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Flashcards in Quiz 2 Deck (83)
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1
Q

Retinopathy treatments

A

no specific drugs

photocoagulation procedure may slow-but not really reverse

2
Q

retinopathy prevention

A

Fundoscopic exams
BP control <140/80
smoking cessation
glycemic control

3
Q

Fundoscopic exam & nephropathy screening in TYPE 1 for retinopathy prevention

A

within 5 years post-diagnosis then yearly

4
Q

Fundoscopic exam & nephropathy screening in TYPE 2 for retinopathy prevention

A

at diagnosis (once stable) then yearly

5
Q

______ is a predictor/risk factor for subsequent renal insuffiecienies

A

microalbuminuria

6
Q

Nephropathy screening

A

yearly if microalbuminuria not already diagnosed

7
Q

urine albumin excretion

A

Gold standard. Random spot urine albumin/creatinine ratio

if positive, repeat test 2-3X in 6 months-> if 2/3 are abnormal= diagnosis

8
Q

Spot creatinine values (microg/mg)

A

normal: 300

9
Q

Nephropathy treatment

A

no real treatment can reverse (some regression)
- ACE-inhibitors/ARBs
Prevention!- control HTN/lipids/GLU, smoking cessation, annual assessment for microalbuminuria

10
Q

ACE-inhibitors & ARBs in nephropathy treatment

A
slows progression (may slightly reverse)
treat even if normotensive
11
Q

protein restriction in nephropathy

A

once proteinuria occurs

  1. 8-1g/kg/day in early stages (GFR>60)
  2. 8g/kg/day in later stages (GFR<60)
12
Q

Diabetic neuropathy include

A

periphery neuropathy

GI/GU abnormalities

13
Q

Peripheral neuropathy

A

reduced/loss sensation
painful neuropathies
ranges from numbing/tingling/burning/lancinating pain
major risk factor for foot ulcers/amputations

14
Q

Neuropathic pain treatment

A
focused primarily on symptomatic relief
anticonvulsants/AEDs
antidepressants (lower doses)
capsaicin cream
NSAIDs/pain meds
15
Q

Anticonvulsants/Antiepileptic drugs for neuropathic pain

A

Gabapentin: most commonly used
pregabalin (Lyrica): only one FDA approved for neuropathic pain/tid dosing
phenytoin
carbamazepine

16
Q

Antidepressents for neuropathic pain

A
tricyclinc antidepressants (TCAs): cheap/anticholinergic side effects
Duloxetine (Cymbalta): only FDA approved antidepressant; expensive; GI side effects
17
Q

prevention of diabetic foot ulcers

A

glycemic & HTN control
smoking cessation
proper foot care & inspections

18
Q

diabetic foot ulcers can turn into:

A

osteomyelitis or gangrene

19
Q

duration of treatment is ____ & healing is_____ in diabetics

A

increased; slower

20
Q

Diabetic foot ulcer treatment

A

wound debridement
pressure relief
oxygen therapy
regranex gel (topical GH): inc tisue granulation & healing

21
Q

dyslipidemia in DM

A

High TG & low HDL

LDL- may have ok #, but density may be different

22
Q

Lipid ADA goals in DM

A

LDL40(men); >50 (women)

23
Q

____ are the best at LDL reduction & are the preferred agent

A

statins

use regardless of baseline LDL in: patients w/ CHD or 40+ w/ >1 CVD risk (HTN/proteinuria/smoke)

24
Q

Dyslipidemia in DM treatment

A

> TGs: fibric acid derivative (gemfibrozil/fenofibrate) or niacin

<HDL: Niacin
limit use of niacin- lots of ADRs & do not use if significant hyperglycemia exists

25
Q

hypertension in DM

A

comorbidity in ~20-60% of DM
significantly increases complications with DM +HTN
aggressive control
likely will need multiple meds

26
Q

goal BP for diabetics

A

<140/80

27
Q

most advantages med for HTN in DM

A

ACE-inhibitors: kills 2 birds with one stone (also nephropathy)

28
Q

Other treatment options for HTN in DM

A

thiazides: may increase GLU; ok at low levels
CCBs
Beta-blockers: can mask hypoglycemia; reduces complications

29
Q

HTN treatment in DM ADA guidelines

A

Should contain either ACE-I or ARB

Add thiazide/amlodipine (w/ GFR<30)

30
Q

antiplatelet therapy in DM

A

Aspirin
secondary CHD prevention: everyone
primary CHD prevention: >50 (men), >60 (women) AND >1 CHD risk factor (family history, smoke, proteinuria, dyslipidemia, HTN)

31
Q

Aspirin dose in DM

A

75-162mg/daily

32
Q

therapeutic glycemic goals in DM

A

fasting glucose: 70-130

postprandial glucose: <7%

33
Q

corner stone of therapy for DMT2

A

diet & exercise

34
Q

if initial presentation is hyperglycemia PLUS weight loss, use ____ as initial therapy

