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Seizures, Eye, Diabetes Flashcards

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1
Q

which two agents have most benefits in CV outcomes for diabetes

A

empagliflozin and liraglutide

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2
Q

name DPP4 inhibitors- which do you use with caution in HF

A

saxagliptan (caution HF), sitagliptan, alogliptan

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3
Q

which diabetic agents cause hypoglycemia most

A

SUs, meglitinide (insulin secretagogue) insulin

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4
Q

name short acting insulins

A

aspart, glulisine, lispro

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5
Q

what renal fx is metformin CI? cautioned?

A

caution 60, CI less than 30

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6
Q

who are thiazoledinediones CI in?

A

heart failure

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7
Q

what is type 1 diabetes

A

deficiency of insulin due to autoimmune beta cell destruction

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8
Q

what is type 2 diabetes

A

insulin resistance with some degree of deficiency

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9
Q

what to start with diagnosis of type 2 diabetes

A

-A1C less than 8.5- lifestyle, metformin if not controlled in 2-3 months. If greater, start metformin right away and often need combination therapy

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10
Q

how many SMBG should be done per day for those on basal-bolus insulin (insulin more than once per day)

A

minimum 3x- mix of both pre and post prandial

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11
Q

SMBG in patients on oral therapy- with or without insulin

A

individualize based on risk of hypo, dosage changes or evaluation of new agents, concurrent illness. Infrequent is okay if achieving targets and not on agents that induce hypo. When not meeting targets, do some pre and post, individualized. If on oral and once daily insulin- test at least once daily at different times

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12
Q

how much activity is recommended in diabetes

A

greater than or equal to 150 minutes per week- exercise increases insulin sensitivity so adjust insulin accordingly (moderate exercise will likely decrease, but a stress response with intense exercise may increase blood glucose)

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13
Q

monitoring for people with diabetes

A

BP at all appropriate visits, foot exams yearly, A1C q3m, SCr and urine ACR yearly, eye exam q1-2 years,

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14
Q

which insulin regimen is inappropriate in type 1 diabetes

A

conventional

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15
Q

when around a meal do you give regular and rapid acting insulins

A

regular- 20-30 minutes before meal. rapid- shortly before or within 20 minutes of starting a meal

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16
Q

symptoms of mild-mod hypoglycemia- how to treat

A

sweating, tremors, tachycardia, hunger, N, weakness. Give 15g glucose- will raise BG about 2mmol within 20 minutes. Retest in 15, and if still below 4mmol/L, give another 15

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17
Q

symptoms of severe hypoglycemia- how to treat

A

neuroglycopenic sx like confusion, difficulty speaking, uncounsious, etc. Give 20g carbs/glucose, retest in 15 minutes, if still below 4 mmol/L give another 20

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18
Q

what is localized fat hypertrophy

A

result of frequent use of same injection site resulting in low or unpredictable absorption of insulin from that site

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19
Q

when should you aim to reach target a1c in newly diagnosed diabetes patients

A

3-6 months

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20
Q

MOA of SU and meglitinides

A

insulin secretagogues- squeeze pancreas to release more insulin

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21
Q

MOA of metformin and thiazolidinediones

A

decrease hepatic glucose production (shut off leaky liver) and increase tissue sensitivity to insulin

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22
Q

MOA of DPP4 inhibitors and GLP1 agonists

A

mimic or enhance incretin hormones. DPP4 augments the action on GLP1 by preventing its breakdown, while glp1 agonists increase insulin, suppress glucagon, and increase satiety by slowing gastric emptying

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23
Q

MOA acarbose

A

delay or prevents digestion of complex carbs

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24
Q

which antidiabetics are associated with weight gain?

