Test #5

Question 1

For diagnosis in diabetes, what must the fasting plasma glucose be? random plasma glucose? oral glucose tolerance test?

Answer 1

greater than 126; greater than 200 with symptoms of diabetes; greater than 200 after 2h of glucose intake

Question 2

How often should you monitor the A1 C

Answer 2

Every 3 to 6 months depending on previous value

Question 3

In addition to high blood sugar what secondary disease should be corrected when treating diabetes

Answer 3

Hyperlipidemia

Question 4

When are medications started in diabetic treatment

Answer 4

Upon diagnosis

Question 5

What is included in step two of type II diabetes treatment

Answer 5

Add a second drug and consider a sulfonylurea for basal insulin if patient does not achieve goal with these drugs

Question 6

What is included in step three of type II diabetes treatment

Answer 6

Progress to a three drug combination

Question 7

What is included in step 4 of diabetes management

Answer 7

If a three drug combination therapy including insulin does not achieve treatment goals after 3 to 6 months, proceed to a combination injectable regimen including insulin and possibly a GLP 1 receptor agonist

Question 8

What stuff do you start out if a patient has an A1 C of 9% or higher at the time of diagnosis

Answer 8

Step two, 2-drug therapy

Question 9

What step do you start at if the patient has an A1 C of 10% or greater, has a fasting blood glucose of 300 or more, or is markedly symptomatic?

Answer 9

Start at step 4 - combination injectable therapy

Question 10

What are the target values for a blood glucose before meals and at bedtime

Answer 10

before meals - 70-130

at bedtime - 100-140

Question 11

The A1 C a should be measured every ___ months until the value drops below 7 percent in at least every ___ month thereafter

Answer 11

3,6

Question 12

The presence of what in the blood indicates the pancreas is still producing some insulin of its own

Answer 12

The presence of C-peptide

Question 13

Activation of beta2 adrenergic preceptors in the pancreas ___ secretion of insulin and activation of alpha-adrenergic preceptors in the pancreas ____ insulin release

Answer 13

promotes; inhibits

Question 14

Insulin is responsible for what metabolic actions

Answer 14

Increased glucose uptake and storage, increased amino acid uptake and synthesis, and conversion of fatty acids into triglycerides

Question 15

Stewart acting insulins must be used in conjunction with what in patients with type I diabetes

Answer 15

Intermediate or long acting insulin

Question 16

What kind of insulin is insulin lispro and how long does it take for effects to begin and how long do they last

Answer 16

Rapid acting analog; 15 to 30 minutes; 3 to 6 hours

Question 17

Which insulin is administered 30 to 60 minutes before a meal

Answer 17

Regular insulin

Question 18

What is the onset time and the duration of insulin aspart

Answer 18

10 to 20 minutes and lasts 3 to 5 hours

Question 19

How long does regular insulin last

Answer 19

Up to 10 hours

Question 20

Which insulin is the only one suitable for mixing with short acting insulin

Answer 20

NPH

Question 21

What is the onset and duration of lantus

Answer 21

70 minutes, 18 to 24 hours

Question 22

In pregnancy, when are insulin needs increased and decreased

Answer 22

Increased after the first trimester and decreased during the first trimester

Question 23

What is defined as hypoglycemia

Answer 23

Blood sugar less than 70

Question 24

What does alcohol do to blood sugar

Answer 24

Lowers it

Question 25

What is a fatal complication of metformin

Answer 25

Lactic acidosis

Question 26

does metformin stimulate the release of insulin from the pancreas?

Answer 26

no

Question 27

who shoudl you be cautious in prescribing metformin to? why?

