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How do you disperse the particles in suspension prior to administration in order to prevent frothing that can make dosing of NPH insulin inaccurate?

Gentle agitation

What class of drugs masks the hypoglycemic events by suppressing tachycardia and palpitations?

Beta blockers.

Give a few examples of stimulant laxatives.

Bisacodyl (Dulcolax) and Senna (Ex-Lax), Castor Oil.

How do H2 receptor blockers promote ulcer healing?

Blocking H-2 receptors decreases acid production in the stomach.

Which vitamin has been shown to decrease congenital malformations such as spina bifida?

Folic Acid.

In patients with insulin resistance, the insulin levels are (increased or decreased)?

Increased

What does hyperinsulinemia do to the body?

Increases smooth muscle proliferation, increases angiotensin II, & enhances sympathetic activation

How do thiazolidinediones (TZDs) such as rosiglitazone (Avandia) and pioglitazone (Actos) reduce blood sugar?

They increase glucose uptake by muscle and decrease glucose production by the liver

What is the mechanism of action of sulfonylureas?

They stimulate release of insulin from the pancreas.

Name drug classes that can increase blood sugar levels

Thiazide diuretics, sympathomimetics, glucocorticoids, antipsychotics, and possibly statins

When does insulin aspart (NovoLog) peak?

1-3 hours

What is the onset of action of insulin aspart (NovoLog)

10-20 minutes

What is the maximum dose of metformin?

2000 mg/day

How long does it take for levothyroxine to reach plateau?

4 weeks according to study mate flashcards. 6-8 weeks after starting treatment

What level of HbA1c is considered "pre-diabetes" or impaired fasting glucose (IFG?)

5.7-6.5

What level of blood glucose is considered hypoglycemia?

70 mg/dL or if the patient is symptomatic

Insulin resistance occurs in type 2 diabetes. Which ethnic groups are at higher risk for developing insulin resistance?

African Americans, Asian Americans, and Mexican Americans

What types of antacids cause constipation?

Aluminumm hydroxide

Is insulin detemir (Levemir) considered a long acting or intermediate acting insulin?

At higher doses (0.4 units/kg) it has a duration of 20-24 hours

Why is atropine added to the diphenoxylate?

Atropine is present to discourage (diphenoxylate) drug abuse.

If a patient injects regular insulin and then eats breakfast, when would you be worried about hypoglycemia?

Before lunch when the insulin is at its peak.

Why are patients receiving TPN at risk for infection?

Because aseptic technique may not be used at any point giving the feeding. Using a central venous cath that has been impregnated with antiseptics (chlorhexidine plus silver sulfadiazine). Use of a 0.22 micron filter can provide partial protection.

Alpha-glucosidase inhibitors promote fermentation of carbohydrates in the gut and can cause intolerable GI effects such as___________?

GAS!

Pituitary tumors can cause excessive levels of prolactin that stimulate production of breast milk. Name a drug used to inhibit excessive production of prolactin (hyperprolactinemia).

Cabergoline (Dostinex), bromocriptine (Parlodel)

Morning hyperglycemia may be due to Somogyi or Dawn phenomenon. How can the two problems be distinguished?

Check the 3:00 AM glucose

How is diabetic ketoacidosis treated?

Correct hyperglycemia and acidosis, replace lost water and sodium, normalize potassium. Give IV fluids and electrolytes, follow with IV insulin, reduce glucose level slowly.

Diphenoxylate in combination with atropine (Lomotil) and loperamide (Imodium) are used to treat (diarrhea or constipation)?

Diarrhea

Children who are candidates for GH replacement have (decreased or increased) serum levels of growth hormone?

Decreased

What are the consequences of chronic exposure to laxatives?

Decreased defecatory reflexes, reliance on laxatives and electrolyte imbalances.

How long is treatment given for H-pylori eradication?

Depending on the drug combination used, 10-14 days.

In a patient with Graves' disease, the TSH would be (elevated or depressed)?

Depressed

What are the GI adverse effects associated with metformin?

Diarrhea

How many units of insulin are in one ml of U100 insulin?

Each ml contains 100 units of insulin

In a patient with hypothyroidism, the TSH would be (elevated or depressed)?

Elevated

Incretins are hormones that are released from the GI tract after a meal. They slow gastric emptying, stimulate insulin release for the pancreas, inhibit postprandial release of glucagon, and suppress appetite. An injectable drug that mimics this effect is called__________?

