Pharmacology Exam 4 (Diabetes Mellitus) hsc1149

What are the ABC's of diabetes?

* A1C < 7.0% & Blood Glucose <180 mg/dL * BP 140/90 mmHg *CHOLESTEROL <100 mg/dL without overt CVD, <70 mg/dL w/overt CVD TG <150 mg/dL HDL >40 mg/dL men and >50 mg/dL women

What is TYPE 1 Diabetes?

* Autoimmune destruction of pancreatic Beta-cells - insulin deficiency * Insulin dependent * Usually occurs <30 yrs old * Family history usually not a factor * Not strongly correlated with obesity * DKA (Diabetic ketoacidosis)

What is TYPE 2 Diabetes?

* Peripheral resistance to insulin action and increase hepatic glucose output - ineffective insulin utilization/insulin resistance * More likely in patients >40 yrs old, increase in younger people due to obesity and sedentary lifestyles * Family history a RF. African Americas, Asians, Hispanics, and Native Americans at higher risk * Strong correlation with obesity * DKA rare (b/c residual insulin present)

How is Diabetes DIAGNOSED?

* symptoms of hyperglycemia crisis (polyuria, polydipsia, & unexplained weightless) * plasma glucose level of ≥200 mg/dL OR * fasting plasma glucose of ≥126 mg/dL OR * 2 hr plasma glucose of ≥200 mg/dL during oral glucose tolerance test OR *A1C ≥6.5%

Longterm complications for MACROVASCULAR disease?

*Coronary artery disease -2-4x higher *Cerebrovascular disease -stroke 2-4x higher *Peripheral artery disease -insuff. circulation impairs healing, incr. rick for gangrene and amputation

Longterm complications for MICROVASCULAR disease?

*Retinopathy *blindness *Nephropathy *Peripheral Neuropathy *foot infections and amputations *Autonomic Neuropathy *erectile dysfunction, UTI's

What are the SIDE EFFECTS for the GLUCOSE CO-TRANSPORTER 2 INHIBITORS? (Invokana)

*UTI's *Hyperkalemia *Increased urination and thirst *Hypoglycemia *Hypotension *Hypovolemia *Renal insufficiency

What exams need to be performed in order to prevent MICROVASCULAR complications?

*annual eye exams *annual urine test *Immunizations *foot care *smoke cessation

What are the risk factors for TYPE 2 Diabetes?

*first degree relative *native american, african american, asian american, hispanic and pacific islander *obesity *physical inactivity *hypertension *history of CVD *history of gestational diabetes or deliver of >9 lb baby * A1C ≥ 5.7% *women with polycystic ovary syndrome

METFORMIN??

*first line medication *little to no risk for hypoglycemia when used alone *may decrease triglycerides and LDL's *used for insulin sensitivity *can reduce A1C by 1-2% *may reduce diabetes progression from pre-diabetes *positive cardiovascular benefits in obese pts.

What are the contraindications for the SODIUM GLUCOSE CO-TRANSPORTER 2 INHIBITORS?

*severe renal impairment *end stage renal failure *dialysis

What is the protein level for MICROALBUMINURIA?

30-299 mg/day

What is the proper dose for METFORMIN?

500 mg-1000 mg *max dose 2550 mg

What is the protein level for MACROALBUMINURIA?

>300 mg/day

What is the drug class for METFORMIN?

Biguanide

Which agents (meds) cause a metallic taste?

Biguanides (Metformin)

How should blood glucose levels be lowered in patients with HHS?

Blood glucose should be lowered slowly in patients with HHS.

What is the mechanism of action (MOA) of METFORMIN?

Decreases hepatic glucose production, intestinal glucose absorption and increases peripheral insulin sensitivity.

What are the contraindications for METFORMIN?

Do NOT use Metformin if: * Serum Cr >1.4 (F) and >1.5 (M) * Creatinine clearance <60 ml/min * Metabolic acidosis * Hold 48 hrs after iodinated contrast media *dye can slow kidney function *SE: diarrhea, N&V, flatulence, metallic taste

What are the contraindications for the TZD's? (Pioglitazone & Rosiglitazone)

Do NOT use pioglitazone in its with active bladder cancer.

What does "FS QAC & HS" mean?

Finger stick before meals and at bedtime

What class of drug causes BOTH Hyperglycemia and Hypoglycemia?

Fluoroquinolones

What kind of GLUCOSE & KETONES will a patient with DKA present with?

Glucose >250 mg/dL Ketones are elevated

What VACCINES should a patient WITH DIABETES receive?

Hepatitis B = 19-59 yrs of age and have never completed a series Influenza = annually Pneumovax = 2-64 yrs of and again at 65 if >5 years since previous vaccination Tdap = once and Td every 10 years *more frequent if pt. has a deep wound

Humulin N (NPH)

Intermediate-Acting Insulin

What is LINAGLIPTIN (DPP-4 Inhibitor) best used for?

It is best used for older patients and patients who have diabetic nephropathy.

Lantus

Long-Acting Insulin

Levemir

Long-Acting Insulin

UNITS/MLS ON A SYRINGE: 9 UNITS 20 UNITS 4 UNITS 46 UNITS

MLS: 0.09 ML 0.2 ML 0.04 ML 0.46 ML

What are the steps to mixing two insulins?

Make sure its not insulin GLARGINE (NEVER!!!) * Roll the CLOUDY to mix * Clean BOTH tops with alcohol * Pull back the plunger of dose of CLOUDY * Insert needle and air into CLOUDY * Pull ball plunger of dose of CLEAR * Insert needle and air (UPSIDE-DOWN) into CLEAR * Draw out CLEAR draw out CLOUDY

HumaLOG

Rapid-Acting Insulin

NovoLOG

Rapid-Acting Insulin

Which two drug classes cause low blood sugar (HYPOGLYCEMIA)?

SULFONYLUREAS MEGLITINIDES

HumuLIN R

Short-Acting Insulin

NovoLIN R

Short-Acting Insulin

What is the role of the LIVER?

The liver produces, stores and releases glucose.

What is the role of the PANCREAS (w/ Diabetes)?

The role of the pancreas is to produce insulin Type 1 DM = beta cells that prod. insulin are attacked and killed by the body; pancreas struggles to prod enough insulin to keep the glucose levels down and the beta cells of the pancreas are destroyed (NO PANCREAS) Type 2 DM = The pancreas is prod too much insulin because more insulin is needed to bring down glucose levels (resistance) and the body is unable to use it effectively.

What is the difference between Type 1 & Type 2 Diabetes?

Type 1 = No insulin production (insulin dependent) Type 2 = Insulin Sensitivity (non-insulin dependent) (given drugs to help with sensitivity)

How do you properly dose and INSULIN INFUSION?

Usually dosed at 5-10 units/hour

Can Gestational Diabetes cause diabetes after pregnancy (later)?

Yes, history of gestational diabetes mellitus is a risk factor for type 2 diabetes.

How is insulin stored?

insulin can be stored @ room temperature for 28 days unused insulin should be refrigerated and exp. on the date posted on the vial

What is the onset of action for INTERMEDIATE-ACTING INSULIN?

it takes 1 to 1.5 hours for medication to work

What is the onset of action for RAPID-ACTING INSULIN?

it takes 15 minutes after administration for medication to work

How do you dispose of needles?

needles should be placed in a puncture resistant hard plastic (sharps) or metal container with a screw on top or tightly securable lid (empty paint can, liquid detergent bottle to bleach bottle @ home)