Therapeutics 2 Exam 2

Front 1

Ketosis is common in this type of diabetes

Back 1

Type 1

Front 2

Patient has a random plasma glucose of ____ to be diagnosed with DM

Back 2

> or = to 200 mg/dL plus signs and symptoms of diabetes

Front 3

Patient has a fasting plasma glucose of ____ when diagnosed with DM

Back 3

> or = to 126 mg/dL

Front 4

Patient has a 2 hour post prandial glucose of ____ when diagnosed with DM

Back 4

< or = to 200 mg/dL during oral glucose tolerance test

Front 5

For diagnosis of pre-diabetes impaired fasting glucose would be

Back 5

100-125 mg/dL

Front 6

For diagnosis of pre-diabetes post prandial glucose would be

Back 6

140-199 mg/dL

Front 7

ADA Goal of preprandial plasma glucose in a patient with DM is

Back 7

70-130

Front 8

ADA Goal of postprandial plasma glucose in a patient with DM is

Back 8

<180

Front 9

ADA Goal of glycosylated hemglobin in a patient with DM is

Back 9

<7% (or more stringent of <6%)

Front 10

ADA Goal of blood pressure in a patient with DM is

Back 10

<130/80

Front 11

ADA Goal of LDL lipid levels in a patient with DM is

Back 11

<100 (if Diabetes and CHD or other heart issues then <70 mg/dL)

Front 12

ADA Goal of HDL lipid levels in a patient with DM is

Back 12

>40 (Males) and >50 (females)

Front 13

ADA Goal of TG lipid levels in a patient with DM is

Back 13

<150

Front 14

Formula for estimated average glucose (eAG) =

Back 14

Average glucose (mg/dL) = 28.7 X A1c - 46.7

Front 15

Insulin that has no peak, eliminates hypoglycemia

Back 15

Long acting basal insulin - insulin detemir (levemir) and insulin glargine (lantus)

Front 16

Use this insulin 15 minutes before eating

Back 16

Rapid-Acting Bolus (Lispro - Humalog, Aspart - Novolog, Glulisine - Apidra)

Front 17

Use this insulin 30 minutes before eating

Back 17

Short acting, Regular (Humulin R and Novolin R)

Front 18

This insulin is dosed twice a day, used for basal control or dosed once a day at bedtime for Type 2 on oral medications

Back 18

Isophane insulin suspension (NPH) (Humulin N and Novolin N)

Front 19

Average insulin requirements for Type 1 and Type 2

Back 19

0.5 units/kg actual body weight

Front 20

Traditional Method - Split MIxed

Back 20

Total Daily dose - 2/3 in am and 1/3 in pm
2/3 of am dose = intermediate acting
1/3 of am dose = rapid short acting

2/3 of pm dose = intermediate acting
1/3 of pm dose = rapid short acting or can do pm dose in 1/2 and 1/2

Front 21

Split Mixed, TID

Back 21

total daily dose - 2/3 in am prior to breakfast and 1/3 in pm with rapid/short given priior to dinner and NPH at HS

2/3 of AM dose = intermediate
1/3 of AM dose = rapid/short acting

PM dose = 1/2 intermediate (at bedtime) and 1/2 rapid/short prior to dinner

Front 22

Basal - Bolus dose (QID)

Back 22

Total daily dose
Basal = 50% of total daily dose administered once daily
Bolus - 50% of total daily dose divided evenly TID AC (rapid-acting)

Front 23

Adjust basic insulin dose ___ to ___ units at a time; __ to __ units for more extreme cases

Back 23

1 to 2 units; 3 to 4 units for extreme cases

Front 24

Rule of thumb: every unit of rapid acting insulin may decrease glucose by __ to __ mg/dL

Back 24

25 to 50 mg/dL

Front 25

Adjust long-acting insulin based on ____

Back 25

fasting glucose

Front 26

Post hypoglycemic hyperglycemia (untreated nighttime hypoglycemia, resulting in high blood sugar levels in the morning)

Back 26

Somogyi effect - test blood sugar at 3 am to diagnose. Decrease evening NPH or give evening NPH later or switch to long-acting basal insulin or eat bedtime snack

Front 27

Rise in blood glucose in early morning hours

Back 27

Dawn phenomenon - increase evening NPH dose or basal insulin

Front 28

___ mcg pramlintide = ___ units on insulin syringe = ___ mL

Back 28

15 mcg = 2.5 units = 0.025 mL (pramlintide is 0.6mg/mL)

Front 29

An incretin mimetic agent for treatment of Type 2 Diabetes as an adjunct to metformin, sulfonylurea, or thiazolidinedione