Exenatide (Byetta)

Prochlorperazine (Compazine) and promethazine (Phenergan) suppress emesis by blocking Dopamine2 receptors in the CTZ. What are the major side effects of these two drugs?

Extra-pyramidial reactions, anticholinergic effects, hypotension, and sedation

How is DM diagnosed?

Fasting blood sugar > or equal to 126 mg/dl or random check > 200 mg/dl. or HbA1c greater than 6.5

What is the Dawn phenomenon?

Fasting hyperglycemia due to increases in growth hormone in the dawn hours

Glucose interacts spontaneously with Hgb in RBCs to form glycated derivatives that can be measured in the blood. What is the name of this test that serves as an index of average glucose levels over the prior 2-3 months?

Glycosylated hemoglobin (HbA1C)

What are the antiandrogenic effects of cimetidine?

Gynecomastia, reduced libido, and impotence.

What is the gram-negative organism is associated with peptic ulcer disease (PUD)?

H. pylori

State other factors that may lead to PUD

H. pylori, NSAIDS, gastric acid, pepsin, and smoking.

TZDs are contraindicated in patients with_________________?

Heart failure

State the clinical signs and symptoms of hypothyroidism.

High TSH, low T4. Flat affect, puffy pale face, dry skin, brittle hair and hair loss, lethargy, fatigue, intolerance to cold, elevated TSH and depressed T4.

What is the Somogyi phenomenon (rebound hyperglycemia)?

Hyperglycemia following an episode of nocturnal hypoglycemia

Graves' disease results from excessive levels of thyroid hormone. A patient with Graves' disease has (hypothyroidism or hyperthyroidism)?

Hyperthyroidism

Propylthiouracil (PTU), methimazole (Tapazole) and radioactive iodine-131 are used to treat (hypothyroidism or hyperthyroidism).

Hyperthyroidism

What are the clinical signs of lactic acidosis?

Hyperventilation, myalgia, malaise, unusual somnolence

What are the major adverse effects from the oral hypoglycemics for Type 2 diabetics called sulfonylureas?

Hypoglycemia

What is the major complication from insulin treatment?

Hypoglycemia

What is the cause of the rebound hyperglycemia with the Somogyi phenomenon?

Hypoglycemia episode leads to release of counter-regulatory hormones (epinephrine, cortisol, & growth hormone) and stored glucose in the liver

When a patient is receiving total parenteral nutrition (TPN) what may occur to the blood sugar if the infusion is disrupted? Why does this occur?

Hypoglycemia. Why, because insulin levels are elevated during dextrose therapy. If the infusion is stopped, the pancreas continues to secrete the same amount of insulin. With out the dextrose, blood sugar can drop.

Hashimoto's thyroiditis is associated with (hypothyroidism or hyperthyroidism)?

Hypothyroidism

What non drug measures relieve constipation?

Increase fiber and fluid in diet and exercise.

What type of therapy lowers the HbA1c the most in patients with DM?

Insulin

Which of the basal insulins has the longest duration?

Insulin glargine (Lantus)

Which insulins are considered long acting or basal insulins?

Insulin glargine (Lantus) and insulin detemir (Levemir) at higher doses

Glucagon is used to treat __________________________?

Insulin overdose

Describe how sucralfate (Carafate) promotes ulcer healing.

It forms a very sticky gel that adheres to the ulcer crater, creating a barrier to back-diffusion of hydrogen ions, pepsin, and bile salts.

What is the target value HbA1C for patients with diabetes?

Less than 7% (ADA)--- Ideal is 6.5 (AACE)

What problems may cause a patient taking metformin to be more prone to lactic acidosis?

Liver disease, severe infection, history of lactic acidosis, excessive alcohol, shock, hypoxemia

What are the clinical signs of Graves' disease?

Low TSH, high T4.Dysrthythmias, angina, nervousness, insomnia, increased metabolism, increased temperature, skeletal muscle atrophy, weight loss.

What type of antacids cause diarrhea?

Magnesium hydroxide.

Which class of anti diabetic drugs stimulate the release of insulin from the pancreas, can lead to hypoglycemia, and must be given before meals?

Meglitinides such as repaglinide (Prandin) and nateglinide (Starlix).

Most patients with Type 2 diabetes can be started on___________?

Metformin

Which anti diabetic drug suppresses gluconeogenesis, enhances glucose uptake and utilization by muscle and does not promote insulin secretion or cause hypoglycemia?

Metformin (Glucophage).

What is the most important rare side effect associated with the use of metformin?

Metformin inhibits lactic acid oxidation leading to lactic acidosis.

