Pharm Unit 5 Exam

Where is excess glucose stored?

In the liver + muscles as glycogen

Used in periods of fasting

Insulin

Peptide hormone

Produced by beta cells in pancreas

Type I diabetes mellitus

Autoimmune

Destruction of beta islet cells

Lack of insulin

Type 2 diabetes

Insulin resistance

Production may be reduced

Less glucose intake = hyperglycemia

Gestational diabetes

Type 2 during pregnancy

Due to hormone changes

Risk for fetal macrosomia and newborn hypoglycemia

Risks for mothers who had hyperglycemia

At risk for hemorrhage and birth complications

50% will develop type 2 diabetes later in life

Type 1 diabetes risk factors

White individuals

Family history

Bottle fed as infant

Type 2 risk factors

Obesity

Age

Family hx

Hx of gestational diabetes

Different manifestations of type 1

Weight loss

N/V

DKA

Different manifestations of type 2

Weight fain

Weakness

Blurry vision

Microvascular complications

Retinopathy

Neuropathy

Nephropathy → kidney damage

Macrovascular complications

CAD

CVD

PVD

Diabetic Ketoacidosis

Life threatening

• Hyperglycemia

• Ketosis

• Dehydration

• Electrolyte imbalances

• Metabolic acidosis!

Hyperosmolar hyperglycemia nonketotic syndrome (HHNKS)

Life threatening

• Hyperosmolality

• Hyperglycemia

Why does HHNKS not have ketones?

Because there is still insulin so there is not as much fat breakdown

Diabetes A1C level

>6.5

Normal: <5.7

Diabetes fasting blood sugar

>126

Normal: <99

s/s of DKA

Polydipsia/uria/phagia

N/V

Kussmauls respirations

Fruity breath

Confusion/coma

s/s of HHNKS

Polyuria/dipsia/phagia

Extreme dehydration

Changes in mental status

Sulfonylureas

Glipizide

Glyburide

Glimepiride

Sulfonylureas (Glipizide) MOA

Increased insulin secretion and sensitivity

Decreased insulin metabolism

Sulfonylureas (Glipizide) Adverse effects

Hypoglycemia

Weight gain

Sulfonylureas (Glipizide) Implications

Take w food

HOLD if patient can’t eat

Monitor for hypoglycemia

Biguanides

Metformin

Biguanides (Metformin) MOA

Decreased gluconeogenesis and absorption in GI tract

Increased glucose uptake

Biguanides (Metformin) Indication

Type 2 DM

PCOS

Biguanides (Metformin) Adverse effects

GI upset (diarrhea)

Vit. B12 and folic acid deficiency

Lactic acidosis → Rare!

Biguanides (Metformin) Implications

Alcohol → Increases risk of lactic acidosis

HOLD if pt received contrast

Thiazolidinediones

Plioglitazone

Thiazolidinediones (Plioglitazone) MOA

Increase glucose uptake

Decreased insulin resistance and glucose production

Thiazolidinediones (Plioglitazone) adverse effects

Fluid retention

Increased LDLs

Hepatotoxicity

SGLT-2 Inhibitors

Canagliflozin

SGLT-2 Inhibitors (Canagliflozin) MOA

Stops glucose spike

Excretes through kidneys → WILL be in urine

Weight loss

SGLT-2 Inhibitors (Canagliflozin) adverse effects

Cystitis

Polyuria

Dizziness

Hypotension

SGLT-2 Inhibitors (Canagliflozin) Implications

Change positions slowly

Caution: diuretics

Admin BEFORE breakfast

GLP-1

Semaglutide

GLP-1 MOA

Reduces the amount of GLP-1 hormone used

• Slows gastric emptying

GLP-1 Adverse effects

Nausea

Loss of appetite

Pancreatitis

GLP-1 Implications

Hypoglycemia if insulin/sulfonylureas

Once a week, SubQ

Rapid acting insulin

Aspart, lisipro

Start: 15 min

Peak: 1 hr

Right before a meal

Short-acting insulin

Regular (Humulin)

Start: 1/2-1hr

Peak: 2-3 hrs

Given 30-60min before a meal!