A

insulin

35
Q

Usually first line therapy for DMT2

A

oral agents

36
Q

non-insulin agents contraindications/precautions & drug interactions

A
  • DMT1, diabetic ketoacidosis, pregnancy

- beta blockers: masks hypoglycemia

37
Q

sulfonylureas & metaglinides can cause ____ & ____ and reguire ____

A

weight can and hypoglycemia

require functioning beta cells

38
Q

sulfonylureas work on

A

mainly fasting blood sugar, some postprandial

39
Q

metaglinides work on

A

postprandial blood sugar

40
Q

biguanide

A

metformin

41
Q

metformin MOA

A

decreases gluconeogenesis, decreasing endogenous GLU; first line therapy

42
Q

Black box warning for metformin in:

A

renal impairment: SCr >1.5 (men) & >1.4 (women)

can lead to lactic acidosis

43
Q

metformin side effects

A

weight loss
diarrhea
lactic acidosis- renal impairment

44
Q

characteristics of a best response with Metformin

A
central obesity (weight loss/weight neutral)
mild-moderate hyperglycemia
insulin resistance strongly suspected
1st line therapy
trends toward reducing CV risk
45
Q

Thiazolininediones (TZDs) MOA

A

increase peripheral sensitivity to insulin-> increase GLU uptake

46
Q

avoid TZDs in___

A

active liver disease or increased AST/ALT >2.5X normal

contraindicated in CHF 3 & 4

47
Q

Rosiglitazone (Avandia) controversies

A

suggested increased risk of CV events

2013 FDA lifted restrictions

48
Q

Pioglitazine (Actos) controversies

A

increase bladder cancer?

49
Q

Alpha-glucosidase inhibitors (AGI)

A
acarabose (precose)
Miglitol (Glyset)
blocks carb absorption/breakdown in the gut
effects postprandial BS only
only works when taken with food
50
Q

Alpha-glucosidase inhibitor main complaint & contraindication

A

gas

contraindicated in GI disorders

51
Q

GLP-1 agonist efficacy

A

shorter acting: reduce postprandial glucose

longer acting: reduce fasting & postprandial glucose

52
Q

GLP-1 agonist side effects

A

Nausea, hypoglycemia, weight loss (pro)

53
Q

DPP_4 inhibitors reduce

A

postprandial sugars; often used in combo with other agents

54
Q

SGLT-2 inhibitors MOA

A

prevent reabsorption of sugar from the urine (pee out more sugar)

55
Q

SGLT-2 inhibitors side effects

A
weight loss (pro)
genitourinary infections (women>men), >K, <kidney function
dont use in renal impairment
56
Q

Bromocriptine (cycloset)

A

DA agonist
may reset circadian rhythms
dose in AM w/in 2 hours of waking

57
Q

Colsevelam (WelChol)

A

Bile acid sequestrant that reduces fasting blood sugars; may <intestinal glucose absorption
6-8 pills/day

58
Q

Weight: obese pts, use:

A

Metformin or GLP-1

59
Q

Renal insufficiency, do NOT use

A

metformin or glyburide

60
Q

hepatic insufficiency, do NOT use

A

TZD, glipizide

61
Q

Heart failure, do NOT use

A

TZD or metformin

62
Q

if monotherapy fails:

A

add second oral agent (or possibly insulin)

63
Q

If dual oral combo fails:

A

add third oral agent or begin insulin

64
Q

insulin should be considered if:

A

failing combo therapy (keep sensitizers)

initial presentation is hyperglycemia + weight loss

65
Q

Basal-bolus goal

A

to replicates physiologic release to match body’s needs

66
Q

basal component

A

homeostatic glucose release by liver

increases nocturnal glucose release

67
Q

bolus (prandial) component

A

elevated glucose- postprandial, excursions

68
Q

slow acting insulin products

A

lispro, aspart, glulisine, regular

69
Q

longer acting insulin

A

NPH, detemir, glargine

70
Q

Route of insulin administration

A

SQ

if given IV- would be used up in 5-10 minutes; regular insulin is the only one approved for IV admin

71
Q

rarely use once daily insulin in DMT2 alone without:

A

oral meds

72
Q

Insulin indicated in DMT2:

A

oral failure

once daily: A1C8.5% (TDC) or >9% (ADA)

73
Q

cannot use once daily insulin in:

A

type 1 diabetes

74
Q

once daily insulin starting dose

A

0.1-0.25u/kg

75
Q

short-acting insulin pearls

A

role is to lower postprandial hyperglycemia

aka bolus insulin

76
Q

NPH pearls

A

AKA intermittent acting
cloudy
can be mixed with R or rapid acting
variability

77
Q

Glargine pearls

A

peakless
cannot be mixed (acid)
may burn
decrease hypoglycemic events

78
Q

detemir pearls

A

dose dependent duration

cannot mix with other insulins

79
Q

two daily injections

A
require meals to be at certain times
requires constant carb intake-snacks needed
risk for overnight hypoglycemia
difficult to achieve treatment goals
Breakfast-Rapid & NPH
Supper-Rapid & NPH
80
Q

three daily injections

A

decreases risk for overnight hypoglycemia
still requires constant carbs & meals at certain times
breakfast-rapid & NPH
supper- rapid
bedtime snack-NPH

81
Q

true basal-bolus injection regimen

A

4+ injections

Breakfast, lunch, supper-rapid acting & bedtime snack- glargine

82
Q

single insulin given

A

in the evening (supper or PM snack)

83
Q

Type 1 and 2 initial daily dose of insulin (u/kg/day)

A

0.5 for both initially
T1: 0.3-0.5
T2 :0.2-0.6