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Nap RxP Diabetes
NAPLEX
56
Pharmacology
Post-Graduate
08/03/2019

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Cards

Term
Primary MOA: increases/replaces insulin secretion
Definition
insulin, SUs, meglitinides
Term
Primary MOA: decreases heaptic glucose output
Definition
metformin
Term
Primary MOA: decreases glucagon, which decreases glucose production
Definition
GLP-1, DPP-4, pramlintide
Term
Primary MOA: slows gastric emptying, which increases satiety
Definition
GLP-1, pramlintide
Term
Primary MOA: Increases glucose excretion
Definition
SGLT2 inhibitors
Term
Primary MOA: Increases insulin sensitivity
Definition
TZDs, metformin
Term
Describe T1D
Definition
Immunne destruction of beta cells --> No insulin production --> No muscle uptake of glycogen --> Fat production --> Keytone production --> DKA
Term
Describe T2D
Definition
Damged beta cells --> Decreased insulin production
Term
Describe HYPERglycemia symptoms
Definition
3 polys (polyuria, polydypsia, polyphagia)
blurry vision
fautigue
unexplained weight loss
Term
Describe HYPOglycemia symptoms
Definition
Shaky, Irritable, HA, Hunger, Confusion, Weak, Sleepy, Dizzy, Sweaty, Tachcardia
Term
DX: prediabetes
Definition
FPG: 100-125
2Hr Plasma Glucose after 75mg OGTT: 140-199
A1C: 5.7-6.4
Term
DX: diabetes
Definition
FPG: ≥ 126
2Hr Plasma Glucose after 75mg OGTT: ≥ 200
A1C: ≥ 6.5
Term
Goals: ADA
Definition
A1C: < 7%
preprandial glucose: 80-130
postprandial glucose: < 180
Term
Goals: hospitalized
Definition
Blood glucose: 140-180
Term
Goals: weekly exercise
Definition
150 mins
Term
Brand/generic: Metformin
Definition
Glucophage
Term
Metformin No-go criteria
Definition
SCr: 1.5 males | 1.4 females
Term
Max dose Metformin
Definition
2000-2550 depending on the dosing form
Term
Metformin causes ____ deficency.
Definition
B12
Term
Metformin counseling
Definition
GI upset; less with ER; will improve with time
Ghost tablet in stool with ER
Stop before/after contrast dye (48h)
Term
Does metformin have hypoglycemia risk?
Definition
NO!
Term
Meglitinides brand/generic (2 drugs)
Definition
repaglinide (Prandin)
nateglinide (Stralix)
Term
Take meglitinides __________
Definition
30 min before meals (like insulin)
Term
Solfnyureas: brand/generic (3 drugs)
Definition
glipizide (Glucotrol)
glimepiride (Amaryl)
glyburide (Glynase)
Term
Solfnyureas: pearls
Definition
Take @ breakfast
Take glipizide (Glucotrol IR) before meals
Sulfa-based
2C9 substrates
Term
Thiazolidinedones: brand/generic
Definition
pioglitazone (Actos)
rosiglitazone (Avandia)
Term
Thiazolidinedones: pearls
Definition
TZDs are 2C8 substrates (rifampin/gemfibrozil)
S/E: edema, weight gain
Cause: liver fail, bone density loss, HF
Term
Sodium Glucose Co Transporter (SGLT2): brand/generic (3 drugs)
Definition
canagliflozin (Invokana)
dapagliflozin (Farxiga)
empagliflozin (Jardiance)
Term
Sodium Glucose Co Transporter (SGLT2): pearls
Definition
Similar action to diurectics
SGLT2s are flozin the sugar out!
Glucose excretion --> UTIs + yeast infections
Leg/foot amputations
Term
Glucagon like peptide 1 agonist: brand/generic (5 drugs)
Definition
exantide (Byetta/Bydureon)
liraglutide (Victoza)
dulaglutide (Trulicity)
albiglutide (Tanzeum)
Lixisenatide (Adlyxin)
Term
Pramlintide brand/generic
Definition
SymlinPen
Term
GLP1/pramlintide: pearls
Definition
DI due to MOA (slowing gastric emptying): Antibiotics / Contraception
S/E: N/V/D, HA, (decreases over time)
SQ inj
Stomach pain = pancrease problem = STOP
