Term
True/False: Type I DM accounts for 10% of all diabetes and results from an autoimmune destruction of the beta cells of the islet of langerhans of the pancreas which leads to insulin deficiency. |
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Definition
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Term
True/False: The pancreas is the major organ involved in Type I diabetes. In type II DM, the liver and endocrine system are the major players. |
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Definition
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Term
What role does the GI system play in regulating the secretion of insulin (specifically GLP-1)? |
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Definition
GLP-1 is decreased following a meal |
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Term
True/False: A year of compensatory hyperinsulinemia may occur before the onset of clinic sx of Type II DM. Eventually the beta cell responsiveness to glucose stimulus diminishes and hyperglycemia prevails. |
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Definition
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Term
What other d/o are a/w DM? |
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Definition
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Term
How does insulin work to lower blood sugar? |
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Definition
- Stimulates peripheral glucose uptake
- Inhibits hepatic glucose production
- Inhibits lipolysis
- Inhibits proteolysis
- Enhances protein synthesis
- Acts on the liver to increase storage of glucose as glycogen
- Decreases urea production, protein catabolism, and CAMP in the liver
- Tryiglyceride synthesis
- Increases k+ and phosphate uptake by the liver
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Term
First class used to treat type II DM |
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Definition
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Term
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Definition
Increase endogenous insulin secretion by the beta cells |
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Term
Contraindications for sulfonylureas |
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Definition
- Ax to sulfonamids, thiazides
- Nursing mothers
- Type I DM
- DKA, uncontrolled infection, burns, trauma, pts w/ adrenal or pituitary insufficiency
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Term
Glyburide is pregnancy category: |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
- Increases peripheral glucose uptake and utilization
- Decreases hepatic glucose production
- Decreases intestinal absorption of glucose
- Does NOT stimulate insulin release from pancreatic beta cells so the risk for hypoglycemia is minimal **
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Term
Precautions and contraindications of biguanides: |
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Definition
- Renal dz
- Metabolic acidosis
- Deyhdration
- Chronic alcoholism
- Lactic acidosis
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Term
Biguanides may be used for prevention of ___ DM. May also lead to ____. |
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Definition
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Term
Patient education on biguanides |
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Definition
- Warn about nausea & GI disturbance
- Warn about s/sx lactic acidosis
- Hypoglycemia NOT common
- Warn about potential metallic taste in mouth
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Term
Examples of alpha-glucosidase inhbitors |
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Definition
- Acarbose (Precose)
- Miglitol (Glyset)
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Term
MOA of alpha-glucosidase inhibitors |
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Definition
Inhibit and delay absorption of carbs from the small bowel |
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Term
Educate pt that while on alpha-glucosidase inhibitors, they may experience _____, but ____ is not an issue. |
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Definition
- Intestinal flatus & abd distention
- Hypoglycemia NOT issue.
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Term
Metabolism of alpha-glucosidase inhibitors: |
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Definition
Metabolized exclusively by intestinal bacteria and digestive enzymes |
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Term
Precautions and contraindications of alpha-glucosidase inhibitors: |
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Definition
Do NOT use in pts w/ IBD, bowel obstruction, chronic intestinal dz
*Pregnancy cat B (but we never use in pregnancy)* |
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Term
Patient education with alpha-glucosidase inhibitors: |
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Definition
- Take w/ 1st bite of meal
- Usual tx for hypoglycemia DOES NOT work! (Treat w/ 8 oz milk or lactose tabs. If severe, tx w/ glucose or glucagon.)