ONLY insulin that can be given IV

Intermediate acting insulin

NPH

Start: 2-4 hrs

Peak: 4-12hrs

Coverage overnight

Long acting insulin

Glargine, detemir

Start: 2hrs

No peak

24hr coverage

Ultra long acting insulin

Degludec

Start: 6 hrs

No peak

36+ hrs coverage

Hypolgycemia

<70mg/dL

<54 is Level 2

s/s of hypoglycemia

Hunger

Diaphoresis

Tremor

Neuro changes

Severe: seizures and loss of consiousness

15-15 rule

Give 15 g of carbs and recheck BBG in 15 minutes

TB treatment

Multi-drug approach (combination therapy)

6-9mo

When is herpes simplex transmission most likely?

During flareups

Complication of shingles

Ophthalmic zoster

• Cause significant vision changes

Epstein-Barr Virus

Causes mononucleosis

Lupus has been linked

May be asymptomatic

Fungal infections caused by antibiotics

Vaginal candidiasis

Oral thrush

In what pts are systemic fungals infections more common?

Immunocompromised pts

Malaria causes

Plasmodium protozoal parasites

Transmitted by female mosquitoes

Knob-like structural changes on RBCs

Sickle cell trait = immune

Malaria MOA

Parasites enter liver and infect hepatocytes

Liver cells rupture and parasites released

Malaria s/s

Flu-like symptoms

• HA

• Tachy

• Cough

N/V/D

High fever!!! 106F

Renal/hepatic failure

Pinworm infection

Most common in school age

Transmission by touching eggs

Perianal itching most common symptom

Antitubercular

Isoniazid

Antitubercular (Isoniazid) MOA

Inhibits myobacterial growth

• Prevention of mycolic acid

Antitubercular (Isoniazid) indication

Active/latent TB

Antitubercular (Isoniazid) contraindication

Liver dysfunction

Caution of alcohol abuse and DM

Antitubercular (Isoniazid) adverse effects

Peripheral neuropathy due to B6 deficiency

Hepatotoxicity

Antitubercular (Isoniazid) implications

Monitor liver function

B6 supplementation

Additional birth control if PO BC

AVOID alc. and tyramine

Antitubercular (Isoniazid) interactions

Phenytoin

Tyramine → Hepatotoxicity

Rifampin MOA

Inhibits protein synthesis

Rifampin indication

In combination to treat TB

First-line for leprosy!

Rifampin contraindications

Pregnancy

Liver dysfunction

Rifampin side effects

Orange discoloration of body fluids

• Expected finding

Rifampin adverse effects

Hepatotoxicity

A/N, Abd pain

Preudomembranous colitis → Caused by C. diff

Rifampin implications

Food decreases effectiveness

Monitor liver function

Avoid alcohol

Acyclovir/valacyclovir MOA

Prevent reproduction of viral DNA

Acyclovir/Valacyclovir indication

Herpex simplex

Varicella zoster

Acyclovir/Valacyclovir contraindications

Monitor w renal function

Acyclovir/Valacyclovir adverse effects

Phlebitis

N/D

HA

Acyclovir/Valacyclovir implications

Educate that it doesn’t cure virus → Just manage symptoms

Antifungals

Fluconazole

Amphotericin B

Nystatin

Fluconazole MOA

Inhibits cell membrane formation

Fluconazole indication

Systemic/superficial fungal infection

Fluconazole contraindications

Liver disease

Nephrotoxicity

Fluconazole adverse effects

Hepatotoxicity

Electrolyte imbalances

Fluconazole implications

Typically 1 dose

Monitor electrolytes

Monitor liver enzymes

4-6 week course

Amphotericin B MOA

Cell membrane death

Amphotericin B indication

ONLY severe infections! → High risk of toxicity

Amphotericin B adverse effects

Nephrotoxicity

Bone marrow suppression!

Electrolyte imbalances

Infusion reactions

Amphotericin B implications

SLOW infusion → 4-6hrs

Highly toxic

IV filter required

Discard if floaters are present!

Nystatin MOA

Changes cell wall permeability

Nystatin indication

Candidiasis → Oral and topical

Nystatin implications

Swish for 30 sec and swallow!

Don’t drink for 30 min

No dilution required