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    NAPLEX > Chapter 38: Diabetes > Flashcards

    Flashcards in Chapter for 1 last update 04 Jun 2020 38: DiabetesChapter 38: Diabetes Deck (43)
    1

    What are the four long-term microvascular complications of diabetes?

    1. Nephropathy

    2. Retinopathy

    3. Peripheral neuropathy - increases risk for foot infections and amputations

    4. Autonomic neuropathy - ED, gastroparesis, loss of bladder control, UTIs

    2

    What are the three long-term microvascular complications of diabetes?

    1. CAD - MI, HF

    2. Cerebrovascular disease - TIA, stroke

    3. Peripheral artery disease

    3

    All of the following would qualify a patient with a diagnosis of pre-diabetes, EXCEPT: (Select all that apply)

    A. HbgA1c 6.4%
    B. FPG 110 mg/dL
    C. 2-hr oral glucose tolerance test of 180 mg/dL
    D. HgbA1c 5.5%
    E. FPG 130 mg/dL

    D and E are the exceptions

    The criteria for diagnosis of pre diabetes is as follows:

    FPG: 100-125mg/dL
    A1c: 5.7-6.4%
    2-hr OGTT: 140-199 mg/dL

    4

    Which of the following statements about diabetes is correct? (Select all that apply)

    A. Classic Sx of DM are polyuria, polyphagia, and polydipsia
    B. A1C ≥ 6.3% is diagnostic for DM
    C. Type 1 DM is caused by autoimmune destruction of pancreatic beta cells
    D. FPG goals for DM in pregnancy are more relaxed than in non-pregnant patients with DM
    E. Fluoroquinolones can both increase and decrease blood glucose

    reverses diabetes type 2 prognosis (🔴 fast) | reverses diabetes type 2 handshow to reverses diabetes type 2 for A, C, and E are correct
    Criteria for diagnosis of DM is as follows:

    Classic Sx AND a random plasma glucose ≥ 200 mg/dL
    FPG: ≥ 126 mg/dL
    A1c: ≥ 6.5%
    2-hr OGTT: ≥ 200 mg/dL
    Must repeat test for true diagnosis for all criteria except if patient presents with classic Sx and random ≥ 200 mg/dL

    Propranolol and octreotide are more examples of drugs that can both raise and lower blood glucose.

    B and D are incorrect
    As mentioned above, diagnosis of DM based on A1c must be ≥ 6.5%.

    FPG goals for DM in pregnancy are actually MORE stringent than DM patients without DM. If patient develops DM during pregnancy (gestational DM) fasting goal is ≤ 95 mg/dL, 1 hr post-meal ≤ 140mg/dL, and a 2 hr post-meal ≤ 120 mg/dL. If patient develops DM prior to pregnancy (pre-gestational DM) fasting goal is 60-99 mg/dL, A1c 6-6.5%, and peak postprandial 100-129 mg/dL.


    5

    Which of the following drugs can raise blood glucose levels

    A. Geodon®
    B. Atazanavir
    C. Linezolid
    D. Simvastatin
    E. Prograf®

    A, B, D, and E are correct.

    Atypical antipsychotics such as ziprasidone (Geodon®), olanzapine, clozapine, quetiapine, etc. can raise blood glucose levels along with protease inhibitors atazanavir (Reyataz®), statins, and tacrolimus (Prograf®)

    C is incorrect
    Linezolid can actually lower blood glucose

    6

    Which of the following is correct regarding DM?

    A. DM patients have increased rates of hospitalizations and mortality from influenza and pneumococcal disease
    B. Niacin, posaconazole, and HCTZ can raise blood glucose
    C. First degree relative with DM is a risk factor for T2DM
    D. Men and women with DM ≥ 50 y/o with one additional risk factor should receive ASA 81mg as primary prevention of CVD
    E. Goal BP for patients with DM is

    A, B, C, D are correct
    ASA should be considered for primary prevention in patients with T1DM and T2DM who have 10-year CVD risk > 10% which includes men and women ≥ 50 y/o with DM and one additional risk factor (smoking, HTN, family hx of CVD, dyslipidemia, or albuminuria).

    E is incorrect
    Goal BP for DM patients is

    7

    Type 2 DM is much more common than type 1 DM and is associated with obesity, physical inactivity, and family history. Which of the following statements about T2DM is true? (Select all that apply)

    A. Due to insulin resistance
    B. Due to insulin deficiency
    C. Due to autoimmune destruction of pancreatic beta cells
    D. Characterized by gradual decline in insulin production
    E. One of the leading causes of CKD

    A, B, D, and E are correct

    T1DM is characterized by autoimmune destruction of pancreatic beta cells

    8

    What alternative antiplatelet therapy is recommended for primary prevention of CVD in DM patients with a 10-year risk > 10% if the patient has an aspirin allergy?

