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124 Cards in this Set

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high blood glucose is an indication that the glucose cannot get into the cells and be properly stored (muscle and other tissue)...constant hyperglycemia leads to microvasc and macro health complications
k
process of DM1?
autoimmune, antibodies destroy the patients pancreatic beta cells (that produce insulin)
primary cause of DM@?
lifestyle
what drugs can indude hyperglycemia (watch for on cases)
corticosteroids, protease inh (ritonavir), niacin, thiazide diuretics, atypical antipsychotics (olanzapine the worst), others diazoxide (proglycem) pentamidine (nebupent), tacrolimus (prograf)
3 P's for signs of hyperglycemia
polyuria, polyphagia, polydipsia...and weight loss (usualy for DM1)...signs for DM2 (blurred vision, recurrent infections, fatigue
blood glucose values for prediabetes fasting and OGTT
100 to 126....140-200
diagnostic values for DM
S&S plus random over 200, FPG over 126, OGTT over 200
what are some microvascular complications of DM?
retinopathy, nephropathy, periph neuropathy, autonomic neuropathy (erectile dysfunction, gastroparesis)
some macro complications?
CAD, cerebrovascualr disease, PAD
explain DKA?
if not enough insulin, body breaks down fat to make energy, which concentrated ketones in blood...can lead to coma or death
DKA symptoms
hyperglyc, 3 P's, blurred vision, met acidosis, dehydration
met acidosis symptoms
fruity breath, dyspena
treatment of DKA
fluids and insulin, watch electrolytes
treatment goals: FBG and postprandial BG?
90-130...under 180
treatment goals: LDL and TGC
under 100, under 150
treatment goals: BP
130/80...use ace or arb
treatment goals: urine tests
annual
what should be done about feet in DM?
examined annually
when should asa therapy begin for DM patients?
after age 40
immunization schedule for DM?
flu shot, pneumococcal vaccine
what is the only therapy for GDM?
insulin...metformin and glyburide can also be used
guidelines know...pg 136
k
what is the drop in A1c for lifestyle modifications?
1-2% (well documented)
what is the decrease when staring metforming therapy for A1c?
1-2 %
what is the initial and goal dose for metformin?
500 qd or BID, titrate to 850-1000 BID
when should additional therapy be added to therapy per the guidelines
after glucophage added, still over 7%
what sulfonlyurea is not rec for 2nd line therapy?
glyburide or chlorpromadine
A1C decrease for sulfonlyruea
1-2%
what thiazolidinedione is not rec for 2nd line therapy?
rosiglitazone
A1c decrease for thiazolidinediones?
0.5-1.4%
expectd decrease in a1c for byetta (exenatide)
0.5%-1%
when insulin is added, what should stop?
insulin secretagogues (sulfonylureas or glinides (repaglinide, nateglinid))
meformin A1c drop
0.8-2%
what are some SE advantages to metformin?
no weight gain, no hypoglycemia
what is the timeline for metformin and IV contrast dye?
hold prior to and wait until 48 hours after procedure
what is metformins issues with alcohol and iodinated contrast dye?
increase risk for lactic acidosis
what is lactic acidosis?
k
what is the inxns of metforming and other vitamins?
it decreases folate and vit B12 absorption
symptoms of lactic acidosis
weakness, increased sleepiness, slow HR, cold feeling, muscle pain, SOB
CI of metformin?
Scr over 1.5 males and 1.4 females....CrCl under 60...need ot confirm renal fxn if pt over 80
what is a cuation in taking metformin?
if HF, hyupoxia, sepsis, resp failure
counseling points on metformin
take with morning and evening meals...dont crush chew or break the ER....GI discomfort is common but usually goes away...ER is taken with supper....glumetaz qwill have the shell in your stool
what meds should not be used with sulfonyrueas?
meglitinides: stim insulin secretion from pancrease also
SE of the sulfonylureas
HYPOGLYCEMIA, weight gain
which sulfonylureas are not rec by the ADA? why?
chlorpropamide and glyburide: both cause long lasting hypoglycemia, glyburide has a renally cleared component
brand name of blipizide?
glucotrol
dosing of glipizide?