A

SUs/insulin secretagogues, insulin, TZDs

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25
which antidiabetics are associated with weight loss?
glp1 agonists, and modest with SGLT2 inhbitors. -almost all are weight neutral. Weight gain ones are SU/insulin secretagogues, insulin, TZDs
26
strongest evidence for antidiabetic agent with reducing mortality and macrovascular endpoints
metformin
27
SU with most risk of hypoglycemia
glyburide -also associated with most weight gain
28
which diabetic medications should be skipped if you skip a meal
meglitinides- repaglinide, etc- take them just prior to meal
29
TZD MOA in diabetes
PPAR gamma agonists- influence gene expression in cell leading ot enhaned insulin sensitivity and lower levels of blood glucose and circulating insulin
30
which antidiabetic meds are CI in bladder cancer (current or past)
pioglitazone, dapigliflozin
31
which groups of antidiabetic meds are associated with rare risk of pancreatitis
GLP1agonists and DPP4 inhibitors
32
diabetes meds CI in those with hx or fam hx of medullary thyroid cancer or multiple endocrine neoplasia syndrome
GLP1agonists
33
which antidiabetic agents have potential for hypotension
sglt2 inhibitors
34
which antidiabetic meds have rare SE of diabetic ketoacidosis-what are sx?
sglt2 inhibitors -N/V, abdominal pain, fruity acetone breath, decreased LOC, seizure, stroke
35
appropriate empiric dose of basal insulin HS for type 2 needing to start insulin
5-10 units HS. Or 0.1-0.2Ukg
36
target A1C is ___; this is based on benefit seen in
less than or equal to 7. reduced microvascular and neuropathic complications. less than or equal to 6.5 may be suggested if benefits thought to outweigh risks of hypogly (prevent nephro and retinopathy). A1C target up to 8.5% may be suggested in frail elderly, limited life expectancy or recurrent hypogly
37
target for FPG or preprandial
4-7 mmol/L
38
target for 2 hour PPG
5-10, or 5-8 if a1c goal not met
39
when might fibrates be useful in cholesterol treatment
TG remain a problem
40
BP target in diabetes
less than 130/80
41
folic acid during pregnancy in diabetic patients:
5mg daily at least 3 months prior to conception, continued until 3 months gestation, then reduced to 0.4-1mg daily and continue through preg and a min of 6 months post partum or until breastfeeding is complete
42
diabetes in pregnancy- drugs
d/c teratogens like ace, arb, statin, and start insulin. Of can't take insulin, start glyburide or metformin
43
What is diabetic ketoacidosis
from severe insulin def
44
SE with metformin
metallic taste, N (take with food), diarrhea
45
SE with DPP4 inh
nasopharyngitis
46
SE GLP 1 inh
N, V, D
47
SE insulin secretagogues
weight gain, hypoglycemia more common,
48
SE SGLT2 inh
GU infections, hypotension, hyperkalemia (caution with loop diuretics and volume depletion),
49
when should ketone testing be performed
BG 14 or more, presence of sx of ketoacidosis or when acutely ill and have high BG
50
major risk factor for AMD
smoking- advise patients to quit and maintain balanced diet
51
treatment for wet AMD
VEG-F inhibitors- effective for decreasing vision loss. Injected directly into eye.
52
beta carotene in AREDs formulas
no longer recommended due to increased risk of lung cancer therefore no forms contain it anymore
53
how long should you wait between different eye drop medications
five minutes
54
side effects of all eye drops
local irritation, blurred vision temp
55
prostaglandin eyedrops examples, what they do and common SE
"prosts" lower pressure of eye- brown pigmentation of iris, elongation of eyelashes
56
only modifiable risk factor for glaucoma
elevated intraocular pressure
57
drug that can commonly worsen glaucoma
corticosteroids
58
drugs used to treat open angle glaucoma initially, and then after
beta blocker or prostaglandin analogue first,then add or substitute carbonic anhydrase inhibitor, adrenergic agonist, or whatever hasn't been used in first line
59
how do beta blockers work in glaucoma
decrease formation of aqueous humour and therfore pressure. CI in certain pulmonary and cardiac diseases
60
examples of carbonic anhydrase inibitors and how they work in glaucoma- what line are they and why
dorzolamide, brinzolamide, decrease aqueous humor. Not first line because not as effective to lower IOP, but can be used as adjunct or in patients CI to BB. Bitter or unusual taste on instillation normal
61
how do prostaglandins work in glaucoma
lower IOP by increasing outflow
62
cholinergic agonists in glaucoma
pilocarpine- directly stimulate muscarinic receptors to contract muscle and increase outflow. SE= miosis (reduced night vision), spasm, brow ache
63
combination products in glaucoma
all more effective than either agent on their own, all contain timolol
64
what products OTC are cautioned in angle closure glaucoma
antihistamines/decongestants- rarely a problem in open angle glaucoma (most common), but can provoke angle closure glaucoma in those predisposed
65
what is there cross reactivity with for carbonic anhydrase inhibitors
sulfonamides
66
what happens when vasoconstricting or decongestant eye drops are used too often
rebound hyperemia
67
first line choice for absense seizures
ethosuximide- not first line or even second for anything else
68
first line anti seizure for generalized tonic clonic and focal/partial
both: carbamaz, lamotrigine, pheny. Tonic also had valproic/divalproex. Partial also has levitiracetam
69
avoid these seizure meds in absense
gaba for sure, carba (may worsen absense seizures) and pheny use with caution
70
avoid these seizure meds in myoclonic
carb (caution), pheny
71
avoid these seizure meds in pregnancy, and give what
valproic acid/divalproex, in child bearing age females give folic acid at least 1mg daily some say 5mg
72
general principles in AED therapy
single AED started at fraction of target dose to minimize AE (expect phenytoin and phenobarb), add second if max tolerated dose isn't satisfactory and gradually withdraw first agent after maintenance dose of 2nd drug has been achieved. Polytherapy reserved for when 2-3 drugs have failed
73
what suggests impending status epilepticus, and what is SE
SE= over 30 minutes and associated with high morbidity and mortality ie brain injury, if over 5 treat as impending
74
name enzyme inducing AEDs that are a problem with COC and may lower efficacy. What else may they be a problem with?
carbamazepine, phenobarb, phenytoin, topiramate, primidone. Use barrier method as well in these patients or other methods (IUD, depot etc) but still use barrier. Also problem with other DI- reduce levels of other drugs
75
AEDS in pregnancy- general principles of choosing therapy
use montherapy if possible, don't change AEDs as risk of malformation is highest during first tri anyway when may not know preg yet and switching puts at risk of seiures, AED levels may drop due to increased clearance so watch, vitamin K given to all newborns at delivery to prevent hemorrhagic diseases. Breastfeeding? ensure watch levels as they may now increase! all appear okay, but barbituates may sedate baby
76
name the epilepsy barbituates
primidone and phenobarb
77
common SE with valproic /divalproex
N, weight gain, tremor, hair loss, blood dyscrasias, hepatotox; cognitive effects less than older AEDs
78
common carbamaz SE
rash (rarely very serious-steen johnson- skin peels off), transient neutropenia, N, dizzy/drowsy (not as much as others)
79
lamotrigine AE and DI
rash (can be serious), insomnia. Must have very slow titration. Valproic acid inhibits metabolism, increased met with enzyme inducing AEDs, hormonal contraceptives reduce serum levels of it up to 50%
80
levetiracetam SE
sleepy, decreased energy, HA, irritable, depression

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