Endo

What medications can increase BG

anti infectives (FQ, PI)

second gen antipsychotics

CV: beta blockers, diuretics, niacin, statins

immunosuppressants::steroids, tacrolimus, cyclosporine

What is the equation for insulin to carb ratio

500/TDD for rapid acting

450/TDD for regular,

amount of carbs covered by 1 unit of insulin

What is the insulin treatment for DKA

0.1 unit/kg bolus + 0.1 unit/kg infusion

Calculate correction factor and what does it mean

1500/TDD regular insulin,

1800/TDD for rapid acting,

for each additional unit insulin, it will lower BG by the CF

What are glycemic goals for pregnant people

fasting ≤95,

1 hr PPG ≤140,

2 hr PPG ≤120

What is the MOA of TZD

activate PPAR-gamma that increases peripheral glucose uptake

How can you mix NPH with other insulins?

Can mix with regular or rapid acting,

inject air into NPH then meal insulin,

draw meal “clear” insulin first then NPH

Which rapid acting insulins are concentrated

linsulin lispro 200 units/mL = humalog kwikpen, lyumjev kwikpen

Which long acting insulins are concentrated

insulin deguldec (200 units/mL) = Tresiba flextouch

insulin glargine (300 units/mL) toujeo

Which patient may benefit from super concentrated insulin u-500

taking >200 units daily

Which insulin is only good for 10 days RT

humalog MIX

humulin 70/30

Which insulin is only good for 14 days

Humulin N,

novolog mix 70/30

Which insulin is good for 42 days

humalin R U 500 vial,

novolin R U-100,

novolin N, novolin 70/30

Which insulin is good for 56 days

tresiba and toujeo

In insulin mixed formulations, which is the NPH?

The first number is NPH

What is the volume of most insulin pens

3 mL

What are the lab values for diabetes diagnostics

A1c ≥ 6.5,

FBG ≥ 126,

Random BG ≥ 200,

OGTT 2 hr ≥ 200

How does a1c correlate to average 3 mo BG level

6% = 126 mg/dL and each additional percent + 28 mg/dL

Pens are not included with which GLP1RA

byetta or victoza

Which GLP1RA have a CrCl limit

byetta (exenatide) <30 bydureon (exenatide ER) <45

What is the max dose of liraglutide

saxenda 3 mg

victoza, 1.8 mg sc qd

What is max dose of trulicity

dulaglutide 4.5 mg sc weekly

What is max dose of mounjaro

tirzepatide 15 mg sc q week

What is the MOA of GLP1RA

analogs of GLP1 that increase glucose dependent insulin secretion, slow GER, reduce glucagon release

Which GLP1RA has an interaction with oral contraceptives

tirzepatide, use back up method for 4 weeks post initiation or after each dose escalation

What is the MOA of SGLT2RA

inhibit glucose reabsorption in proximal tubule

Which SGLT2Ra have greater risks of amputations

canagliflozin and bexagliflozin

Which SGLT2Ra has a risk of hyperkalemia

invokana

Which SGLT2Ra as a renal adjustment

invokana: 100 mg qd max if <60

What are renal cut offs for SGT2s

farxiga <60, jardiance <45 invokana <45

What is the MOA of metformin

decrease hepatic glucose production, decreases intestinal glucose absorption

What is the maximum effective dose of metformin

2g IR, 2.55g ER

When can you restart metformin post contrast

48 hours if eGFR stable

MOA of SU

activate potassium channels to release insulin from pancreas

MOA of meglitinides

activate potassium channels to release insulin from pancreas

Which diabetes meds have ghost shells

metformin ER, glucotrol XL (glipizide),

What are the SU max doses

glipizide IR 40 XL 20,

glimepiride 8,

glyburide 20,

glyburide micronized 12

Which antidiabetic meds should be taken before meals

insulin, sulfonylureas, meglitinides

MOA of DPP4 inhibitors

prevent DPP from metabolizing GLP1 and GIP = stimulating glucose dependent insulin secretion

