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Fichas

Diabetes

wade.barrett777 Clinical Pharmacy & Therapeutics I Bachelors Inglés 83 fichas

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  1. 1SymptomsPolyphagia
    Polyuria
    Polydipsia
    Blurred vision
  2. 2Type I DMNo insulin production
    Treat: insulin
    N.B. Type I DM does not respond to oral antihyperglycemic agents
  3. 3Type II DMInvolves insulin resistance, impaired insulin secretion, elevated glucose production by the liver, or all of these components.
  4. 4Risk factors (Type II DM)Overweight or Obesity
    Age (> 45 yr)
    Sedentary lifestyle
    Family History
  5. 5ComplicationsNephropathy
    Heart disease
    Retinopathy
    Neuropathy
  6. 6Normal HbA1C (%)< 5.7
  7. 7Normal Fasting Plasma Glucose (FPG)< 100 mg / dL (< 5.6 mmoL / L)
  8. 8Normal Oral Glucose Tolerance Test (OGTT) value< 140 mg / dL (< 7.8 mmol / L)
  9. 9Diabetic HbA1c>= 6.5
  10. 10Diabetic FPG>= 126 mg / dL (>= 7 mmol / L) on two occasions
  11. 11Diabetic OGTT>= 200 mg / dL (>= 11.2 mmol / L)
  12. 12Drug class that impairs glucose metabolismCorticosteroids
  13. 13Early Diabetic nephropathyMicroalbuminuria
    (Albumin: > 30 mg / g)
  14. 14Treat MicroalbuminuriaGoal: Prevent progression of renal disease
    ACE inhibitors or Angiotensin II Receptor Blockers
    N.B. These anti-hypertensives have renoprotective properties:
  15. 15Manage neuropathyGlycemic control
    Regular foot care & examination
    Management of pain
  16. 16Diabetic Random Plasma Glucose>= 200 mg / dL (>11.1 mmol / L)
    Values can be affected by recent meals and must be confirmed by repeat testing (may not be necessary in the presence of diabetic symptoms)
  17. 17OverweightBody mass index ≥ 25 kg / m2 & < 30 kg / m2
  18. 18Manage Diabetic complicationsACE inhibitors OR ARBs
    Statins
    Aspirin
  19. 19Patient Education (Recommendations)Self-monitoring of blood-glucose
    Diet (low saturated fat & cholesterol; increase fiber intake - whole grains)
    Symptoms of hypoglycemia (2 tsp honey OR 3 tsp table sugar)
    Aerobic exercise (manage cholesterol)
    Avoid smoking (reduce cardiovascular risk)
    Avoid / Restrict alcohol
  20. 20Goals of therapyProvide relief of symptoms and prevent complications by achieving desired glycemic levels:
    - HbA1c: < 6.5
    - Preprandial: < 110 mg / dL (< 6.1 mmol / L)
    - Postprandial: < 140 mg / dL (< 7.8 mmol / L)
    Minimize hypoglycemic episodes during treatment
    Maintain normal activity levels of patient
  21. 21PreprandialBefore a meal
  22. 22Postprandialafter a meal
  23. 23Type II DM treatment Steps1) Diet & lifestyle changes (all steps)
    - Initial therapy for mild hyperglycemia
    2) Single oral antihyperglycemic drug
    - Metformin (unless C/I)
    - initial therapy for moderate hyperglycemia
    - Sitagliptin could be used as an alternative to metformin
    3) Metformin + Pioglitazone
    - Max tolerated dose for single oral ineffective
    4) Metformin + Pioglitazone + Insulin
    - Max tol. dose for met & pio were ineffective
    N.B. Insulin 0.2 units / kg / d hs
  24. 24Type II DM treatment (special case)Pregnancy
    Treat: Insulin
  25. 25Type II DM treatment (Severe hyperglycemia!)>= 400 mg / dL (>= 22.4 mmol / L)
    OR
    HbA1c > 8.5 - 9 % on multiple therapies
    Steps:
    1) Insulin (brief therapy)
    2) Oral antihyperglycemic agent (once blood-glucose has been normalized by insulin)
  26. 26Rapid-acting insulinBolus insulin
    Onset: 15 min (take 15 min before meals)
    Peak: ~ 1 hr
    Duration: ~ 3 hr
    Examples: Insulin Lispro | Insulin Aspart
  27. 27Short-acting insulinCan be used as bolus insulin
    Onset: 30 min (take 30 min before meals)
    Peak: ~ 2 h
    Duration: ~ 6 h
    Example: Regular insulin
  28. 28Long-acting insulinBackground / Basal insulin
    Onset: ~ 2 h
    Peak: --
    Duration: ~ 24 h
    Examples: Insulin Glargine
    Insulin Detemir
  29. 29Premixed insulin exampleHumulin 70 / 30 (NPH / Regular)
    Onset: 30 min
    Duration: ~ 12 h
  30. 30Intermediate-acting insulinExample: NPH
    Can be used as basal insulin
    Onset: ~ 2 h
    Peak: ~ 4 h
    Duration: ~ 12 h
  31. 31Other relevant infoMay cause hypoglycemia
    May cause weight gain (insulin)
    Avoid / Restrict alcohol
    Insulin injections:
    - Rotate site of injection
    - Refrigerate
    - Do not freeze
    - Protect from light
    - Different insulin types can be drawn into the same syringe for injection but not premixed
  32. 32Symptoms of hypoglycemiaHA
    Blurred vision
    Light-headedness
    Confusion
  33. 33Oral Antihyperglycemic drugsMetformin
