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