NU553 Unit 4 Diabetes Mellitus Flashcards Advanced Pharmacology and Pharmacotherapeutics Exam 2

Which skin finding in a child or adolescent is a red flag for insulin resistance?

Acanthosis nigricans

What weight-loss goal is recommended to improve glucose tolerance in obese patients?

A loss of 5 percent to 7 percent of initial body weight

What fasting plasma glucose level confirms diabetes when abnormal on two occasions?

126 milligrams per deciliter or higher

What 2-hour oral glucose tolerance test result confirms diabetes?

200 milligrams per deciliter or higher

What hemoglobin A1c range defines prediabetes?

5.7 percent to 6.4 percent

What fasting glucose range defines impaired fasting glucose?

100 to 125 milligrams per deciliter

What finding can confirm diabetes without repeat testing?

Random glucose of 200 milligrams per deciliter or higher with classic symptoms

At what age should routine screening for type 2 diabetes usually begin in otherwise asymptomatic adults with risk factors?

Age 45 years

At what body mass index should diabetes screening be considered in Asian patients?

23 kilograms per square meter or higher

What is the hallmark pathophysiology of type 2 diabetes mellitus?

Insulin resistance with progressive beta cell dysfunction

Which type of diabetes is autoimmune?

Type 1 diabetes

What is the underlying pathophysiology of type 1 diabetes mellitus?

Autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency

Which oral diabetes drug is considered first-line therapy for type 2 diabetes?

Metformin

What is the primary mechanism of action of metformin?

It decreases hepatic glucose production and improves insulin sensitivity

At what estimated glomerular filtration rate is metformin contraindicated?

Less than 30 milliliters per minute per 1.73 square meters

What vitamin deficiency is associated with long-term metformin therapy?

Vitamin B12 deficiency

What rare but serious complication is associated with metformin, especially in renal impairment?

Lactic acidosis

Why should metformin be held around iodinated contrast exposure?

To reduce the risk of renal injury and lactic acidosis

If a patient taking metformin develops sudden severe vomiting and diarrhea, what major complication should be considered?

Lactic acidosis

A patient with type 2 diabetes has a hemoglobin A1c above 10 percent. What treatment approach is recommended?

Initiate insulin therapy

A patient with type 2 diabetes has a hemoglobin A1c of 9.2 percent at diagnosis. What is an appropriate first-line consideration?

Metformin and lifestyle therapy

What is the usual starting dose of basal insulin in type 2 diabetes?

10 units daily or 0.1 to 0.2 units per kilogram per day

A 70-year-old patient with type 2 diabetes weighs 80 kilograms and is starting basal insulin glargine. What is the most appropriate starting dose?

10 units daily or 0.1 to 0.2 units per kilogram per day

How should basal insulin usually be titrated in type 2 diabetes until fasting glucose goals are reached?

Increase by 2 units every 3 days

At about what basal insulin dose should prandial insulin be considered if hemoglobin A1c remains above target?

About 0.5 units per kilogram per day

What is the usual starting total daily insulin dose in type 1 diabetes?

0.4 to 0.5 units per kilogram per day

In a basal-bolus regimen for type 1 diabetes, what percentage of the total daily dose is usually basal insulin?

About 40 percent to 50 percent

How is the sensitivity factor calculated using the 1800 rule?

1800 divided by the total daily insulin dose

If the total daily insulin dose is 40 units, what is the sensitivity factor using the 1800 rule?

45 milligrams per deciliter

What is the major electrolyte concern when giving insulin?

Hypokalemia

When should patients with type 1 diabetes check urine ketones?

When blood glucose is persistently above 300 milligrams per deciliter or during illness

During sick-day management, how often should patients with diabetes check blood glucose?

Every 2 to 4 hours

During sick days, should patients usually stop their diabetes medications?

No. They should generally continue medications, increase fluids, and monitor glucose more often.

What causes the Somogyi effect?

Rebound hyperglycemia after nocturnal hypoglycemia

How does the Somogyi effect differ from the dawn phenomenon at 3 in the morning?

Somogyi shows hypoglycemia at 3 in the morning, while dawn phenomenon shows normal or high glucose

What causes the dawn phenomenon?

Early morning hyperglycemia from overnight hormone surges

Which basal insulins have no true peak?

Insulin glargine and insulin degludec

Which insulin is considered ultra-long-acting and can last up to 42 hours?

Insulin degludec

How long does insulin glargine usually last?

About 24 hours

Why is neutral protamine Hagedorn insulin often given twice daily instead of once daily?

Its intermediate duration does not reliably provide 24-hour coverage

When does regular human insulin usually peak?

About 2 to 4 hours after injection

What is the onset of rapid-acting insulin analogs such as lispro or aspart?

About 15 to 30 minutes

Which long-acting insulins should never be mixed with other insulins in the same syringe?

Insulin glargine, insulin detemir, and insulin degludec

When using premixed insulin such as 70/30, how is the total daily dose commonly divided?

Two thirds in the morning and one third before dinner

Afrezza is an inhaled form of which type of insulin?

Rapid-acting insulin

Before starting inhaled insulin such as Afrezza, what test is required?

Spirometry

Why are meglitinides useful in patients with irregular meal schedules?

They are taken only with meals

If a patient skips a meal while taking repaglinide, what should they do with that dose?

Skip that dose

Which diabetes medication should be taken with the first bite of each main meal?

Acarbose

What is the major adherence-limiting adverse effect of acarbose and similar alpha-glucosidase inhibitors?

Gastrointestinal distress such as flatulence, bloating, and diarrhea

Which diabetes medication should be avoided in patients with inflammatory bowel disease or colonic ulceration?

