Pharmacology Exam 3 Diabetes Drugs

Front 1

3 Pathophysiologic mechanisms in Type I diabetes

Back 1

1) Insufficient insulin production
2)Production of ineffective insulin
3) Destruction of produced insulin

Front 2

2 pathophysiologic mechanisms in Type II diabetes

Back 2

1) Decreased release of insulin
2) Decreased response to insulin in the cells due to low # of insulin receptors

Front 3

What is the hormone responsible for insulin antagonism in GDM?

Back 3

HPL (Human Placental Lactogen)

Front 4

Ketoacidosis is a feature of which type of diabetes?

Back 4

Type I

Front 5

Why is insulin not bioavailable orally?

Back 5

It is a protein and is digested in the stomach

Front 6

5 types of insulin classified by duration of action

Back 6

Rapid acting
Short acting
Intermediate acting
Combination (70/30)
Basal

Front 7

Onset and uses of rapid acting insulin (lispro, aspart, glulisine)

Back 7

Immediate treatment of blood sugar, given with meals or in an insulin pump

Front 8

Onset and uses of short acting insulin (Regular)

Back 8

Onset= 30-60 minutes
Use before meals

Front 9

Onset and use of intermediate insulin (NPH)

Back 9

Onset 3 hours
Used BID

Front 10

How often is combination insulin (70/30) given?

Back 10

BID

Front 11

Name 3 rapid acting insulins

Back 11

lispro (Humalog)
aspart (Novolog)
glulisine (Apidra)

Front 12

Onset, peak, duration of rapid acting insulins

Back 12

Onset= 5-15 minutes
Peak- 1 hr
Duration - 3-5 hours

Front 13

2 advantages of rapid acting insulin

Back 13

Mimics endogenous prandial insulin secretion

Allows tight control while allowing dosing immediately before meals

Front 14

Which insulin is preferred for subcutaneous insulin infusion devices?

Back 14

Rapid acting

Front 15

Which is the short-acting insulin?

Back 15

Regular

Front 16

Onset, peak, and duration of short acting (Regular) insulin

Back 16

Onset - 30 min
Peak 2-3 hrs
Duration - 3-5 hrs

Front 17

Which insulin can be administered IV?

Back 17

Short acting (Regular)

Front 18

Timing for short-acting insulin

Back 18

30-45 minutes before meal

(Has delayed absorption)

Front 19

Onset, duration, and intensity of peak increase with increasing doses in which 2 insulin types?

Back 19

Regular
NPH

(how does dose regulate action profile?)

Front 20

Intermediate insulin

Back 20

NPH (isophane)

Front 21

Onset, duration, and peak of intermediate (NPH) insulin

Back 21

Onset -- 2-5 hrs
Duration - 4-12 hrs

Front 22

NPH is typically mixed with which other insulins

Back 22

rapid acting or
short acting

Front 23

Timing of NPH insulin

Back 23

Given BID, often mixed with Regular

Front 24

Which are the 2 "basal" or long acting insulins?

Back 24

glargine (Lantus)
detemir (Levimir)

Front 25

Unique features of glargine?

Back 25

Once daily dosing

Front 26

Preferred test for diagnosis of diabetes mellitus in children and adults

Back 26

Fasting plasma glucose

Front 27

3 classic symptoms of DM

Back 27

Polydipsia
Polyuria
Unexplained wt loss

Front 28

Dx criteria for DM

Back 28

1) Symptoms + casual glucose > 200

2) Fasting (no food x 8 hrs)plasma glucose 126 or >

3) 2 hr plasma glucose 200 or > during OGTT

Confirm testing on a different day

Front 29

Dx criteria for impaired fasting glucose (IFG) aka pre-diabetes

Back 29

FPG (fasting plasma glucose) 100-126

Front 30

10 risk factors for DM

Back 30

Obesity
Habitually physically inactive
High risk ethnic group (Native American, Latino, Asian Americans, Pacific Islanders)
1st deg diabetic relative
Hx GDM or baby > 9 lbs
Hx IFG or IGT
Hypertensive
Low HDL or high triglycerides
Have PCOS
Hx vascular disease

Front 31

Recommendations for prevention/delay of Type 2 DM (6)

Back 31

Weight loss
Exercise
Counseling
Manage other CVD risks
Monitor q1-2 yrs
Pretx with meds not recommended at this time

Front 32

Guideline for protein intake in diabetics

Back 32

RDA = 0.8 g/kg

or approx 10% daily calories

Front 33

Guidelines for fat intake in diabetes

Back 33

Total fat 25-35% daily intake
Saturated fat < 7%
Minimize trans fats

Front 34

HbA1c goal

Back 34

<7% (and as close to 6% as possible without causing hypoglycemia)

Front 35

Pts on insulin or insulin secretagogues should add carbs if pre-exercise glucose levels are _________

Back 35

< 100 mg/dL

Front 36

Exercise goals in diabetes

Back 36

150 min/wk moderate aerobic +/or 90 min vigorous

Exercise at least 3 d/wk
No more than 2 consecutive inactive days

Front 37

Resistance exercises for Type 2 DM?

Back 37

Yes.
3x/wk
All muscle groups
3 sets of 8-10 reps with max wt

Front 38

T or F

Protein should be added to carbs to correct hypoglycemia

Back 38

False

Protein will not affect glycemic response and will not prevent subsequent hypoglycemia.

Front 39

Immunization recommendations for diabetics

Back 39

Annual influenza
Pneumococcal at least once (repeat p age 65 if 1st one given age < 64 and longer than 5 yrs ago)

Front 40

BP goals in diabetes

Back 40

Systolic < 130
Diastolic < 80

Front 41

Actions of sulfonylureas (2)

Back 41

Increase insulin secretion
Increase tissue insulin receptor sensitivity

Front 42

Major adverse effect of sulfonylureas

Back 42

Hypoglycemia

Front 43

Per ADA, first line drug in DM type 2

Back 43

Metformin

Front 44

Action of metformin (2)

Back 44

Enhances receptor sensitivity
Inhibits gluconeogenesis and glycolysis

Front 45

Metformin side effects:
Common -
Rare (but major)

Back 45

Common - GI sxs (transient and dose related)
Rare - lactic acidosis

Front 46

Pregnancy classification for sulfonylureas

Back 46

C (per King, can be used)
Lactation unknown to unsafe

Front 47

Metformin --
pregnancy and lactation?

Back 47

Preg cat B
Lactation safe per Hale

Front 48

Metformin contraindications

Back 48

Renal or hepatic disease, COPD (d/t lactic acidosis risk)

Front 49

Sulfonylureas -- drug interactions

Back 49

Multiple -- highly protein bound. Other sulfas, NSAIDS, cimetidine, ranitidine

Front 50

Which of the TZDs (aka glitazones) has few drug interactions?

Back 50

Avandia (rosiglitazone)