Answer 27

renally impaired patients because it is excreted unchanged

Question 28

What is the mechanism of action metformin

Answer 28

inhibits glucose production in the liver, reduces glucose absorption in the gut, and sensitizes insulin receptors in target tissues resulting in increased glucose uptake

Question 29

Metformin decreases absorption of which two vitamins

Answer 29

Vitamin B 12 and folic acid

Question 30

What are the early signs of lactic acidosis

Answer 30

Hyper ventilation, myalgia, malaise, and unusual somnolence

Question 31

What are the two major side effects of sulfonylureas

Answer 31

Hypoglycemia and weight gain

Question 32

With regard to sulfonylureas, hypoglycemic reactions are more common in which patients?

Answer 32

Liver and renally impaired

Question 33

sulfonylureas are contraindicated in which patients

Answer 33

Pregnant and breast-feeding

Question 34

What is the difference between sulfonylureas and meglitinides

Answer 34

The glinides are shorter acting and are taken with each meal

Question 35

A patient who does not respond to a sulfonylurea will likely not respond to which other class

Answer 35

Glinides

Question 36

It is imperative that patients eat no later than 30 minutes after taking which drug

Answer 36

glinides

Question 37

How do TZDs work

Answer 37

Reduce glucose levels by decreasing insulin resistance

Question 38

how does pioglitazone work

Answer 38

Enhances responses to insulin

Question 39

What is the black box warning for Pioglitazone

Answer 39

Heart failure secondary to renal retention of fluid so discontinue or use in reduced dosage

Question 40

Which antidiabetic medication has been associated with heart attack

Answer 40

rosiglitazone

Question 41

Which antidiabetic medication can cause ovulation

Answer 41

pioglitazone

Question 42

Which antidiabetic medication may causing an increased risk for bladder cancer

Answer 42

pioglitazone

Question 43

Which antidiabetic medication can cause increased risk for fractures in women

Answer 43

pioglitazone

Question 44

Monitor which labs with pioglitazone admin?

Answer 44

liver function tests

Question 45

Which antidiabetic medication delays the absorption of carbohydrates

Answer 45

a-glucosidase inhibitors

Question 46

Which antidiabetic medication G.I. upset and a risk for anemia

Answer 46

Acarbose

Question 47

When the patient is taking acarbose and develops hypoglycemia, the patient must receive what and not what?

Answer 47

Glucose and not sucrose

Question 48

What labs should be monitored when acarbose is administered

Answer 48

lfts

Question 49

Which antidiabetic medication enhances the actions of incretin hormones by preventing incretin breakdown

Answer 49

gliptins

Question 50

which antidiabetic medication enhances the actions of incretin hormones by mimicking incretin actions

Answer 50

GLP-1 receptor agonists

Question 51

Inform the patients taking which medication for diabetes about fatal pancreatitis and hypersensitivity reactions

Answer 51

sitagliptin

Question 52

Which medication for diabetes is used only as adjunct therapy

Answer 52

sitagliptin

Question 53

Which medication for diabetes reduces resorption of filtered glucose and causes all glucose to be excreted in the urine

Answer 53

canagliflozin

Question 54

What are the most common side effects of canagliflozin?

Answer 54

Female genital fungal infections, urinary tract infections, and increased urination

Question 55

What can happen if you combine rifampin, phenytoin, or phenobarbital with canagliflozin?

Answer 55

Decreased efficacy of canagliflozin

Question 56

What will happen if you combine canagliflozin and a diuretic?

Answer 56

Risk for dehydration and hypotension

Question 57

Which antidiabetic medication slows gastric emptying, stimulates glucose-dependent release of insulin, inhibit postprandial release of glucagon, and suppresses appetite– all to mimic the incretin actions?

Answer 57

Exenatide

Question 58

hypoglycemia is common when exenatide is combined with what and not common when combined with what?

Answer 58

sulfonylurea; metformin

Question 59

In addition to sitagliptin, which other antidiabetic medication carries a risk for pancreatitis and hypersensitivity reactions/

Answer 59

exenatide

Question 60

exenatide can cause what? especially when what?

Answer 60

renal impairemnt; dehydration is present

Question 61

exenatide and pregnancy?

Answer 61

dont do it