Back 29

Exenatide (Byetta)

Front 30

Bind to beta cells on pancreas, stimulate insulin realease - inhibition of hepatic glucose production, enhanced glucose uptake in muscle

Back 30

Sulfonylureas (1st gen:chlorpropamide, tolazamide, tolbutamide) (2nd gen: glimepiride, glipizide, glyburide)

Front 31

Decrease hepatic glucose production and intestinal glucose absorption, Increases peripheral insulin sensitivity, does not stimulate insulin secretion

Back 31

Biguanides (metformin)

Front 32

Adverse effects are gastrointestinal reactions and lactic acidosis

Back 32

Biguanides (Metformin) - watch lactic acidosis in renal dysfunction (contraindicated Cr > 1.5 males, 1.4 females; elderly)

Front 33

This medication has beneficial lipid and weight loss effects for Type 2 DM but should be avoided in patients with renal dysfunction and congestive heart failure

Back 33

Metformin

Front 34

Can't combine these with sulfonylureas, these are good for people with erratic eating habits

Back 34

Meglitinides - Repaglinide (Prandin) and Nateglinide (starlix)

Front 35

Stimulates insulin release from B-cells in a glucose dependent manner, nonsulfonylurea insulin secretagogue

Back 35

Meglitinides - Repaglinide (Prandin), Nateglinide (Starlix)

Front 36

Causes so much GI upset, flatulence, cramps, diarrhea, borborygmus

Back 36

Alpha glucosidase inhibitors - acarbose (precose), miglitol (glyset)

Front 37

Inhibit hydrolysis of complex carbohydrates into simple sugars, result in delayed glucose absorption, decrease postprandial glucose concentrations

Back 37

Alpha glucosidase inhibitors - acarbose (precose), miglitol (glyset)

Front 38

Increase insulin sensitivity, bind to nuclear receptors that regulate insulin-responsive genes, dependent on presence of insulin; no effect on insulin secretion, decrease hepatic glucose output, increase glucose uptake in skeletal muscles

Back 38

Thiazolidinediones - Pioglitazone (Actos), Rosiglitazone (Avandia)

Front 39

Causes hepatic problems - monitor LFTs at basline, 3-6 months, fluid retention, edema (NOT for CHF!), cardiac effects

Back 39

Thiazolidinediones - Pioglitazone (Actos), Rosiglitazone (Avandia)

Front 40

Decrease glucagon release which decreases hepatic glucose production, Inhibit dipeptidyl peptidase-4 enzyme; DPP-4 (helps with glucagon secretion), slow inactivation of incretins; prolong acction of glucagon like peptide (GLP-1). increase insulin synthesis and release

Back 40

Dipeptidy peptidase-4 (DPP-4) inhibitors - sitagliptin (Januvia) and saxagliptin (Onglyza)

Front 41

Adverse effects are Nasopharyngitis, upper respiratory tract infection

Back 41

Dipeptidyl peptidase-4 (DPP-4) inhibitors - sitagliptin (Januvia) and saxagliptin (Onglyza)

Front 42

Blood glucose <60 mg/dL is considered

Back 42

Hypoglycemia

Front 43

Side effects of Nicotine Gum

Back 43

Mouth Soreness, hiccups, dyspepsia, jaw muscle ache (lightheadedness, N/V, irritation of throat and mouth if chewed too quickly)

Front 44

True or False Nicotine Lozenge (commit) delivers 25% more nicotine than equivalent gum dose

Back 44

True

Front 45

Nicotine Lozenge dosage is based on

Back 45

the time to first cigarette TTFC as an indicator of nicotine addiction:

Use 2 mg if u smoke 1st cig more than 30 min after waking up

Use 4mg if u smoke 1st cig of the day within 30 min of waking up

Front 46

To improve chances of quitting use at least __ pieces of gum daily but no more than __ pieces of gum per day

Back 46

At least 9 pieces, no more than 24

Front 47

Do not use more than __ lozenges per day

Back 47

20

Front 48

Nicotine Patch - if smoke more than 10 cigarettes per day start at step __, if use less than 10 cig/day start at step __.

