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68 Cards in this Set
- Front
- Back
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What value does a FBG have to be to be diagnostic of diabetes?
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>=126
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If I have a random glucose of => 200, is that diagnostic of diabetes?
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Yes
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When do we look at screening kids for diabetes (kids that are older than 10)?
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BMI or weight >85%
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What are the risk factors (which we must have two of) to have provocation to check a child >10 y/o for diabetes?
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Family history - 1st or 2nd degree relative.
Ethnic/race Signs or symptoms of insulin resistance |
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When would I want to use an ACE for my diabetic patient?
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THey are hypertensive OR have microalbuminuria
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If I reduce my A1c by 1%, how much have I decreased my risk for developing a complication?
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21% decrease in risk
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What is the first line oral hypoglycemic for overweight/obese patients?
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Metformin
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How does Metformin work?
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It acts on the liver cells to decrease glucose production.
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Do you get weight gain or hypoglycemia with Metformin?
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No
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Does Metformin lower insulin and lipid levels?
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Yes.
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When should I use caution in prescribing Metformin?
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In:
Elderly. Renal dysfunction. Cardiopulmonary disorders. Hepatic disease. |
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How many days before giving IV contrast should I hold Metformin?
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2 days
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Should I check a creatinine prior to initiating Metformin?
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Yes.
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If my creatinine is >1.5 should I initiate Metformin?
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No
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What are the the two thiazolidinediones?
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Rosiglitasone (Avandia)
Pioglitasone (Actos) |
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Rosaglitasone is also known as?
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Avandia
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Pioglitasone is also known as?
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Actos
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What are Actos and Avandia?
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Insulin sensitizers. They decrease insulin resistance.
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WHat is an odd side effect of Rosaglitasone (Avandia) and Pioglitasone (Actos)
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Ovulation
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When should I use caution in using Rosaglitasone (Avandia) and Pioglitasone (Actos)?
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THe elderly
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Why should I use caution when using the insulin sensitizers Rosaglitasone (Avandia) and Pioglitasone (Actos)?
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Due to declining ventricular function.
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Should I use caution with patients with cardoipulmonary overload and Actos and Avandia?
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Yes
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WHat must I monitor when I use Rosglitasone (Avandia) or Pioglitasone (Actos)?
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LFT's
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Is it possible that Rosiglitasone (Avandia) can increase cardiovascular risks?
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Yes
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Does Pioglitazone (Actos) have some additional positive effects/
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Yes, decreased risk of MI, stroke and death (decreased triglyceridses, increased HDL).
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Is it true that both Pioglitazone (Actos) and Rosiglitazone (Avandia) may increase risk of fractures in women?
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Yes
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What are the sulfonyureas?
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Glipizide (Glucotrol)
glyburide (Micronase) Glimeperide (Amaryl) |
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GLipizide is also known as?
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GLucotrol
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Glyburide is also known as?
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Micronase
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Glimeperide is also known as?
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Amaryl
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What do the sulfonyureas:
Glipizide (Glucotrol) Glyburide (Micronase) Glimeperide(AMaryl) do? |
They stimulate the pancreatic beta cells to release insulin.
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What are some potential side effects of the sulfonyureas:
GLipizide (Glucotrol) Glyburide (Micronase) Glimeperide (Amaryl)? |
Weight gain.
Hypogylcemia. |
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Can you use the sulfonyureas:
glipizide (Glucotrol) glyburide (Micronase) glimeperide (Amaryl) in the elderly? |
Yes - in low doses.
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Can I use the sulfonyureas:
glipizide (Glucotrol) glyburide (Micronase) glimeperide (Amaryl) in a patient with renal dysfunction, sleep apnea and CHF? |
Yes
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Is glyburide (Micronase) as effective as insulin in treating gestational diabetes with women with a FBS of 140 or less that fail diet therapy?
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Yes
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Are the sulfonyureas the least or most expensive?
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Least - $25 to $75/month
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What are the meglitinides?
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Repaglinide (Prandin)
Nateglinide (Starlix) |
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What's the MOA of the meglitinides:
Repaglinide (Prandin) nateglinide (Starlix)? |
They are a rapid acting insulin secretagogues.
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The half life of the meglitinides repaglinide (Prandin) and nateglinide (Starlix) is?
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<1 hour.
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If I have an erratic eating schedule, would the meglitinides: repaglinide (Prandin) and nateglinide (Starlix) be helpful?
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Yes
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Can I use the meglitinides (repaglinide (Prandin) and nategilnide (Starlix)) in the elderly, renal failure and cardiopulmonary disorders?
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Yes
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What are the alpha glucosidase inhibitors?
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acarbose (Precose)
Miglitol (Glyset) |
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acarbose is AKA
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Precose
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miglitol is AKA
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Glyset
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What do the alpha glucosidase inhibitors do?
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They delay carbohydrate absorption in the gut. Decrease glucose levels. No hypoglycemia.
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What is the major side effects of the alpha glucosidase inhibitors:
acarbose (Precose) miglitol (Glyset) ? |
GI side effects.
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What is the other name for exenatide?
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Byetta
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What is exanatide (Byetta)
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It is a GLP-1 agonist (incretin mimetic)
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When would I use Byetta?
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for type 2 diabetics who aren't controlled on an oral agent
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What is pramlintide
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Symlin
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What does pramlintide (symlin) do?
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It is the synthetic analogue of human amylin. It slows gastric emptying, suppresses postprandial glucagon secretion and increases satiety.
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When is pramlintide (Symlin) used?
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Poorly controlled diabetics who inject insulin at mealtimes.
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Can Symlin be mixed with insulin?
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No
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What are the side effects of pramlintide (Symlin)?
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Nausea, vomiting, headache, anorexia, hypoglycemia
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Sitagliptin is AKA
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Januvia
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What does sitagliptin (Januvia) primarily do?
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Lowers postprandial glucose
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What is the average dose of insulin per day?
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0.6 to 0.8 units/kg body weight/day
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What are the rapid acting insulins?
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Lispro (Humalog)
Aspart (Novolog) Glulisine (Apidra) |
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What is the:
onset: Peak: Duratoin: of the rapid (Humalog, Novolog, Apidra) acting insulins? |
Onset: 15 minutes.
Peak: 1-3 hours. Duration: 2-5 hours |
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What are the long acting insulins?
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NPH
Glargine (Lantus) Detemir (Levemir) |
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What are the microvascular complications of diabetes?
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kidneys, eyes, nerves
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What is the treatment for the microvascular complications?
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Glycemic control.
BP control. Lipid control. Smoking cessation. |
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Is there evidence that ASA is helpful for microvascular compilcations?
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No
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To protect the kidneys, if a patient has microalbuminuria or proteinuria, should they be considered for an ARB?
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Yes
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Should I screen my patient for microalbuminuria at the time of diagnosis of type 2 DM?
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Yes
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What's my goal for BP if I have HTN and I'm diabetic?
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<130/80
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What's the drug of choice for diabetic with HTN?
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ACE
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Should I consider a statin for its cardioprotective effects even if my diabetic patient doesn't have high cholesterol?
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Yes
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