Test 2: Pharm- Diabetes

Front 1

What is Diabetes Mellitus a disorder of & what does it involve?

Back 1

Carbohydrate metabolism & insulin deficiency or resistance

Front 2

Uncontrolled Diabetes cause what three major adverse effects?

Back 2

Leading cause of blindness, end-stage renal disease, lower limb amputations, 6th leading cause of death

Front 3

Because Type 1 diabetes has no endogenous insulin pt. are more prone to what, that require exogenous insulin therapy for survival?

Back 3

prone to ketosis

Front 4

When does Type 1 diabetes occur?

Back 4

before age 30

Front 5

What is almost always present in pts. with Type II diabetes?

Back 5

obesity

Front 6

Is there a high risk for ketoacidosis in pts. with Type II diabetes?

Back 6

little risk

Front 7

What is considered the N high range for blood glucose?

Back 7

120 BG

Front 8

Name the 3 short term complications of Diabetes?

Back 8

Hyperglycemia (when insulin is too low), Hypoglycemia (insulin doses are too high), Ketoacidosis

Front 9

Why does ketoacidosis develop?

Back 9

When hyperglycemia persists over a long time

Front 10

Most often long term complications occur secondary to what, that disrupts blood flow?

Back 10

macrovascular or microvascular damage

Front 11

Non Compliance of Diabeters ultimatelyl causes what systemic problem due to vascular damage?

Back 11

Cardiovascular problems

Front 12

What long term complication occurs because of a combination of events: hyperglycemia & altered lipid metabolism?

Back 12

hypertension

Front 13

What is the major cause of blindness?

Back 13

Retinopathy

Front 14

What is Nephropathy characterized by?

Back 14

proteinuria, reduced glomerular filtration, & increased arterial blood pressure

Front 15

Are renal problems higher in Type I or Type II pts?

Back 15

Type I

Front 16

What long term complications have gastroparesis (problems w gastric emptying) affects?

Back 16

Autonomic Neuropathy

Front 17

How many times should pts. with Diabetes self monitor?

Back 17

3 times/day

Front 18

What are target BG levels before & after meals?

Back 18

80-120ug/dl before; after meals 100-140ug/dl at bedtime

Front 19

What provides an index of average glucose levels over 2-3 months because RBC's live 120 days?

Back 19

Glycated Hemogloving (HbA 1 C)

Front 20

Should Short duration: rapid acting insulin be administered alone?

Back 20

No it's not a mono therapy drug it only lasts 4 hrs max. Needs to be used along w intermediate or long-acting agents

Front 21

Short Durations: Rapid Acting Insulins must be taken with food, true or false?

Back 21

TRUE

Front 22

Name three Short Duration: Rapid Acting insulins?

Back 22

Aspart (Novolog), Glulisine, Lispro (Humolog)

Front 23

With Short Duration: Rapid Acting insulins effect begins, lasts for, and should be given how long before eating?

Back 23

effects begin w/in 10-20 min, lasts for 3-5 hrs, 5-10 minutes before eating

Front 24

Short Duration: Slower Acting Insulin Humilin R, Novolin R, Exubera are also known as what kind of Insulin?

Back 24

Regular Insulin

Front 25

What is the only insulin that can be given IV?

Back 25

regular

Front 26

What kind of insulin is used for postprandial hypergycemia, infused SQ infusion for basal glycemic control?

Back 26

Regular insulin

Front 27

When do the effects of regular insulin begin, when is the peak, and how long does it last up until?

Back 27

Effects begin 30-60 min, peak in 1-5 hrs, lasts up to 10 hrs

Front 28

What is NPH insulin considered?

Back 28

intermediate duration ( prepared by conjugating regular insulin w/ a protamine: The protamine decreases the solubility of NPH insulin which slows absorption, this delays the onset & extends the duration)

Front 29

How many times is NPH usually injected?

Back 29

twice daily

Front 30

What is the only insulin suitable for mixing with short acting insulin?

Back 30

NPH

Front 31

Detemir (Levemir) at low doses effects last about 12 hours & 20-24 at high doses. Describe Determir...