Not for folks with self/fam thyroid cancer
Term
Exantide (Byetta): pearls
Definition
BID; AM/PM before meals
60 doses per pen = 30days
Term
Exantide (Bydureon): pearls
Definition
Inject immediately after mixing powder/liquid
Term
Liraglutide (Victoza): pearls
Definition
select dose!
Qday
Term
Bydureon, Trulicity, Tanzeum dosing interval?
Definition
Qwk
Term
Pramlintide (SymlinPen)
Definition
Separate from insulin by 3hrs
Decrease insulin meal time dosing by 50% to prevent hypoglycemia
Term
DDP4 inhibitors brand/generic (4 drugs)
Definition
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
Term
DDP4 inhibitors: pearls
Definition
DDP4s are glucagon-free gliptin tea
linagliptin + saxagliptin are 3A4 and Pgp substrates
Qday dosing - Food does not matter
Stomach pain = pancrease problem = STOP
Saxagliptin + algogliptin --> HF; trouble breathing = STOP
Term
Rapid acting insulin: brand/generic (4 drugs)
Definition
Aspart (Novolog)
Glusine (Apidra, Solostar)
Lispro (Humalog) **kwikpen = 200u/mL
Afrezza ***inhaled
Term
Regular insulin: brand/generic (2 drugs)
Definition
Humlin R,
Humlin R U-500 *500u/mL
Novolin R
Term
Intermediate "basal" insulin: brand/generic (2 drugs)
Definition
NPH (Humlin N, Novolin N)
Term
long-acting "basal" insulin: brand/generic (3 drugs)
Definition
Detemir (Levimir)
Glargine (Lantus, Basaglar, Toujeo)
Degludec (Tresiba)
Term
Mixed insulin: brand/generic (4 drugs)
Definition
Novolog Mix 70/30 = 70% protamine, 30% aspart
Novolin Mix 70/30 = 70% NPH, 30% Humlin
Humalog Mix 75/25 =75% protamine, 25% lispro
Humalog Mix 50/50 =50% protamine, 50% lispro
Term
Most insulin product are ___units/mL. What are 4 exceptions?
Definition
most products = 100u/mL
Humalog kwikpen = 200u/mL
Humulin R U-500 = 500u/mL
Tresiba = 200u/mL
Toujeo Solostar = 300u/mL
Term
Most insulin pens are ___mL, with one exception _________ .
Definition
Most pens are 3mL
Toujeo = 1.5mL
Term
Most insulin pens have _____ unit increments, with two exceptions _____________, _____________ .
Definition
Most pens; 1 increment = 1 unit
Humulin R u-500; 1 increment = 5 units
Tresiba Flextouch; 1 increment =2 units
Term
What types of insulin is used in insulin pumps?
Definition
Rapid-acting
Regular
Term
When converting between insulin brands reduce dosage by
Definition
20.00000%
Term
How to dose insulin? (3 steps)
Definition
1. 0.6u/kg/day = Total Daily Dose (TDD)
2. Divide TDD by 2 to determine Total basal dose and total bolus dose
3. Further divide total bolus dose by 3 to determine meal-time dosing
Term
Describe the rule of 450 and 500
Definition
Determines the insulin to carb ratio.
500/TDD = g of carb covered by 1U of rapid acting insulin
450/TDD = g of carb covered by 1U or regular insulin
Term
Describe the rule of 1800 and 1500
Definition
1800/TDD = corr. factor for rapid acting insulin
1500/TDD = corr. factor for regular insulin

(BG Now - Target BG)/corr. factor = corr. dose
Term
When mixing insulin which type is drawn up first?
Definition
1rst Clear (regular)
2nd Cloudy (NPH)
****These are the ONLY types of insulin that can be mixed****
Term
Define / TX hypoglycemia
Definition
BG ≤ 70.
TX with 15-20g SIMPLE carbs repeat Q15min PRN
Term
Drugs that cause hypoglycemia
Definition
linezolid
lorcaserin (Belviq)
Octreotide
pentamidine
Propanolol
Quinine
Quinolones
Term
Drugs that cause hyperglycemia
Definition
B blockers
diuretics
immunosuppressents
naicin
Pis
Quinolones
2nd gen AP
Statins
Steroids
Azole AF
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