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Diabetes Pharm 331
| Question | Answer |
|---|---|
| What are the s/s of diabetes? | polyuria polydypsia polyphagia ketosis acidosis muscle breakdown ^bun ^blood sugar Thickening of basement membranes |
| What does it mean when there's a thickening of basement membranes and where does it affect the most? | The capillary beds get thicker eyes, kidneys |
| What is the most effective test to check blood glucose management? | HbA1c |
| What is the goal for a HbA1c level? | less then or equal to 7 |
| What are the endocrine functions that the pancreas performs? | Alpha cells: ^glycogen release, ^ blood sugar Beta cells: release insulin, lower blood sugar Delta cells: decrease blood sugar, blocks insulin and glucagon, slows GI emptying |
| What causes insulin to be released? | Insulin released in response to incretins (GLP-1), released when you eat |
| What metabolizes incretins? | DDP-4 metabolizes incretin, which halts the release of insulin, stimulates production of glycogen. |
| What vitamin is needed to push glucose into cells? | K+ |
| What is adiponectin? Where does it come from and how does it influence glucose management? | secreted by fat cells increase insulin sensitivity decrease the release of glucose from liver |
| What 4 things increase insulin in the bloodstream? | Catecholamines Corticosteroids Norep. and Epi Growth hormone |
| What are the ideal glucose levels for critically ill and non-critically ill patients? | critically ill: 140-180 ml/dl non critically ill: 140 ml/dl pre-meal or less then 180 randomly |
| What are the s/s hyperglycemia? | fruity breath thirst, hunger, glucose in urine ketoacidosis Kussmull respirations to decrease acid levels Dry, warm, flushed skin tachycardia, hyPOtension |
| What are the s/s hypoglycemia? What is the Blood glucose level indicitive of hypoglycemia | less then 40 ml/dl Diaphoresis ^ BP parasymp. stimulation Cool, clammy skin sudden onset Anxiety seizures, weakness, muscle spasms tachycardia, hypERtension, palpitation |
| What are the three rapid acting insulins? When do you have to take them in regard to meals? | Lispro Aspart Glulisine 15 min before meals-if delay could cause hypoglycemia |
| What is short acting insulin? When do you have to take it with regard to meals? | Regular insulin 30 min before meal |
| When do you check fasting blood glucose? When do you check post-prandial glucose levels? | fasting: before eating in the morning PP: 2 hours after meal |
| Which insulins can you mix in the same syringe? Which insulins are NEVER to be mixed? | Rapid acting/regular and NPH ok to mix-clear before cloudy, always rapid first, NPH last Never mix glargine or detamir |
| Which two insulins are considered basal insulins? When are they given with regard to meals? How long do they last for? | Glargine and Detamir are basal (long acting) insulins Given without regard for meals last for about 20 hours |
| Which classes of drugs can cause problems with diabetic patients by increasing glucose levels? | Diuretics + steroids |
| How long is insulin good for out of the fridge? | 28 days |
| What should you always check on a diabetic patient? | Feet! Watch for lesions and poor circulation issues |
| What drugs are used to treat hypoglycemia? | Either glucagon-elevate BG by stimulating liver to release glucose, might cause hypokalemia or diozoxide--don't use with thiozide diuretics! |
| What is the name of DDP-4 inhibitor and what does it do? | Sitagliptin Prolongs effect of insulin secretion, decreases glucagon secrection No hypoglycemia bc body regulates |
| What is the name of the incretin mimetic drug and what does it do? | Exenatide mimics effect of GLP-1: increased insulin secretion by beta cells, decreased glucagon secretion results in lowered BGL less hypoglycemia risk then sulfonylurias |
| What do you have to monitor with incretin mimetics? | Renal fxn! Possible pancreatitis |
| What does Metformin do? What do you have to give with metformin and when? | Metformin lowers glucose levels by working on the LIVER to decrease production of glucose and increase uptake of glucose Prevents B12 absorption so have to give with B12 2 hours before or after |
| What are the major SE of metformin and when is it contraindicated? | AE: GI problems rare lactic acidosis Contrindicated when SrC is 1.5< for men and 1.4< for women |
| What is important pt. teaching for metformin? | Always take after meals to reduce GI upset. |
| Does metformin cause hypoglycemia? | No. (unless combined with other drugs) |
| What do the TZDs do? | Work on receptor sites to decrease insulin resistance |
| What are the two TZDs? | (-glitazone) pioglitazone rosiglitazone |
| When should you use caution with TZDs, and what are the Contraindications? | Caution: hepatic impairment NOT: with CHF (can cause edema) |
| What are Alpha-glucosidase inhibitors and how do they work? | Acarbose Miglitol Work by preventing conversion of polysaccharides to monosaccharides |
| What is the main AE of Alpha-glucosidase inhibitors? | Severe hepatoxicity |
| What are the sulfonylurias and how do they work? | -amide and -ide endings Chlorpropamide tolazamide tolbutamide glimepiride glipizide glyburide Work by stimulating pancreas to produce more insulin |
| What is the main AE of sulfonylurias? What do they need to work? | AE: hypoglycemia! Need to have some fxn beta cells for them to work at all |
Created by:
SarahTzipporah
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