Back 48

1; 2

Front 49

True or False: Patients should NOT wear the Nicotine patch while swimming, bathing, showering, or exercising. Water will damage it

Back 49

False water will NOT damage the patch. Patients can wear the Nicotine patch while swimming, bathing, showering, or exercising

Front 50

If experience vivid dreams or sleep disturbance while on the Nicotine patch then apply patch ___

Back 50

in the morning

Front 51

One dose of the nicotine nasal spray contains __ nicotine

Back 51

1 mg of nicotine (2 sprays, one 0.5 mg spray in each nostril) Start with 1-2 doses per hour then increase to max of 5 doses per hour or 40 mg daily (80 sprays)

Best results use 8 doses/day for 1st 4-6 weeks

Front 52

Should not use this type of NRT with bronchospasms

Back 52

Nicotine inhaler

Front 53

This type of smoking cessation decreases cravings for cigarettes and decreases symptoms of nicotine withdrawal

Back 53

Bupropion (Zyban)

Front 54

This smoking cessation aid is contraindicated in a patient with active seizures or on an MAOI in preceding 14 days

Back 54

Bupropion

Front 55

This is a nonnicotine cessation aid that is a partial nicotinic receptor agonist

Back 55

Varenicline (chantix)

Front 56

May induce nausea in up to 1/3 of patients

Back 56

Varenicline (Chantix)

Front 57

2nd line therapies for smoking cessation

Back 57

Clonidine (catapres transdermal or oral)
Nortriptyline (Pamelor oral)

Front 58

An herbal drug for smoking cessation, partial nicotinic agonist, no trials, no evidence

Back 58

Lobeline

Front 59

Has the highest long term quit rate for available cessation products

Back 59

Nicotine Nasal Spray = #1
Chantix = #2
Bupropion = #3
Nicotine Gum = #4
Nicotine Inhaler = #5
Nicotine Lozenge
Nicotine Patch

Front 60

Combination regimens that are ok together

Back 60

Long acting patch and short acting formulation (gum, inhaler, nasal spray)

Bupropion Sr and Nicotine Patch

Front 61

Name the 4 strongest factors that predict fracture risk

Back 61

Low peripheral bone mineral density (BMD)
Prior fragility fracture - spine, wrist, ankle
Advanced Age
Family History of Osteoporosis

Front 62

a multinucleated giant cell specialized for bone resorption, secretes acids and proteases to dissolve bone

Back 62

Osteoclast (cut bone)

Front 63

a cell that is responsible for the formation of new bone tissue, bone-forming cells lay down bone matrix by secreting proteins and proteoglycans.

Back 63

Osteoblasts (build bone)

Front 64

With glucocorticoid induced osteoporosis, ___ are the drug of choice, __ is not recommended

Back 64

Bisphosphonates are DOC, Calcitonin is not

Front 65

Outward curvature of the spinal column sometimes due to multiple vertebral fractures

Back 65

Dorsal Kyphosis

Front 66

Forward curvature of the cervical and lumbar regions of the spinal column sometimes due to multiple vertebral fractures

Back 66

Cervical Lordosis

Front 67

The worst complication of osteoporosis is

Back 67

Hip fracture - up to 50% of hip fracture patients do not regain prefracture function for up to 1 yr and 10 to 20% die within 1 yr of the fracture

Front 68

The gold standard assessment method for osteoporosis/Bone mineral density is

Back 68

central skeletal (hip/spine) dual-energy x-ray absorptiometry (DXA).

Front 69

A BMD value within 1 Standard deviation of the young adult mean is diagnosed as

Back 69

Normal

Front 70

A BMD value between -1 Standard deviation and -2.5 SD below the young adult mean is diagnosed as

Back 70

Osteopenia

Front 71

A BMD value at least -2.5 SD below the young adult mean is diagnosed as

Back 71

Osteoporosis

Front 72

Biomarkers of bone resorption are

Back 72

C-terminal and N-terminal telopeptides and urine deoxypyridinoline because they are by-products of collagen degradation

Front 73

Biomarkers of bone formation are

Back 73

bone-specific alkaline phosphatase; osteocalcin

Front 74

Laboratory tests include

Back 74

CBC, chem-7 including calcium corrected for albumin, serum PTH conc, TSH, and 24 hr urine collection for calcium, serum creatinine and BMD. (biomarkers are not for diagnosis only for drug selection)

Front 75

AACE goals for treatment of osteoporosis are

Back 75

prevent fractures, stabilize or increase bone mass, symptomatic relief of fractures and deformities, and enhance physical functionality

Front 76

Adults < 50 need ___ mg of calcium
Adults > 50 need ___ mg of calcium daily in divided doses (max 600 mg per dose)
Adults > 70 need ___ mg in divided TID

Back 76

1000 mg, 1200, 1500 (max is 600 per dose)

Front 77

T or F: Hormonal Replacement therapy may increase the risk of cardiovascular events

Back 77

True

Front 78

Selectively activates and blocks estrogenic pathways by binding to specific estrogen receptors - bone resorption is reduced and BMD is increased.

Back 78

SERMs (selective estrogen receptor modulator) (Evista - raloxifene)