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72 Cards in this Set
- Front
- Back
What are the common symptoms of diabetes |
1.Polyuria 2. Polydispia 3. Polyphagia |
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What is the Fasting Glucose and the Post Meal Glucose levels for diabetics |
Fasting Glucose = ≥7 Post Meal Glucose = ≥11 |
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What is a normal glucose level |
4.4-6.1 mmol/L |
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What is Type 1 Diabetes |
Autoimmune destroys beta cells Insulin dependent/Juvenile onset |
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What is type 2 diabetes |
Insulin resistant Non insulin dependent/maturity onset |
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What are 4 things Diabetes is caused by |
1. Decreased insulin secretion 2. Insulin resistance 3. Excess glucagon & corticosteroids 4. Anti-insulin Antibody |
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Which 6 tissues are insulin sensitive |
1. Skeletal, Cardiac, Smooth Muscle 2. Adipose 3. Leukocytes 4. Pituitary |
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Which 5 tissues are non insulin senstivie |
1. Brain 2. Kidney 3. Intestinal 4. RBC 5. Endothelium |
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What are 3 defects you see in diabetes |
1. Increased Extracellular glucose 2. Decreases Intracellular glucose (insulin sensitive) 3. Increase Intracellular glucose (non insulin sensitive) |
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What are the 4 long term complications of Diabetes |
1. Micro and macro vessel disease 2. Retinopathy 3. Nephropathy 4. Neuropathy |
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What are the goals of therapy for type 2 diabetes |
1. Get normal blood glucose 2. Delay/prevent mobility/mortality from long term complications |
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What is the Insulin Synthesis Pathway |
Preproinsulin => signal sequence removed => proinsulin => chain C removed => insulin (2 chains linked by disulfied bridge) |
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What does 1 Unit of Insulin equal |
1 Unit = amount of insulin needed to reduce fasting glucose of a rabbit to 45 mg/dL (2.5mM) |
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What is the Short Acting Insulin Medication |
Insulin Lispro |
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1. What is Insulin Lispro an analog of 2. What is its duration 3. What is its impact on Pharmacodynamics |
1.Insulin (Amino acid 28 & 29 in beta chain reversed) 2. Rapid absorption and short action 3. No impact on pharmacodynamics |
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1.When do you use Insulin Lispro 2. Which type of diabetes is it used in |
1. 15 min before a meal (typical insulin 30-45 min before meal) 2. Type 1 and late stage Type 2 |
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What are the benefits of Insulin Lispro |
Decrease incidence and risk of hypoglycaemia |
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1.What are the 2 long acting insulin medications 2. When are they good to use |
1. a. insulin Glargine b. insulin Detemir 2. Good for bedtime
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What are the 3 benefits of using long acting insulin medication |
1. Slowly absorbed 2. Long duration (20.5 hours) 3. Loss of nocturnal hypoglycemia |
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What are the 3 adverse effects of Glargine |
1. Pain at injection site 2. Possible tumor growth 3. Can not be diluted or mixed with any other insulins |
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What are 3 new types of technology for insulin administrations |
1. Nasal spray 2. Insulin inhaler 3. Insulin pump (juvennile diabetes research fund) |
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What 5 things decrease the actions of Insulin |
1. Glucocorticoids 2. Glucagon 3. Epinephrine 4. Growth Hormone 5. Thyroid Hormone |
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What 5 things increase the actions of Insulin |
1. ACEi 2. Alcohol 3. Salicylates 4. Beta Blocker 5. MAO inhibitor |
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What are the side effects of Insulin |
1. Hypoglycemia (Hunger, sweating, blurred vision, death, be careful in elderly) 2. Lipotrophy (loss of fat) 3. Allergy |
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What are the 2 Sulfonylureas |
1. Gilburide 2. Tolbutamine |
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What are the MOA of the Sulfonylureas |
1. Release insulin from beta cells 2. Reduce Glucagon from blood 3. Potentiate the action of insulin |
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What are the adverse effects of the Sulfonylureas |
1.Hypoglycemia 2.Secondary failure (don't work as well as time goes on) 3.Skin rash, photosensitivity, GI, intolerance to alcohol |
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What is the meglitinide |
Repaglinide |
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What is the MOA of Repalglinide |
1. Increase insulin secretion by binding to ATP sensitive K+ channels at a distinct site from that of sulphonylurea |
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What are the adverse effects of Repalglinide |
1. Weight gain
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What medication is in the Biguanide class |
Metformin |
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What is the MOA of metformin |
Not fully understood Activated cylic AMP activated protein kinase which reduces glucose release from the liver |
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What are the uses for Metformin |
1. Euglycemic rather than hypoglycaemic 2. Mild weight loss |
