Diabetez pt 1 (basics, oral meds) Flashcards Preview

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Flashcards in Diabetez pt 1 (basics, oral meds) Deck (42)
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1
Q

When do we treat prediabetes with pharm therapy and what do we use? How often do we monitor?

A

When BMI is greater than 35, age < 60, or women with history of gestational diabetes

Use metformin

Monitor annually

2
Q

Gestational diabetes - goals? Treatment?

A

Fasting < 95, 1-hour post meal < 140, 2-hours post meal < 120

Insulin is preferred treatment

3
Q

When should we test someone for T2DM? How often should we repeat if tests are normal?

A

Screen adults who are overweight or obese (BMI > 25 or > 23 in Asian Americans) and who have one or more additional risk factor

Test after age 45 regardless of risk factors

Normal test results should be repeated every 3 years

4
Q

Waist circumference goals

A

< 35 in for females, < 40 in for male

5
Q

Nutritional supplements recommended

A

Omega-3 fatty acids (EPA and DHA) and omega-3 linolenic acid (ALA)

6
Q

Carbohydrate serving is how many grams?

A

15

7
Q

Which diabetic agents have been shown to decrease cardiovascular and all-cause mortality when added to standard treatment?

A

Empagliflozin (Jardiance)

Liraglutide (Victoza)

8
Q

When should aspirin be added to diabetes therapy?

A

Primary prevention: age > 50 years who have diabetes and at least one additional ASCVD risk factor

Secondary prevention: everyone

9
Q

When are statins recommended with diabetes therapy?

A

In most patients with diabetes, intensity of dosing is based on ASCVD risk
ACC/AHA: Recommend high intensity in patients age 40-75 who have diabetes plus ASCVD risk

ADA recommends:
Age < 40 years, only if they have ascvd risk factors
Age > 75 years, mod intensity of they have no risk factors or mod/high if they have risk factors

10
Q

Preferred anti-htn in diabetes?

A

ACEi or ARB preferred in patients with albuminuria (urine albumin > 30 mg/24 hours or UACR > 30 mg/g)

Otherwise any agent from the preferred classes are fine

11
Q

How to monitor for renal disease progression in diabetes?

A

Annual urine albumin excretion

12
Q

How to monitor for retinopathy in diabetes?

A

Eye exams every 2 years

Women with preexisting diabetes who become pregnant: higher risk, check each trimester and up to 1 year postpartum

13
Q

How to monitor for neuropathy?

A

Assess annually using 10-g monofilament and at least one additional test (pinprick, temperature, or vibration sensation)

14
Q

Preferred agents for neuropathy per the ADA?

A

Duloxetine, pregabalin

15
Q

How to monitor for foot ulcers etc?

A

Comprehensive foot exams once per year

All patients with diabetes should inspect their feet daily

16
Q

Foot care counseling

A

Underlined:
Check feet every day
Avoid walking barefoot
Protect feet from hot and cold

17
Q

Vaccinations for patients w diabetes

A

Annual flu
Pneumococcal (23 x 1 between age 2-64
13 then 23 after age 65, spaced at least 1 year apart and 23 separated by 5 years after previous admin)
Hepatitis B vaccine? approved ages 19-59, per ACIP can be used in age > 60

18
Q

How often should A1C be measured?

A

Quarterly

19
Q

Drugs that can cause hyperglycemia

A
Beta blockers (or hypo)
Diuretics (thiazides/loop)
Immunosuppressants (cyclosporine, tacrolimus)
Niacin
Protease inhibitors
Quinolones (or hypo)
Second-gen antipsychotics
Statins
Steroids
20
Q

Janumet

A

Metformin and sitagliptin

21
Q

Qtern

A

Saxagliptin and dapagliflozin

DPP-4 inhibitor and SGLT2 inhibitor

22
Q

Xultophy

A

Liraglutide and insulin degludec

GLP-1 agonist + long acting insulin

23
Q

Soliqua

A

Lixisenatide and insulin glargine

GLP-1 agonist + long acting insulin

24
Q

Metformin boxed warnings

A

Lactic acidosis, increased risk with intravascular iodinated contrast, age > 65, hypoxic states, dehydration, alcohol