What are the risks associated with DPP4

pancreatitis,

arthralgia,

acute renal failure,

HF with saxagliptin and alogliptin

Which DPP4 has no renal adjustment

linagliptin Trajdjenta

What is the max dose of pioglitazone

45 mg

List a glucosidase inhibitors and MOA

acarbos miglitol:

inhibit metabolism of complex carbs delaying glucose absorption

How do you correct hypoglycemia in a patient taking a glucosidase inhibitors

must use glucose tablet or gel, sucrose (in food) will not get broken down. NEED PURE SUGAR

Which BAS can be used in diabetes

colesevelam

What is pramlintide

amylin analog that slows GER, suppressing glucagon secretion

DDI with pramlintide

hypoglycemia risk, reduce meal time insulin by 50%

What insulin is preferred for insulin pump

rapid acting

What container should insulin be prepared in for IV admin

NON PVC

Which insulin is cloudy

NPH

Which insulins are OTC

regular,

NPH,

NPH 70/30 regular

What is recommended basal starting for T2DM

0.1-0.2 units/kg/day

What is recommended starting insulin for T1DM

0.5 units/kg/day

What volume syringe is recommended per unit administered

0.3 if less than 30 u,

0.5 if 31 -50 u,

1 mL for 51-100

*most insulin is 100 units/mL

The insulin syringe cap correlates to what colors

orange = u-100,

green = u-500

What are the preferred needle sizes for pens, regular patients and obese patients`

4-5 mm pens,

8 mm average,

12.7 mm (½ in) obese

What is the equivalent of 15 g of carbs

4 oz of juice/regular soda,

1 cup of milk,

1 tbsp pure sugar,

3-4 glucose tabs

What is treatment for HHS

0.05 units/kg/hr infusion

What medications can cause weight gain

ASM: VPA, gabapentin, pregabalin

anti-diabetic: insulin, SU/meglinitides, TZD

psych:

AD: mirtazapine, TCA

AP: quetiapine, olanzapine, risperidone, clozapine, Lithium,

other: integrase inhibitors, systemic GCS, oral contraceptives

What are goals of weight loss therapy

long term: 5-10% loss in 6 mo,

short term: 5% loss in 12 weeks

What supplements are used for weight loss

bitter orange, caffeine (guarana, green tea)

Who is eligible for pharmacotherapy for weight loss

BMI ≥27 with 1 weight related condition or inability to lose weight with life style management,

BMI ≥30

Who is contraindicated for all weight loss pharmacotherapy

pregnancy

List GLP1 RA only indicated for weight loss

saxenda, wegovy, zepbound

Dose for saxenda weight loss

0.6 mg sc qd (max 3 mg)

Dose for wegovy weight loss

0.25 mg sc qd then 0.5 (max 2.4 mg)

Dose for zepbound weight loss

2.5 mg sc qwk (max 15)

CI for phentermine use

uncontrolled HTN, CVD,

glaucoma,

hyperthyroidism (exacerbation of CV symptoms)

hx of drug abuse

ADR with phentermine

tachycardia, increased BP

Dosing for phentermine

15-37.5 mg PO QD for 12 weeks or indefinitely if weight loss ≥5% after 12 weeks

CI for Qsymia

phentermine (glaucoma, uncontrolled HTN, hyperthyroidism)

topiramate (use of MAO-I in last 14 days)

ADR for qsymia

stimulant (tachycardia, inc BP)

reduced bicarb,

vision problems,

suicidal ideation,

seizure risk if stopped abruptly

Dosing for qsymia

3.75/23 starting

max 15/92 or 7.5/46 for CrCl < 50

Which weight loss medication is REMS monitored

qsymia

How should contrave be taken

do not take with fatty meals, reduced absorption.

Do not take with opioids, can precipitate withdrawal

CI for contrave use

chronic opioid use, opioid withdrawal, uncontrolled HTN, seizures, MAO-I inhibitor within 14 days

MOA or orlistat

lipase inhibitor and reduces absorption of dietary fats

Dosing for orlistat

Alli: 60 mg PO QD, Xenical 120 mg PO QD, taken with low fat diet (30% kcal from fats)

ADRs for orlistat

steatorrhea, GI disturbances, reduced absorption of ADEK vitamins