingy
  3. Hemoglobin A1c
2
Q

Hb A1c requirement for diagnosis of Diabetes

A

Hb A1c over 6.5%

3
Q

Fasting glucose requirement for diagnosis of Diabetes

A

Plasma glucose over 126 mg/dL

4
Q

Pancreatic Islet changes in Type 2 Diabetes

A

a-cells secrete inappropriately high levels of glucagon

B-cells secrete insufficient levels of insulin (exhaustion) –> decreased B-cell mass

Amyloid plaque deposits

5
Q

[Oral/IV] glucose stimulates a higher insulin response

A

Oral

b/c of Incretin

6
Q

Incretin Hormones

A

Synthesized in L cells (in ileum and colon)

Stimulates insulin secretion

example: Glucagon-like peptide 1 (GLP-1)

7
Q

What metabolizes GLP-1?

A

DPP-4 (dypeptidyl peptidase-4)

Rapid metabolization (T1/2 = 2-3min)

8
Q

First drug used in T2D?

A

Metformin = biguanide, decreases hepatic gluconeogensis overnight

9
Q

Important advantages and disadvantages of Metformin?

A
  • -Weight neutral = no weight gain
  • -No hypoglycemia
  • -GI side effects (start w/ low dose, titrate up)
  • -Contraindication = low kidney function
10
Q

[Sylfonylureas/Meglitinides] have fast/short acting insulin increasing effect

A

Meglitinides – take w/ meals

11
Q

Mechanism of Sulfonylureas and Meglitinides

A

Increase insulin secretion by closing Potassium ATP channels in B-cell plasma membrane

12
Q

Thiazolidinediones (TZDs) mechanism and side effects

A

Activate PPAR-y nuclear transcription factor –> Increase peripheral insulin sensitivity

Side effects: weight gain, edema, heart failure, bone fractures

13
Q

T2D drug class that decreases/slows intestinal carbohydrate digestion

A

a-Glucosidase inhibitors = Acarbos, Miglitol

14
Q

Incretin Mimetic drug class effects:

A
  • -Increase insulin secretion
  • -Decrease glucagon secretion
  • -Slow gastric emptying
  • -Increase satiety
15
Q

Mechanism of class of drug that includes: Sitagliptin, Alogliptin, Saxagliptin, Linagliptin

A

DPP-4 Inhibitors = decrease metabolism of Incretins (GLP-1)

16
Q

SGLT2 Inhibitor drug class mechanism and effect

A
  • -Inhibit glucose resorption (through sodium glucose cotransporter 2) in kidney
  • -Increase a-cell glucagon secretion

–Increase urine glucose excretion

17
Q

What class of T2D drug can cause DKA?

A

SGLT2 Inhibitors – increased Glucagon:Insulin ratio

18
Q

Mechanism of Bile acid sequestrant drug class in T2D

A

Decrease hepatic glucose production

19
Q

Hypoglycemia is most common with what 2 drug classes?

A
  1. Sulfonylurea

2. Insulin

20
Q

Treatment of hypoglycemia

A
  1. Give 15g of glucose (or equivalent in carbohydrate snack)

2. Wait 15 minutes, check again

21
Q

How does stress affect blood glucose?

A

Increases blood glucose

22
Q

Pramlintide mechanism of action

A

Amylin analog = slow gastric emptying, suppress postprandial glucagon secretion, reduce appetite

Injection before each meal

23
Q

3 Rapidly acting Insulin analogs:

A
  1. Lispro
  2. Aspart
  3. Glulisine
24
Q

Long-acting Insulin analog

A

Glargine insulin – pH = 4 –> burning at injection

25
Q

Ultra long-acting Insulin analog

A

Degludec

26
Q

Premixed Insulins are rarely used in [Type1/Type2] Diabetes

A

Type 1

27
Q

What Insulins don’t have peak action time?

A
  1. Glargine = long acting

2. Degludec = ultra long-acting

28
Q

What is lipohypertrophy and how do you treat it?

A

Fat tissue accumulation at place of insulin injection

Treat: rotate injection site

29
Q

What kind of insulin do Continuous Subcutaneous Insulin Infusion (CSII) Systems use?

A

Rapid-acting insulin

30
Q

What is ideal post-prandial glucose?

A

Post-prandial = 3hr period following food intake

Ideal peak value below 180mg/dL

31
Q

What kind of insulin is normally used IV (ex. inpatient setting)

A

Regular insulin

32
Q

Lactic acidosis is a rare side effect of this T2D drug

A

Metformin