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50 Cards in this Set
- Front
- Back
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Describe Type I Diabetes
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Insulin dependent
Faulty Beta cells Affect mostly children 25% of diabetics |
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Describe Type II Diabetes
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defective insulin secretion and insulin resistance or reduced insulin sensitivity
Mostly affects adults 75% of diabetics Genetic |
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Name other types of diabetes
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Gestational
Drugs and chemicals Pancreatic disease Cystic fibrosis Hyperthyroidism Cushings syndrome |
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what are the symptoms of DM?
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polyuria
Polydipsia Polyphagia Blurred vision |
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how do you Dx DM?
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Random glucose >200 c Sx
Fasting glucose > 126 Glucose Tolerance Test(GTT)- p 2 hr >200 |
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what are risk factors for type II DM?
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>45 y/o
BMI > 25-obesity First degree relative |
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what is the initial tx of Type II?
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Diet- decrease carbs
Exercise Weight loss |
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These hypoglycemics act by increasing insulin release from the beta cells in the pancreas and limit glucose production in the liver
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Sulfonylureas
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what is HbA1c test?
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used primarily to identify the mean plasma glucose concentration over 3 months
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what are the side effects of sulfonylureas?
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HIGH
Hypoglycemia Increase LFTs GI Hematologic-agranulocytosis |
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an HbA1c of 6 correlates to?
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135mg/dl mean plasma glucose; normal is 4-6
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In which type of DM are sulfonylureas used with?
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with type II because you need the Beta cells to be working so they can be stimulated
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what is the normal HbA1c level?
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6.5
you want to keep diabetics below 7 |
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you have a pt whom you might think is allergic to sulfa, would you put him on a sulfonylurea?
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yes
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which sulfonylureas have active metabolites?
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First generation:
ACT Acetohexamide Chlorpropamide Tolazamide |
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what is the recommended startin dose of Glyburide?
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2.5mg BID
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which sulfonylurea has a duration of 60 hrs
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Chlorpropamide
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what is the duration for all the sulfonylureas?
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12-24 hrs
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what are the effects of Metformin?
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> insulin sensitivity
< hepatic glucose < intestinal glucose absorp < TG > HDL Weight loss |
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what is the dose of Metformin?
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500mg PO BID
Max dose is 850mgx3=2500 daily >2500 can cause lactic acidosis |
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what are the adverse side effects of metformin?
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AND
Anorexia Nausea Diarrhea #1 side effect |
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which drug would be used in combo with metformin?
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mostly glyburide
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You have a male pt and his SCr is >1.4, should you give Metformin?
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No, because of > risk of lactic acidosis
For females is >1.5 |
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Your patient is having a contrast CT done and is on metformin, what do you do?
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hold the meformin a day of and the day after the study. In emergent situations give acetylcysteine 600mg PO BID to prevent renal complications
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What is the MOA of Alpha-Glucosidase inhibitors?
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delays breakdown of sugars to glucose; these need to be taken with meals
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Name 2 Alpha-Glucosidase Inhibitors and their dose
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Acarbose 25mg with meals
Miglitol 25mg with meals |
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what are the adverse effects of AGI's(Alpha Glycoside Inhibitors)?
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GI symptoms:
Diarrhea Gas |
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what are the C.I. of AGI's?
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IBS
Chronic ulcers partial obstructions |
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which drug has no effect on insulin secretion but increases insulin sensitivity?
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Thiazolidinedione (TZD)
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Name 2 TZD's
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Rosiglitazone
Pioglitazone |
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what do you worry about with TZDs?
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Hepatotoxcicities(get LFTs)
Edema Anemia |
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what are the C.I of TZDs
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Acute CHF-edema
Severe hepatic impairment Increase in LFTs |
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what drug can you give to resume ovulation?
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TZD
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what are the drug interactions of TZDs?
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Birth control pills; reduces estrogen levels
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which drug reduces absorption of TZD?
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Cholestyramine; it is a drug binder
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what is the MOA of Meglitinides?
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Stimulates insulin secretion from Beta cells
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Name 2 meglitinides
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Prandin
Starlix |
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what is the dosing for prandin?
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If no h/o A1c >8, then 0.5mg before meals
If h/o A1c >8, then 1-2mg before meals Max is 16mg/day |
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which drugs interact with meglitinides?
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Cyp 450 3A4 inducers
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Name the rapid insulins
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Lispro- humalog
Aspart- novolog |
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which insulin is the most similar to basal insulin?
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Glargine (lantus)
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what is the "Dawn effect"?
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early-morning increase in glucose — usually between 4 a.m. and 8 a.m
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what is the Symogi effect?
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the tendency of blood sugar to rise as a result of low blood sugar. Low blood sugar can trigger release of hormones such as glucagon that raise blood sugar
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what is the initial dosing of insulin for Type I?
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0.5 IU/kg/day
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what type of insulin is used with a drip?
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Regular
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what is the initial dosing of insulin for Type II?
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0.7 IU/kg/day
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what is Byetta used for?
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Type II DM
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what is the MOA of Byetta and Symillin?
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They're amylin peptides which enhance glucose-dependent insulin secretion
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name the inhaled insulin
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Exubera
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what is a disadvantage of Exubera
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We don't know its effects with COPD and pulmonary fibrosis patients. Therefore, pulmonary function tests and peak flow tests must be performed prior to starting this drug.
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