    Clopidogrel 75mg daily

    9

    Jorge, a 38 y/o male, presented to his PCP c/o of "" His PCP took a random plasma glucose and A1c and the results are as follows:

    Random plasma glucose: 310 mg/dL
    A1c: 10.2%

    Jorge''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''s significantly elevated random plasma glucose and A1c, this patient should be started both metformin and insulin. If the patient''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''s can lower blood glucose. FQ''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''s PCP diagnoses him with T2DM. Which of the following vaccinations is indicated for Jorge assuming he received all of his childhood vaccinations, but hasn''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''t received any vaccinations in the past 15 years. Since being diagnosed with T2DM, Jorge should receive influenza (Fluzone), pneumococcal (Pneumovax), and Hep B (Recombivax).

    B and C are incorrect
    Havrix is the vaccination for Hep A. Hep A vaccination is not indicated for patients with DM.

    Recombivax is the vaccination for Hep B. UNVACCINATED adults with DM aged 19-59 should receive the Hep B vaccine. The question clearly states that this patient received ALL of his childhood vaccinations, which according to the CDC, includes the 3-dose series for Hep B.

    12

    Jorge, a 38 y/o male, presented to his PCP c/o of "" His PCP took a random plasma glucose and A1c and the results are as follows:

    Random plasma glucose: 310 mg/dL
    A1c: 10.2%

    Based on Jorge''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''back blur-card card-face''suggestedAnswer''http://schema.org/Answer''card-face-overlay''card-face-header''card-answer''card-answer-text''text''card''http://schema.org/Question''card-header''card-number''card-face front''card-face-header''card-question''card-question-text''name text''t) meglitinides be used with sulfonylureas?

    Meglitinides should NOT be used with SU! Meglitinides (repaglinide, nateglinide) are basically rapid acting sulfonylureas with a shorter duration of action taken TID with the same MOA, stimulating insulin secretion from the pancreatic beta cells. Not only would this increase the risk of hypoglycemia, there would be no added benefit in helping control blood glucose because both drugs are targeting the same MOA.

    29

    Symptoms of hypoglycemia include all of the following, EXCEPT:

    A. Shakiness
    B. Confusion
    C. Tachycardia
    D. Bradycardia
    E. Sweating

    D. Bradycardia

    Hypoglycemia causes rapid HR (tachycardia), NOT bradycardia

    30

    How often and when should Prandin® be taken?

    repaglinide (Prandin®) is a meglitinide used in the treatment of T2DM. Meglitinides are taken TID 15-30 minutes before meals. They are useful in decreasing post-prandial blood glucose levels.

    31

    All of the following are common SE of Prandin®, EXCEPT: (Select all that apply)

    A. Hypoglycemia
    B. Weight gain
    C. Weight loss
    D. URTI
    E. UTI

    C and E are the exceptions

    repaglinide (Prandin®) is a meglitinide used in the treatment of T2DM. It causes weight gain, NOT weight loss. It does not cause UTI, this is a more common SE for the SGLT-2 inhibitors and DPP-4 inhibitors

    32

    Why are the older 1st generation sulfonylureas, like tolbutamide, not used anymore and instead the 2nd generation SU like Glucotrol® favored?

    1st generation SU like tolbutamide cause a longer duration of hypoglycemia

    33

    What is the MOA of TZDs?

    Thiazolidinediones (TZDs) are peroxisome proliferator-activated receptor gamma agonists. Agonists of this nuclear receptor increase peripheral insulin sensitivity which increases uptake and utilization of glucose by the peripheral tissues. TZDs are considered insulin sensitizers. They have many AE with a slow onset of effect taking up to 12 weeks for maximum lowering of blood sugar. This slow onset is due to their MOA. Activation of nuclear PPARgamma receptors influences the production of several gene products involved in glucose and lipid metabolism.

    34

    Brand name and class of pioglitazone?

    Pioglitazone (Actos®) is a TZD used for the treatment of T2DM. Typical daily dose is 15-30 mg po daily

    35

    Brand name and class of rosiglitazone?

    Rosiglitazone (Avandia®) is a TZD used for the treatment of T2DM. Typical daily dose is 4-8 mg po daily

    36

    What condition are TZDs contraindicated with?