Acarbose

What serious adverse effect has been reported with sitagliptin and other dipeptidyl peptidase 4 inhibitors?

Acute pancreatitis

Which dipeptidyl peptidase 4 inhibitor does not require renal dose adjustment?

Linagliptin

Which diabetes drug class is associated with euglycemic diabetic ketoacidosis?

Sodium-glucose cotransporter 2 inhibitors

A patient on empagliflozin has nausea, abdominal pain, elevated ketones, and only mildly elevated glucose. What is the most likely diagnosis?

Euglycemic diabetic ketoacidosis

What common infections are associated with sodium-glucose cotransporter 2 inhibitors?

Mycotic genital infections and urinary tract infections

What is the mechanism of action of sodium-glucose cotransporter 2 inhibitors?

They block glucose reabsorption in the proximal renal tubule and increase urinary glucose excretion

Which sodium-glucose cotransporter 2 inhibitor is known to reduce hospitalization for heart failure?

Dapagliflozin

Which sodium-glucose cotransporter 2 inhibitor reduces cardiovascular death in type 2 diabetes with established cardiovascular disease?

Empagliflozin

Which diabetes drug class helps slow chronic kidney disease progression?

Sodium-glucose cotransporter 2 inhibitors

Which two drug classes should be prioritized in type 2 diabetes with established atherosclerotic cardiovascular disease or chronic kidney disease?

Sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists

Which sodium-glucose cotransporter 2 inhibitors should be stopped if kidney function remains persistently below 45 milliliters per minute?

Empagliflozin and dapagliflozin

Which diabetes drug class can increase potassium levels, especially in kidney dysfunction?

Sodium-glucose cotransporter 2 inhibitors

What is the mechanism of action of glucagon-like peptide 1 receptor agonists?

They increase glucose-dependent insulin secretion, suppress glucagon, and slow gastric emptying

Which injectable diabetes drug class is helpful when minimizing weight gain or promoting weight loss is important?

Glucagon-like peptide 1 receptor agonists

Which diabetes drug class slows gastric emptying?

Glucagon-like peptide 1 receptor agonists

Which diabetes drug class commonly causes weight loss and has cardiovascular benefit?

Glucagon-like peptide 1 receptor agonists

What boxed warning applies to glucagon-like peptide 1 receptor agonists?

Risk related to medullary thyroid carcinoma and multiple endocrine neoplasia type 2

Which glucagon-like peptide 1 receptor agonists have shown cardiovascular risk reduction?

Liraglutide, semaglutide, and dulaglutide

What drug class does pramlintide belong to?

Amylin analog

Which injectable non-insulin agent is taken just before major meals and usually requires mealtime insulin to be reduced by 50 percent?

Pramlintide

When starting pramlintide, by how much should mealtime insulin usually be reduced?

By 50 percent

What is the mechanism of action of sulfonylureas?

They stimulate insulin release by closing adenosine triphosphate-dependent potassium channels in beta cells

What adverse effect is most commonly associated with sulfonylureas such as glyburide and glipizide?

Hypoglycemia

Why do sulfonylureas cause hypoglycemia?

They stimulate insulin release regardless of glucose level

Which second-generation sulfonylurea is sometimes considered safer in pregnancy if insulin is not an option?

Glyburide

Which drug classes can decrease the effectiveness of sulfonylureas and raise glucose?

Thiazide diuretics and corticosteroids

What is the mechanism of action of thiazolidinediones?

They are peroxisome proliferator-activated receptor gamma agonists that increase insulin sensitivity

How do thiazolidinediones commonly affect body weight?

They often cause weight gain

Besides heart failure risk, what are two major concerns with thiazolidinediones?

Weight gain and edema

Which malignancy has been associated with pioglitazone?

Bladder cancer

Which diabetes drug class primarily increases insulin sensitivity in muscle and fat?

Thiazolidinediones

Which intervention was more effective than metformin in the Diabetes Prevention Program?

Intensive lifestyle intervention

What urine test is used to screen for diabetic kidney damage?

Urine albumin-to-creatinine ratio

What early kidney marker is used to detect diabetic renal damage?

Urine microalbumin or albumin-to-creatinine ratio

What is the leading cause of death in patients with diabetes mellitus?

Cardiovascular disease

What is the major macrovascular complication of diabetes?

Atherosclerotic cardiovascular disease

What syndrome is marked by hypertension, dyslipidemia, central obesity, and insulin resistance?

Metabolic syndrome

What preprandial glucose range does the American Diabetes Association recommend for most adults?

80 to 130 milligrams per deciliter

What postprandial glucose goal does the American Diabetes Association recommend for most adults?

Less than 180 milligrams per deciliter

What premeal glucose goal is recommended by the American Association of Clinical Endocrinology?

Less than 110 milligrams per deciliter

What blood pressure goal is recommended for many diabetic patients with elevated atherosclerotic cardiovascular risk?

Less than 130 over 80 millimeters of mercury

What hemoglobin A1c goal is recommended for most adults?

Less than 7 percent

How often should hemoglobin A1c be checked in patients who are meeting treatment goals?

Every 6 months

How is diabetic ketoacidosis characterized?

Hyperglycemia, ketosis, and metabolic acidosis

How is hyperosmolar hyperglycemic state typically characterized?

Severe hyperglycemia with little or no significant ketosis

What are the two major contributors to type 2 diabetes mellitus?

Insulin resistance and beta cell dysfunction

Which diabetes medications are approved for adolescents with type 2 diabetes?

Insulin, metformin, and liraglutide

Which test is preferred for screening gestational diabetes?

Oral glucose tolerance test

At what gestational age is screening for gestational diabetes usually performed?

24 to 28 weeks