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What is the metabolism of metformin |
Not metabolized therefore excreted through kidneys as active form
(less secondary failure) |
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What is the adverse effects of the early forms of metformin (i.e. phenformin) |
Killed patients from lactic acidosis |
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What are the 2 Glitazones |
1. Rosglitazone 2. Pioglitazone
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What is the MOA of the Glitazones |
1. Decrease insulin resistance by binding nuclear receptors that regulate genes responsible for lipid metabolism 2. Decrease gluconeogenesis, glucose output and TG synthesis in liver 3. Increase glucose uptake in skeletal muscle and adipose
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What is the metabolism of Glitazones |
Liver (CYP) Better absorbed with food |
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What are Glitazones used for |
1. Type 2 diabetes (not 1st line more adjunct with metformin) (need > 30 units of insulin a day and HgbA1C > 8.5%)
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What is the Glucosidase inhibitor |
Acarbose |
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Who does Acarbose work well with |
Elderly |
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What is the MOA of Acarbose |
Acts ONLY on gut and slows CHO breakdown |
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What do you use Acarbose for |
Type 2 diabetes |
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What are the side effects of Acarbose |
Bloating and farting |
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What is the MOA of Orlistat |
Blocks intestinal lipase Reduce absorption of dietary fat
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When is Orlistat effective |
Only at meal time |
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What is the use of Orlistat |
Improve insulin sensitivity |
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What are the side effects of Orlistat |
Fatty stool, nausea, diarrhea |
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What is Pramlintide |
Synthetic analog of Amylin (amylin = hormone co-secreted with insulin from beta cells) |
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What is the MOA of Pramlintide |
Suppresses glucagon secretion Decreases glucose absorption from gut |
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What are the uses of Pramlintide |
Mixed with regular insulin just before injecting Good for type 1 and 2 |
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What are incretins |
Glucagon like peptides (GLP-1) |
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What are the function of incretins |
Mimics effects of insulin |
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When are incretins secreted |
after a meal |
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What are the 2 types of DPP-4 Inhibitors |
1. Sitagliptin-PO4 2. Saxagliptin |
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What is the function of DDP-4 |
breaks down GLP-1 |
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What type of diabetes do you use the DPP-4 inhibitors |
Type 2 diabetes |
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What is the side effect of DDP-4 inhibitors |
anaphylaxis |
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What are the two types of GLP-1 Analoges |
1. Exenatide 2. Liraglutide |
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What is the function of the GLP-1 Analoges |
1.Enhances insulin secretion 2.Suppresses Glucagon secretion during hyperglycemia 3.Decreases food intake and slows gastric emptying |
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Can you use Exenatide alone |
No, used in adjunct with metformin or sulphonylurea |
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What is Exenatide |
Synthetic version of Extendin-4 |
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Is Exenatide hyper, hypo, or euglycemic on its own |
Euglycemic |
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What are the side effects of exenatide |
1. Pancreatitis 2. Renal dysfunction |
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What is Dapaglifozin |
Sodium Glucose Transport Protein 2 inhibitor (SGLT-2) |
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What is the MOA of Dapagliflozin |
Works in kidney to prevent reabsorption of glucose |
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What are the side effects of Dapaglaiflozin |
Glycosuria Hypotension, UTI, bladder infection |
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What is the treatment option for Type 1 (insulin dependent) Diabetes |
Control blood glucose with insulin and diet |
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What are the treatment options for type 2 (non insulin dependent) diabetes |
1. Diet (exercise does not work) 2. Mild = oral hypoglycemic as 1st line 3. Oral combination therapy and diet 4. Insulin 5. Reduce hypertension (to prevent complications) |
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What are some future therapies of Diabetes |
1. CGM + insulin pump 2. Beta cell transplantation 3. Aldose reductase inhibitors 4. Dapagliflozin |
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How do you treat diabetes in the elderly |
1. Oral agent 2. Sulfonylurea used with causation because of hypoglycemia 3. Doses should be halved and increased slowly |
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What are the steps for type 2 diabetes |
1. Nonpharmacotherapy 2. Oral agent monotherapy 3. Oral combination therapy 4. Bedtime insulin +/- oral agent 5. Insulin injections 1-4 days |