IR is 2.5-10 bid
brand of glimepiride?
amaryl
brand of glyburide?
diabeta, micronase
sulfonylruea inxns?
insulin (both hypogylcemia), cuastion with other hypoglycemia meds (alcohol, azole antifungals, diazoxide, pentamide, quinine, phenytoin, bactrim
counseling sulfonyl
if once daily take at breakfast, this med causes hypoglyemia (be aware of symtpoms, keep sugar source near)
maglitinide drugs
repaglinide, nateglinide
a1c for meglitinide?
0.6-1.8%
AE for meglinidides
hypoglycemia and weight gain (less than sulf)
dosing of the meglitinides
15-30min prior to meals
primary inxns with the meglitinides?
hypoglyemia issues (insulin, alcohol ect)
meglitinides counseling
15-30 min before dose, if missed dose then skip it, rec low blood sugar symptoms
thiazolidinedione MOA
increase peripheral insulin sens (increase insulin entry to muscle cells)
brand of pioglitizone?
actos
brand of rosiglitazone?
avandia
which thiazolidinedione is no longer recommended and why?
rosiglitazone, increased CVD risk, BBW...fluid retention
AE of thiazolidinediones
peripheral edema, macular edema, HA, increased fracture risk, hepatic cuation
thiaz counseling
may take several weeks to lower Blood sugar...once daliy with or without food, if brown or dard urine contact doctor or eyes or skin yellow...can cause water retention (ankles swell) if trouble breathing also, contact doctor
MOA of alph glucosidase inh
inh alpha glucosidase in INTESTINE and alpha mylase in pacrease which will lower post prandial BG
what is the A1c decrease for alph gluco
0.4-1.3%
brands of alpha gluco inh
acarbose and miglitol
brand of acarbose?
precose
brand of miglitol
glyset
SE issues with the alpha glud inh
GI SE, CI with IBS and intestinal obstruction
Counseling with alpha gluc inh
take with full glass of water with FIRST BITE OF FOOD, ...will cuase gas and diarrhea, but tihs should go away....sucrose will not treat hypoglycemia with this, need glucose tablets....no weight gain and do imporve chol levels
what is an added bonus with alpha gluc inh?
improve chol levels, no weight gain
DPP4 inh moa?
incretin enhancer (stim pancrease to release insulin and liver to decrease glucose production)
metformin moa
decrease hepatic glucose output
a1C decrease of DPP4 inh?
0.6-0.8%
DPP4 inh meds?
sitagliptin, saxagliptin, sitagliptin plus metformin
what is an added bonus with alpha gluc inh?
improve chol levels, no weight gain
DPP4 inh moa?
incretin enhancer (stim pancrease to release insulin and liver to decrease glucose production)
metformin moa
decrease hepatic glucose output
a1C decrease of DPP4 inh?
0.6-0.8%
DPP4 inh meds?
sitagliptin, saxagliptin, sitagliptin plus metformin
brand of sitagliptin?
januvia...janumet (+metformin)
gliptin counselin?
once daily inmorning with or without food...if trouble breathing, see doctor....know signs of pancreatitis (pain, vomiting in stomach)
SE profile of the gliptins?
very well toleratied, no hypogylcemia or weight gain
warnings about the gliptins?
pancreatitis, allergic rxns
Exenatide moa
incretin mimic (increase insulin from pancrease) Gila monster saliva, slows gastric empyting
exenatide brand?
byetta
exenatide a1c
0.5%-0.8%
dosing exenatide?
SC
storage of exenatide?
fridge
SE of exenatide?