Which medications target post prandial glucose elevations?

Metformin, meglitinides, alphaglucosidase inhibitors, & incretin enhancers

Which types of insulin are always cloudy?

NPH and any type of pre-mix (70/30 or 75/25) that contains NPH.

Which vitamin is used to lower cholesterol levels?

Niacin.

Can you mix insulin glargine (Lantus) with rapid acting insulins?

No

A patient has a known severe allergy to sulfa. Can a sulfonylurea be used?

No, sulfonylureas are contraindicated in patients with sulfa allergy

How should oral levothyroxine be administered?

On an empty stomach in order to enhance absorption. Dosing usually done in the morning, at least 30 minutes before breakfast.

How do proton pump inhibitors (PPIs) promote ulcer healing?

PPIs inhibit H+, K+-ATPase, the enzyme that generates gastric acid.

When are laxatives contraindicated?

Patients with acute abdomen, abdominal pain, nausea, & cramps.

What are the clinical signs of diabetes mellitus (DM)?

Polyuria, polydipsia, polyphagia, weight loss

What is the principle cause of constipation?

Poor diet-specifically, a diet deficient in fiber and fluid.

Patients with normal fasting blood sugar may have elevated HbA1c levels because of elevations of___________________?

Post prandial glucose

What two drugs lower blood sugar by inhibiting digestion and absorption of dietary carbohydrates thereby reducing the rise in blood sugar that occurs after meals?

Precose and Glyset (alpha-glucosidase inhibitors)

How does ondansetron (Zofran) help patients undergoing chemotherapy?

Prevents nausea and vomiting by blocking type 3 seratonin receptors in the CTZ & afferent vagal neurons in GI tract.

How does propranolol help in the treatment of hyperthyroidism?

Propranolol can suppress tachycardia and other symptoms of Graves' disease. They work quickly and are highly individualized.

Why are C-peptide levels measured in patients with diabetes?

To assess residual capacity for insulin synthesis. They indicate that the pancreas is still producing insulin on its own.

How is hypothyroidism treated?

Replacement therapy with the thyroid hormone levothyroxine (T4).

Why is metformin usually held prior to diagnostic tests using dyes and prior to surgery?

Risk of acute renal failure, exacerbate lactic acidosis

What is the recent warning regarding Avandia?

Risk of heart failure, increases LDL, hepatotoxic

Name two drugs that decrease motion sickness.

Scopolomine and antihistamines (dimenhydrinate - Dramamine, meclizine - Antivert)

What is the MOA of DPP4 inhibitors such as sitagliptin (Januvia)?

Stimulate glucose sependent release of insulin, suppress post prandial release of glucagon

What are the therapeutic uses of misoprostol (Cytotec)?

Stomach ulcer, induction of labor

Metoclopramide (Reglan) is a prokinetic drug. What are the therapeutic uses for this drug?

Suppress post-op nausea & vomiting, emesis associated with chemo, and GERD; relief of diabetic gastroparesis.

How is Graves' disease treated?

Surgical removal of thyroid tissue, destruction of thyroid with radioactive iodine, and suppression of thyroid hormone synthesis

What is the MOA of thiazolidinediones (TZDs) such as rosiglitazone (Avandia)?

TZDs reduce blood sugar by increasing insulin sensitivity.

What are the clinical signs of hypoglycemia?

Tachycardia, palpitations, diaphoresis, nervousness, fatigue, and headache.

Why is it important to draw regular insulin up first when combinations of insulin are used?

The NPH will inactivate or contaminate the rapid acting insulin.

What is the definition of 'basal" insulin?

The small amount of insulin that the pancreas produces to keep the blood sugar normal in between meals

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) results in dehydration and hemoconcentration and is more common in patients with (Type 1 or Type 2 diabetes)?

Type 2-Acidosis and ketosis does not occur

Give an example of a patient that would be inappropriate for treatment with radioactive iodine.

Very young children, and pregnant and breast-feeding mothers.

Which vitamin is teratogenic in excessive amounts?

Vitamin A. Can also cause liver injury, and bone related disorders.

Which vitamin is used as an antidote for warfarin (Coumadin) overdose)?

Vitamin K reverses hypoprothrombinemia and bleeding caused by excessive dosing with Warfarin. Bleeding is controlled within hours.

State the major drug classes used to treat inflammatory bowel disease (Crohn's disease and ulcerative colitis).

aminosalicylates, glucocorticoids, immunosuppressants, and immunomodulators

Docusate sodium (Colace) is an example of what type of laxative?

surfactant