    NYHA Class III/IV HF

    37

    Which of the following statements regarding TZDs is correct? (Select all that apply)

    A. TZDs may cause HF
    B. Anovulatory, premenopausal women should be instructed to use contraception while taking TZDs
    C. Pioglitazone can help patients with lipid abnormalities
    D. TZDs decrease risk of bone fractures
    E. Actos® provide mortality benefit in patients with bladder cancer

    A, B, and C are correct
    TZDs can cause peripheral edema and retention of fluids which can cause or exacerbate HF. Anovulatory, premonopausal women with insulin resistance may actually start ovulating again which could lead to unintended pregnancy and therefore these patients should be instructed to use contraception. Pioglitazone can increase HDL, and decrease TC and TGs

    D and E are incorrect
    TZDs increase risk of bone fractures in upper arm, hand, and foot, particularly in women. Pioglitazone (Actos®) should be avoided in patients with active bladder cancer since it increases risk with duration of use.

    38

    What are the top (3) AE of TZDs?

    1. peripheral edema
    2. weight gain
    3. URTI

    39

    What is the brand name and class of acarbose?

    Acarbose (Precose®) is an alpha-glucosidase inhibitor used in the treatment of T2DM. Precose® reversibly inhibits membrane-bound intestinal alpha-glucosidases which hydrolyze oligosaccharides and disaccharides to glucose and other monosaccharides in the brush border of the small intestine. By inhibiting this enzyme the ultimate result is delayed glucose absorption and lowering of post-prandial hyperglycemia.

    Typical starting dose of acarbose (Precose®): 25mg with 1st bite of each MAIN meal

    40

    What is the brand name and class of miglitol?

    Miglitol (Glyset®) is an alpha-glucosidase inhibitor used in the treatment of T2DM. Glyset® reversibly inhibits membrane-bound intestinal alpha-glucosidases which hydrolyze oligosaccharides and disaccharides to glucose and other monosaccharides in the brush border of the small intestine. By inhibiting this enzyme the ultimate result is delayed glucose absorption and lowering of post-prandial hyperglycemia.

    Typical starting dose of miglitol (Glyset®): 25mg with 1st bite of each MAIN meal (same dose as acarbose Precose®)

    41

    Which of the following are SE of alpha-glucosidase inhibitors? (Select all that apply)

    A. Flatulence
    B. Hypoglycemia
    C. Weight gain
    D. Increased LFT
    E. Diarrhea

    reverses diabetes type 2 range (⭐️ pregnancy) | reverses diabetes type 2 overweighthow to reverses diabetes type 2 for A, D, and E are correct

    There are (2) alpha-glucosidase inhibitors: miglitol (Glyset®) and acarbose (Precose®) and they both cause GI effects such as flatulence, diarrhea, and abdominal pain. They also can increase LFT, which should be monitored while taking these medications.

    B and C are incorrect

    These agents do NOT cause hypoglycemia, nor weight gain

    42

    T/F:

    If a patient is skipping a meal, they should still take Glyset® since this DM medication works independent of meals/food?

    reverses diabetes type 2 juvenile (⭐️ common complications) | reverses diabetes type 2 low blood sugarhow to reverses diabetes type 2 for False

    miglitol (Glyset®) is an alpha-glucosidase inhibitor and should be taken with the 1st bite of each main meal since it works by inhibiting the metabolism of polysaccharides in the gut.

    43

    Which of the following statements is correct? (Select all that apply)

    A. When treating hypoglycemia, fruit juice is the sugar of choice in a patient taking Precose®
    B. TZD have a warning for vision changes/damage
    C. Avandamet® is the brand name for metformin + glimepiride
    D. Byetta® has a boxed warning for thyroid C-cell carcinoma
    E. Primary AE of GLP-1 agonists is nausea

    B and E are correct
    TZDs can cause macular edema which can affect/damage vision. Nausea is a common AE of GLP-1 agonists which is why these agents are often titrated.

    A, C, and D are incorrect
    Precose® is an alpha-glucosidase inhibitor and its MOA involves inhibiting metabolism of polysaccharides like sucrose (which would be present in fruit juice) and therefore this type of sugar would not adequately treat hypoglycemia. Hypoglycemia in patients taking alpha-glucosidase inhibitors need to purchase glucose tabs or gel. Avandamet® is brand for metformin + rosiglitazone (Avandia®). All GLP-1 agonists have a boxed warning for thyroid C-cell carcinoma, EXCEPT Byetta®. Avoid use of all other GLP-1 agonists in patients with thyroid cancer (Bydureon, Liraglutide (Victoza®), Dulaglutide (Trulicity®), Albiglutide (Tanzeum®)

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