• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/183

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

183 Cards in this Set

  • Front
  • Back
which type has reduction of c peptide due to destruction of beta cells
type 1
which type has normal insulin production
type 2
dx of dm

FBG value
>/= 126 mg/dl
dx of dm

random glucose value
> 200 mg/dl

+

symptoms
when will OGTT be used to dx dm
during pregnancy
dx of dm

A1C value
>/= 6.5%

symptoms

BG > 200
components of metabolic syndrome

abd obesity: men?

women?
men: > 40 in

women: > 35 in
components of metabolic syndrome

TG?
> 150 mg/dl
components of metabolic syndrome

HDL: Men?

women?
men: < 40

women: < 50
components of metabolic syndrome

BP?
> 130/85
components of metabolic syndrome

FPG:
> 110 mg/dl
fasting plasma glucose
not eaten in 8 hrs
preprandial glucose
before meals
postprandial glucose
1-2 hrs after meal
according to DCCT intensive tx resulted in delay in onset and slowing of progression of ----- complications
microvascular
for a person w/ IGT or IFG what the % weight loss and amount of phy activity recommended
5-10% weight loss

150 min/week
what would you consider for high risk patients who are obese and under 60 yrs of age
metformin
why consider metformin
less side effects
what drugs can induce hyperglycemia
beta blockers

diuretics

corticosteroids

pentamidine

phenytoin

sympathomemetics

nioctinic acid (keep dose below 1 gm)
what meds can induce hypoglycemia
salicylates in high doses

beta blockers

alcohol

quinine

pentamindine

ace inhibitors

insulin,sulfonylureas, repaglinide
how will b blockers cause hyperglycemia
decrease insulin secretion and tissue sensitivity to insulin
how will b blockers cause hypoglycemia
decreased glycogenolysis and warning signs
rapid acting
lispro (humalog)

aspart (novolog)

insulin glulisine (apidra)
short acting
regular ( humulin R, Novolin R)
intermediate acting
NPH (Humulin N, Novolin N)
long acting
insulin glargine (lantus)

insulin detemir (Levemir)
lispro (humalog)
rapid acting
insulin glargine (lantus)
long acting
NPH (humulin N, novolin N)
intermediate acting
regular (humulin R, Novolin R)
short acting
insulin glulisine (apidra)
rapid acting
aspart (Novolog)
rapid acting
insulin glargine (lantus)
long acting
NPH (humulin N, novolin N)
intermediate acting
regular (humulin R, Novolin R)
short acting
insulin glulisine (apidra)
rapid acting
aspart (Novolog)
rapid acting
70/30 is mixed w/
70% nph

30% regular
50/50 is mixed w/
50% nph

30% regular
75/25 is mixed w/
75% lispro protamine sulfate

25% lisporo
why add protamine
makes it longer acting
side effects of insulin
weight gain

hypoglycemia

lipohypertrophy

lipoatrophy
why should injection site be rotated
can cause lipohypertrophy
which insulins should you take just before a meal
rapid

short
which are basal
intermediate

long acting
rapid acting onset?

peak?

duration?
onset: 5-15 min

peak: 0.5 -1.5 hrs

duration: < 5
regular

onset?

peak

duration
onset: 30-60 min

peak: 2-3 hrs

duration: 5-8 hrs
When switching from bid NPH to glargine or detemir, reduce total daily NPH dose by --- %.
20%
When switching from bid --- to glargine or detemir, reduce total daily NPH dose by 20 %.
NPH
Least expensive oral agents available:
Sulfonylureas
Sulfonylureas exert their major effect on glucose by increasing ----- secretion from functioning beta cells in the pancrease and enchancing --- --- sensitivity
Insulin; beta cells
sulfo. also exert minor ---- ---- mechanism such as ----- hepatic glucose production and ----- insulin receptor sensitivity and/or number
extrapancreatic

decreasing

increasing
would you select a 1st or 2nd gen sulf?
a 2nd
SE of sulfon.
hypoglycemia

weight gain

GI (nausea, vomiting, heartburn)

hematologic rxns

skin rxns
---- gen sulf bind extensively to plasma proteins
1st
which 2nd gen of sulf has the highest incidence of hypoglycemia among 2nd generation agents
glyburide
initial dose of glyburide
usu 2.5 mg qd am

1.5mg qd am w/ micronized glyburide
how much glyburide do you give to get the desired effect
may have to give bid
max dose of glyburide
20 mg

12 w/ micronized
safest 2nd gen sulfon for pt w/ renal failure
glipizide
initial dose of glipizide
5 mg q day am
to get the desired effect how much glipizide should you give
glucotrol bid
how often is glucotrol xl given
daily
make dose for glucotrol?