NVD, Nausea is the major one, weight loss, Pancreatitis, renal (wathc dehydration with N/V)
when should exenatide not be used?
when Hx of pancreatitis, gallstones, alcoholism, high TGC
Incretin meds (gliptins and exenatide)
issues with pancreatits
exenatide counseling?
once dialy in mornign w/ or w/o food...see doctor if rash or trouble breathing...maintain fluids is nausea and vomiting....abdomen is the preferred area for injection....never inject AFTEr a meal....the doses are premeasured, dont adjust yourself....know the signs of pancreas se....store pen in fridge...hold for 5 seconds before removing pen from SC
KNOW INSULIN WELL
k
DM risk factors? 6
Family history, ethnicity (AA, asian, hispanic, native american, pacific islander), overweight (BMI over 25), prediabetes, history of GDM, poor diet and low physical actiivty
Pramlintide moa
synth analog of human neuroendocrine hormone, amylin (amyline is made in pancreas to assist in postprandial glucose control)
brand name of pramlintide
symlin
major concern with SE?
hypoglycemia (decrease 50% of insulin), GI nausea, anorexia, CI in gastroparesis
counseling for pramlintide
never mix with insulin, inject just like insulin...if late dose just skip it....dont take if you plan on eating a very light meal...opened vials only last for 28 days (RT or refridge)....watch for hypoglycemia....nausea is a very prominetn SE
bile acid binding resin moa?
binds bile, blocking reabsorption. this will lower cholesterol
seperate fenofibrate and niaspan by 4-6 hours
k
welchol counseling
check for other consipating drugs, also use laxatives such as senna or the stool softener docusate...adequate fluid intake is required...if you take a multivitamin seperate the time you take it
what are the 3 rapid acting, or Mealtime insulins?
lispro aspart glulisine
brands of lispro, aspart, glulisine
lispro (humalog), aspart (novolog), glulisine (apidra)
what are the 2 regular or short acting insulins?
humulin R, novolin R
NPH and R are usually mixed together
k
what are the 2 baseline insulins?
glargine, detemir
brands of glargine and detemir
lantus, levemir
how are4 the baselines dosed?
q12h or q24h...usually given at bedtime
what is the weight issues with hypoglycemia?
weight gain
counseling insulin (IMPORTANT)
keep unused vials in fridge 30 days...Do not shake the insulin, just roll int he palms...when mixing R or rapid with nph, add the R or rapid first...abdomen is the preferred site for injection (dont inject within an inch of the naval)....alternate injection sites....prior to injecting clean the area...pinch the skin to inject SQ...proper disposal
hypoglycemia def?
BG below 70
at what Blood sugar point does seizure coma and death occur?
20
symptoms of hypoglycemia
fatigue, anxiety, shakiness, sweating (diaphoresis), hunger, confusion, tremors, blurred vision
what medication can cover up or mask the symptoms of hypoglycemia?
BB
what med wan be used for stage freight?
propranolol...masks symptoms of shakiness and anxiety...most notable for non cardioselective
when is glucagon indicated?
when the patient is unconscious (1mg SC, IM or IV)
how to treat hypoglycemia
10-20g rapidly absorbed carbs>>>1/3cug apple juice, 2 cubes sugar, 1/2 cup OJ or soda, 2 glucose tabs
glucometers
k
when should exenatide not be used?
when Hx of pancreatitis, gallstones, alcoholism, high TGC
Incretin meds (gliptins and exenatide)
issues with pancreatits
exenatide counseling?
once dialy in mornign w/ or w/o food...see doctor if rash or trouble breathing...maintain fluids is nausea and vomiting....abdomen is the preferred area for injection....never inject AFTEr a meal....the doses are premeasured, dont adjust yourself....know the signs of pancreas se....store pen in fridge...hold for 5 seconds before removing pen from SC
KNOW INSULIN WELL
k
DM risk factors? 6
Family history, ethnicity (AA, asian, hispanic, native american, pacific islander), overweight (BMI over 25), prediabetes, history of GDM, poor diet and low physical actiivty