Underlined: contrast, alcohol, eGFR stuff

25
Q

Renal dosing metformin

A

based on eGFR
Contraindicated in eGFR < 30
Not recommended to initiate if between 30-45, assess benefit if already taking if eGFR < 45 and already taking

26
Q

Side effects metformin

A

N/V/D
Flatulence
Abdominal cramping (give w/ meal)
Vitamin B12 deficiency

27
Q

Sulfonylureas and meglitinides MOA

A

Insuline secretagogues; work by stimulating insulin secretion from the pancreatic cells to decrease postprandial blood glucose

28
Q

Sulfonylureas and meglitinides side effects, counseling

A

Meglitinides (nateglinide, repaglinide): Take 15-30 mins before meals
Sulfonylureas: once or twice daily

Can cause weight gain, hypoglycemia
Take before meals (sulfonylureas take 30 min before breakfast, except glipizide IR take 30 mins before any meal
Hold doses if NPO!

29
Q

True or false: It’s ok to use sulfonylureas and insulin together

A

False - high risk of hypoglycemia

30
Q

Thiazolidinediones MOA

A

Increase peripheral insulin sensitivity by agonizing PPAR-gamma receptors

31
Q

Actos dosing, generic, drug class, contraindications/warnings, side effects

A

Pioglitazone
Thiazolidinediones
15-30 mg daily
Contraindicated in Class III/IV heart failure
Can cause hepatic failure, edema (including macular edema)
Increased risk of bladder tumors, do not use in patients with active bladder cancer
Can cause peripheral edema, weight gain
Monitor for s/sx of HF

32
Q

SGLT-2 inhibitors MOA

A

Increases reabsorption of filtered glucose in the proximal renal tubule (underlined)
Increases urinary glucose excretion

33
Q

Invokana generic, MOA, dose

A

Canagliflozin
100 mg daily but can inc to 300 mg daily
Decrease based on eGFR - if 45-59, dec to 100 mg daily max
Not recommended in 30-44, contraindicated < 30
SGLT-2 inhibitor

34
Q

SGLT2 inhibitor boxed warnings, warnings, side effects, monitoring

A

Canagliflozin has a boxed warning for increased risk of leg and foot amputations
Contraindicated in eGFR < 30
Warnings of ketoacidosis, genital mycotic infections, urosepsis, and pyelonephritis
Also can cause intravascular volume depletion (hypotension, dehydration) when used with diuretics, RAAS inhibitors, or NSAIDs
Canagliflozin can cause hyperkalemia
Side effects: wt loss, hypoglycemia
Monitor: renal fx

35
Q

Jardiance generic, MOA, dose

A
Empagliflozin
SGLT-2 inhibitor
10 mg daily, up to 25 mg daily
Not recommended in eGFR 30-44
Contraindicated eGFR < 30
36
Q

DPP-4 inhibitor MOA

A

Increases insulin release from pancreatic beta cells and decreases glucagon excretion from pancreatic alpha cells

37
Q

Januvia generic, MOA, dose

A
Sitagliptin
DPP-4
100 mg daily
CrCL 30-49: 50 mg daly
CrCL < 30: 25 mg daily
38
Q

Warnings w DPP-4, side effects, counseling

A

DPP-4
Acute pancreatitis
Saxagliptin (Onglyza) and alogliptin (Nesina) can inc risk of heart failure

SIde effects: nasopharyngitis, URTI’s, UTI’s

39
Q

Onglyza generic, MOA, dose

A

Saxagliptin
DPP-4 inhibitor
2.5-5 mg daily
eGFR < 45: 2.5 mg daily

40
Q

Tradjenta generic, MOA, dose

A

Linagliptin
DPP-4
5 mg daily
No renal dose adjustment!

41
Q

Nesina generic, MOA, dose

A
Alogliptin
DPP-4
25 mg daily
eGFR 30-59: 12.5 mg daily
< 30: 6.25 mg daily
42
Q

Which drugs require glucose (not sucrose) for tx of hypoglycemia if caused by another drug?

A

Acarbose (Precose) or miglitol Glyset)
These block metabolism of intestinal sucrose, which delays glucose absorption to reduce BG
Need glucose gel or tablets if pt is on these

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