glucotrol xl
glucotrol 40 mg

glucotrol XL: 20 mg
glimepiride is a true ---- daily sulfon
once
t/f

glimepiride binds to affect one part of the receptor complex
f

affects different parts of the complex
which of the 2nd gen will cause less hypoglycemia
glimepiride
ex of meglitinides
repaglinide (prandin)

nateglinide (starlix)
meglitinides stimulates the release of insulin from ---- beta cells
functioning
why is there less likely chance of getting hypoglycemia from meglit
insulin release is glucose dependent

the effects are dimished at low serum glucose conc
the least likely meg to cause hypoglycemia

most likely
least: repaglinide

most: glyburide
metabolism of meg can be inhibited by
antifungal agents

mycins, fluoxetine

nefazdoone
metabolism of meg induced by
rifampin

barbituates

phenytoin

carbamazepine
t/f

interactions of meg are shown w/ dig, theophylline, and warfarin
f
would you give repaglinide for someone who's never used it and a A1c of 9
no

their A1c should be < 8%: in that case they should be give a dose of 0.5 mg
you can give repaglinide to someone who's been treated an A1c >8% a dose of -- to ---
1 or 2 mg
how often should replig be taken
2, 3, 4 x a day 0-30 min before each day

Noncompliance!
for replig: skip a meal, ---- a dose; add a meal, --- a dose
skip

add
dosage of nateglinide
120 mg tid w/ meals

may start w/ 60 mg tid
ex of biguanides
metformin: glucophage, glucophage XR, fortamet, glumetza
t/f

metformin also available in combo
t
t/f

mod of action of metformin is to increase hepatic glucose production
f

decrease hepatic glucose formation
the 2ndary moa of biguan is to enhance --- muscle glucose uptake and ----- rate of GI glucose absorption
peripheral

reduce
t/f

biguan stimulates insulin release
f

it does NOT, but requires insulin presence to be effective
initial dose of biguan
500 mg bid

or

850 mg qd am
max dose of biguanide
2500 mg/day ( given 1000 mg q am, 500 mg q noon, 1000 mg q pm)

2550 mg/d ay (given 850 mg tid)
t/f

all doses of biguanides should be given w/ meals to reduce gi distress
t
t/f

metformin should be given tid
f

XR formulation given QD can also be given BID
why should you start low w/ big
to reduce GI effects
t/f

bigu causes weight gain and you have to watch out for hypoglycemia
f

neither happens
when can bigu cause hypoglycemia
in conjunction w/ sulfony, repag or insulin
very rare SE of bigu
lactic acidosis
risk factor of getting lactic acidosis in biguan
renal failure

radiographic dye studies

hypoxemia

sepsis

acute/chronic metabolic acidosis

liver impairment
s/s of lactic acidosis
malaise

myalgias

resp distress

somnolence

abd distress

hypothermia

hypotension
bigu have drug interactions w/
cimetidine: increase met conc by 60%

cationic drugs: amilirde, dig, vanco

so w/ these drugs you might have to reduce the dose of metformin
metformin decreases: -----, total and LDL cholesterol, and increases -----
triglycerides

HDL (slightly)
when should metformin be held
2 days prior to and 2 days after radiographic dye studies

check renal fx prior to restarting metformin
who should you measure Cr levels in when wanting to rx metformin
> 80 yrs old

pt w/ CrCl below 50-60 mg/dl
alpha glucosidase inhibitors examples
acarbose (precose)

miglitol (glyset)
alpha ---- carb absorption and thus reduces the increase in ------ glucose conc
delays

postprandial
t/f alpha affects absorption of lactose, fructose, glucose
f

does not
does alpha increase insulin levels or cause hypoglycemia when used along
no
if you double the dose of metformin what will you double the efficacy
no

you'll just double the SE
t/f

alpha works locally
t
initial dose of alpha
25 mg tid

some may start qd and then increase
when should alpha be given
w/ 1st bite of each meal
when is alpha dose adjusted
4-8 wk intervals
max dose of alpha
50 mg tid for patients less than equal to 60 kg

100 mg tid for over 60
how are alpha available
in 25, 50, 100 mg tabs
SE of alpha
mostly GI

abd pain/d, fatulence: these minimized slowly

elevated serum tranaminases: usu seen in high doses of 100 mg tid
why should you titrate alpha up
to prevent gi effects
what can reduce effect of acarbose and miglitol
digestive enzymes

intestinal adsorbents
miglitol can decrease these meds
dig

propranolol

ranitidine
alpha contraindicated in
inflammatory bowel disease

cirrhosis

colonic ulceration

partioal intestinal obstruction

dx of digestion or absorption

SCr > 2.0 mg/dl
alpha have a neutral or slightly favorable effect on:
total cholesterol