Back 31

It is a longer acting: slower onset & longer duration insulin

Front 32

How long is Lantus duration of action & how many times must it be given/ day?

Back 32

24 hours & once daily

Front 33

When should the single injection be given& why?

Back 33

at bedtime less risk for hypoglycemia or hyperglycemia

Front 34

Should clear solutions ever be mixed w/ other insulins or be given IV?

Back 34

NEVER

Front 35

What is the only insulin appropriate for mixing w/ short acting insulins?

Back 35

NPH

Front 36

How many days are mixtures stable for?

Back 36

28 days

Front 37

Should short acting insulins be drawn up first or last when mixing?

Back 37

FIRST

Front 38

What blood glucose levels define hypoglycemia & what can cause it?

Back 38

below 50ug/dl, decreased food intake, vomiting, diarrhea, excessive consumption of alcohol, extra exercise

Front 39

What are symptoms of Tachycardia, palpitations?

Back 39

sweating & nervousness for rapid decrease

Front 40

What are the complications insulin can cause?

Back 40

hypoglycemia, tachycardia, palpitations, HA, confusion, drowsiness, fatigu

Front 41

How can Hypoglycemia be treated?

Back 41

fast acting oral sugar, glucose tabs, orange juice, administer D50 IV if unable to take by mouth

Front 42

What are Lipodystrophies & Lipohypertrophy?

Back 42

altered deposition of sub Q fat, loss of SQ fat; accumulation of fat

Front 43

Name the 5 families of Oral Hypoglycemics only indicated for Type II diabetes?

Back 43

Sulfonylureas, Meglitnides, Biguanides, Thiazolidinediones, Alphy-glucosidase inhibitors

Front 44

Are there oral insulins and why?

Back 44

No because of first pass effect

Front 45

What were the first available oral hypoglycemics and how do they work?

Back 45

Sulfonylureas, promote insulin release

Front 46

What has to be working for Sulfonylureas to work?

Back 46

beta cells

Front 47

Are Meglitinides used for type I or II diabetes?

Back 47

Type II

Front 48

Name two Meglitinides?

Back 48

Repaglinide (Prandin) & Nateglinide (Starlix)

Front 49

What is the main Biguanides & how does it work?

Back 49

Metformin & it lowers the glucose by decreasing production of glucose in the liver

Front 50

Does Biguanides: Metformin cause hypoglycemia or Lactic acidosis?

Back 50

does not cause Hypoglycemia but does rarely cause Lactic acid

Front 51

Does Biguanides: Metformin suppress gluconeogenesis?

Back 51

YES

Front 52

Other than Diabetes what is Metformin used for?

Back 52

Polycystic Ovary Syndrome

Front 53

What are the side effects of Metformin?

Back 53

decreased appetite, nausea & diarrhea

Front 54

How do Thiazolidinediones (Glitazones) reduce BG levels in Type II diabetes pts?

Back 54

reduce by decreasing insulin resistance

Front 55

When do Glitazones start working?

Back 55

after several weeks

Front 56

What patients should use Glitazones with caution?

Back 56

pts. w/ heart failure

Front 57

What combinations should be avoided w/ Alpha-Glucosidase inhibitors & why?

Back 57

Metformin & Acarbose because of GI upset

Front 58

How do Amylin Mimetics reduce postprandial levels of glucose?

Back 58

delay the gastric emptying & suppressing glucagon secretions

Front 59

What is the biggest side effect of (Symlin) Amlyin Mimetics?

Back 59

Hypoglycemia

Front 60

Name a Incretin Mimetic & where its found?

Back 60

Byetta found in the saliva of the GIla monster

Front 61

How do DPP-4 Inhibitors work?

Back 61

acts to enhance the body's own ability to release insulin. Breaks down the proteins that increase the release of insulin

Front 62

What are the adverse effects of DPP-4 Inhibitor?

Back 62

nausea, stomach pain, diarrhea, stuffy nose, sore throat

Front 63

When should bicarbonate be given in diabetic ketoacidosis?

Back 63

6.9

Front 64

About how much water and sodium replacement do adults require during the first 12 hours of diabetic ketoacidosis tx?

Back 64

8-10L of saline