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Term
Main brand thiazolidinedione |
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Definition
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Term
MOA of thiazolidinediones (Avandia) |
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Definition
- Improve insulin action in cell which leads to increased utilization of available insulin
- Decrease hepatic glucose production
- No hypoglycemia
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Term
Black box warning with Avandia: |
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Definition
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Term
Avandia is pregancy category ___. |
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Definition
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Term
Patient education w/ thiazolidinediones |
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Definition
- Advise pt to report STAT any s/sx hepatocellular injury: N/V, abd pain, fatigue, anorexia, jaundice, dark urine
- Advise about cardiac risk: CP, SOB, peripheral edema
- Females using OCP should use an additional form of BC, consider IUD, or increase their dose
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Term
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Definition
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Term
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Definition
Short acting insulin secretagogues
*Dosed TID no more than 20 mins before meals* |
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Term
Precautions with meglitinides |
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Definition
Not recommended in debilitated, malnourished pts at risk for hypoglycemia |
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Term
Drug interactions w/ meglitinides: |
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Definition
- Ketoconazole
- Miconazole
- EES
- Repaglinide
All increase risk of hypoglycemia |
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Term
Examples of dipeptidyl peptidase-4 inhibitors (gliptins) |
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Definition
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Term
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Definition
Absorbed in GI tract. Don't have to take w/ food. |
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Term
Caution use of gliptins in: |
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Definition
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Term
Gliptins are pregnancy category _. |
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Definition
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Term
Drug interactions with gliptins |
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Definition
Increased risk of angioedema w/ ACE-I |
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Term
Examples of glucagon-like peptide-1 agonists |
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Definition
Byetta, liraglutide (submitted for FDA approval) |
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Term
MOA of glucagon-like peptide-1 agonists |
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Definition
GLP-1 agonists directly bind to GLP-1 receptors in pancreatic beta cells and acts as incretin mimetic |
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Term
How is byetta (glucagon-like peptide-1 agonists) given? |
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Definition
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Term
Glucagon-like peptide-1 agonists are pregnancy category __. |
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Definition
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Term
Example of amylin agonists |
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Definition
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Term
Precautions and contraindications of amylin agonists: |
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Definition
- Closely monitor older adults
- Risk for hypoglycemia increases if given with insulin
- Pregnancy category C
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Term
Black box warning w/ amylin agonists:
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Definition
Increased risk severe hypoglycemia when used w/ insulin |
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Term
Amylin agonists dosing w/ type I DM: |
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Definition
Start @ 15 mcg & go up 15 mcg increments as tol to 30 to 60 mcg
*If nausea: reduce back to 30 mcg* |
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Term
Amylin agonists dosing w/ Type II DM: |
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Definition
- Initiate @ 60 mcg
- Decrease dose of preprandial rapid acting or short acting insulin by 50%
- Increase to 120 mcg when no clinically sig. N/V has occurred for 3-7 days
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Term
Patient education w/ amylin agonists: |
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Definition
- Administer SQ (NOT in the upper arm)
- Give STAT AC containing at least 250 kcal or @ least 30 grams carbs
- Can NOT be mixed w/ any form of insulin
- Admin @ least 2 inches from site where insulin is administered.
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Term
Why would glucagon be administered? What route? |
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Definition
- Reverse hypoglycemia
- IM, IV, SQ
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Term
Onset of action for lispro, aspart, glulisine: |
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Definition
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Term
lispro, aspart, glulisine peak effect: |
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Definition
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Term
Duration of action of lispro, aspart, glulisine: |
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Definition
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Term
onset of action of regular insulin |
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Definition
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Term
peak effect of regular insulin |
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Definition
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Term
duration of action of regular insulin |
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Definition
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Term
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Definition
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Term
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Definition
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Term
duration of action of NPH |
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Definition
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Term
onset of action of insulin glargine |
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Definition
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Term
peak of action of insulin glargine |
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Definition
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Term
duration of action of insulin glargine |
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Definition
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Term
onset of action of insulin detemir |
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Definition
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Term
peak effect of insulin detemir |
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Definition
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Term
duration of action of insulin detemir |
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Definition
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Term
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Definition
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Term
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Definition
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Term
duration of action of NPL |
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Definition
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Term
What are the 3 main types of TRH? |
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Definition
- Levothyroxine (T4)
- Liothyronine (T3)
- Litri (4:1 mixture of T4)
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Term
How much levothyroxine is absorbed after PO administration? |
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Definition
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Term
What increases absorption and when should levothyroxine be taken? |
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Definition
Fasting increases absorption and it should be taken prior to breakfast. |
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Term
When is thyroid replacement therapy contraindicated? |
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Definition
After recent MI or in thyrotoxicosis uncomplicated by hypothyroidism |
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Term
Long term levothyroxine therapy has been a/w what? |
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Definition
Decreased bone density in the hip and spine. |
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