LDL

HDL

triglycerides
t/f

for hypoglycemia, ok to use sucrose
f

need fructose, glucose tabs or gel ( apple/orange, or fruit or lactose milk)
alpha delays absorption of ---
sucrose
thiazolidinediones examples
rosiglitazone (avandia)

pioglitazone (actos)
thia stimulate teh ----- proliferator-activator receptor-gamma (PPAR-gamma)
perioxisome

this increase insulin sensitivity
t/f

2ndary moa of thia: decreases hepatic glucose production
t
thia reduces --- insulin levels
plasma
thia requires presence of --- to be effective
insulin
SE of thia
weight gain, anemia, edema, CHF
who should not received thia
NYHA class 3 or 4 heart failure
use thia w/ caution w/ this med
insulin
t/f

thia will cause hypoglycemia when used along
f
when will there be a risk of hypoglycemia
when used w/ sulfon, repaglinide, insulin
don't give thia w/ osteoporosis
increase risk of bone fx
which test should you monitor w/ thia
LFT's
initial tx for rosi
4 mg/day po qd or bid
when can you increase rosi
after 12 weeks increase to 8 mgj/day po qd or bid
w/ combo when do you decrease sulf/insulin
if FBS falls below 120 mg/dl
t/f

ok to take rosi w/out meals
t

take w/o regard to meals
initail dose of pio
15-30 mg po qd
max dose of pio
45 mg qd
when do you decrease combo tx w/ pio
FBS below 120 mg/dl
t/f

ok to take pio w/ out meals
t
when will you not give thia
ALT > 2.5 x ULN
if on tx w/ thia when do you d/c
if ALT increases above 3 x ULN
with Thia what happens when ALT increases to more than 2.5 ULN
check LFT's more frequently until return to norm or increase
which thia will increase lipids
rosi
which will oral meds produce more insulin
due to incretins
incretin mimetics
GLP-1 agonist (byetta)

DPP-IV inhibitors ( januvia)
dpp-4 will ---- GLP or GIP
disintegrate
thru GLP and GIP will --- insulin thru beta an ---- glucagon thru alpha
increase

decrease
exanatide is indicated for --- tx of type 2 w/ metformin and/or sulfonyurea
adjunct
dose of byetta
5mcg sc bid
max dose of byetta
10 mcg sc bid
when should byetta be given
60 min before morning and evening meal
byetta --- gatric emptying, reduces food ----- and promotes beta cell proliferation
reduces

intake
when does byetta peak
2 hrs
are there sign reductions in A1c w/ byetta
no
when is byetta contraindicated
severe GI disease

severe renal impairment
SE of byetta
hypoglycemia

N/V (will go away in 2-3 weeks)

pancreatitis

antibody formation?
where should you keep byetta
fridge
cost of byetta
$200/month
sitagliptin (januvia) inhibits DPP-4 for up to -- hrs
24
dose of januvia
100 mg po q day as monotheraphy or in combo w/ metform or glitazone
if CrCl 30-50ml/min what's the does
50 mg po qd
CrCl<30ml/min
25 mg po qd
cost of januvia
$175
which is better to reduce A1c januvia or byetta
januvia

w/ baseline of 9 there's a reduction of up to 1.5%
amylin aka
pramlinitide (symlin)
amylin works w/ --- to suppress postprandial glucagon secretion and slow ---- absorption
insulin

carb
when does amylin peak
20 min
duration of amylin
3 hrs
s/e of amyline
N/V

anorexia
do not use amylin for --- pt
gastroparesis
when is amylin used
adjunct for type 1 or 2

uncontrolled patients using mealtime insulin
why might some not take amylin
they might already be on insulin, so 2 shots needed
amylin dose for type 1
15mcg sc prior to each meal

titrate 30-60 mg
amylin dose for type 2
60 mcg sc prior to each meal

titrate to 120 mcg
how much does amylin reduce PPG by
65-125 mg/dl in Type 1
ADA

A1c
<7%
ada

preprandial glucose:
70-130 mg/dl
ada

postprandial
< 180 mg/dl
ada

bedtime
< 140 mg/dl
ada

Bp
< 130/80
ada

lpids
< 70

or

< 100 mg/dl
ada

TG
< 150 mg/dl
ada

HDL
>40 mg/dl
aace

a1c
< 7%
aace

fpg
<110