    Acarbose
    Pioglitazone
    Sitagliptin
  34. 34MetforminOral antihyperglycemic drug of choice
    Biguanide
    Enhances insulin sensitivity of hepatic & peripheral (muscle) tissues, allowing for increased glucose uptake
    Dose: 500 mg bid cc (can titrate dose q 2 weeks)
  35. 35PioglitazoneThiazolidinedione
    Enhances insulin sensitivity (Increases glucose uptake in peripheral tissues)
    N.B. Sufficient insulin must be present
  36. 36Actoplus MetPioglitazone 15 mg / Metformin 500 mg
    i tab bid
  37. 37SEs of MetforminDiarrhea
    Heartburn
    HA
  38. 38ACE inhibitors or ARBDiabetics w/ HTN
    OR
    Patients with evidence of early nephropathy (microalbuminuria or proteinuria) even in the absence of hypertension
  39. 39AspirinMen (> 50 y.o) or Women (> 60 y.o) with risk factors: hypertension, smoking, dyslipidemia, albuminuria, or family history of CVD
    Bayer Aspirin 81 mg od (tab)
    Provide cardiovascular protection (anti-platelet therapy)
  40. 40StatinsDiabetics (40 - 75 years)
    Recommended by the American Diabetes Association (regardless of cholesterol)
    Desirable cholesterol targets:
    LDL < 100 mg / dL (< 2.6 mmol / L)
    HDL > 40 mg/dL (men) | > 50 mg / dL (women)
    Triglycerides < 150 mg / dL (1.7 mmol / L)
  41. 41AtorvastatinStatin
    Brand: Lipitor (tablets)
    Dose: 10 - 20 mg od
  42. 42NiacinHigh TG: 201 - 499 mg / dL (2.27 - 5.7 mmol / L)
    250 mg od (with evening meal)
  43. 43Acarboseα-glucosidase inhibitor
    Slows breakdown of glucose in the GIT
  44. 44ObeseBMI: >= 30 kg / m2
  45. 45Normal weightBMI: >=18.5 & < 25 kg / m2
  46. 46BMI FormulaWt (lbs)
    Height (inches)    BMI Formula
  47. 47Brand name for Metformin & Available strengthsBrand: Glucophage
    Strengths: 500 mg, 850 mg OR 1000 mg tab
  48. 48Brand name for Insulin LisproHumalog (100 units / mL)
    X 3 or 10 mL
  49. 49Brand names for Insulin GlargineLantus SoloStar (100 units / mL) X 3 mL
    Lantus (100 units / mL) X 10 mL
  50. 50General characteristics of Type I DMDeveloped at a young age (< 45)
    Signs & symptoms:
    - Rapid weight loss
    - Ketonuria
    - Ketoacidosis
  51. 51Regular Exerciseimprove blood glucose control
    reduce cardiovascular risk factors
    weight loss
    Recommended:
    Aerobic (30 min X 5 d / wk)
    Resistance (2 X / wk)
  52. 52Ideal Candidates for Oral antihyperglycemic drugDeveloped diabetes: >= 40 y.o
    Has Diabetes < 5 years
    FPG: < 200 mg / dL
    No insulin history OR controlled on insulin < 30 units / d
    No history of ketoacidosis
  53. 53Drug options for Preprandial blood-glucose controlMetformin
    Pioglitazone
    Insulin (intermediate OR Long-acting)
  54. 54Drug options for Postprandial blood-glucose controlInsulin (Rapid-acting or Short-acting)
    Pioglitazone
    Acarbose
    Sitagliptin
  55. 55Brand for PioglitazoneBrand: Actos
    Dose: 15 mg - 45 mg od
  56. 56Brand for AcarboseBrand: Glucobay
    25 mg tid cc (first bite)
  57. 57SitagliptinDPP-4 Inhibitor (Gliptin)
    inhibits Glucagon-Like Peptide-1 (GLP-1) breakdown (stimulates glucose-dependent insulin secretion)
  58. 58ExenatideGLP-1 Agonist
    Enhances insulin secretion + reduces hepatic glucose production
  59. 59Reduce A1c by 1 - 2%Metformin + Pioglitazone
    N.B. Basal insulin can be added
  60. 60Reduce A1c by > 2%Insulin NPH + Insulin Regular
    OR
    Metformin + Insulin NPH + Insulin Regular
  61. 61MonitoringSerum glucose levels
    HbA1c
    Hypoglycemic episodes
    SMBG technique and ability to use data to adjust therapy
    Foot exams
    Eye exams
    Urine Abumin (UA):
    - screen for albuminuria to assess renal function
    - conduct annually
  62. 62Brand name for Insulin AspartNovolog (100 units / mL) X 10 mL
  63. 63Brand name for Insulin DetemirLevemir (100 units / mL) X 10 mL
  64. 64Diabetic Ketoacidosis (Lab values)Plasma glucose: >250 mg / dL & < 600 mg / dL
    Ketones (urine and serum)
    Na: < 15 mEq / L
  65. 65Treat Diabetic KetoacidosisGoals:
    - Rapid intravascular volume repletion
    - Correct hyperglycemia and acidosis - Prevent hypokalaemia
    IV 0.9% saline stat
  66. 66Symptoms of Hyperglycemic Hyperosmolar Non-ketonic Syndrome (HHNS)More common in Type II DM
    Plasma glucose level > 600 mg / dL
    High fever (> 101 degrees F)
    Weakness on one side of the body
    Mainly affects: elderly w/ Type II
  67. 67HypoglycemiaPlasma glucose: < 70 mg / dL
  68. 68SEs of PioglitazoneWeight gain
    Edema
    HA
  69. 69SEs of AcarboseAbdominal pain
    Diarrhea
  70. 70SEs of SitagliptinSore throat
    Runny nose
    HA
  71. 71Brand name for SitagliptinJanuvia
    100 mg od (tab)
    N.B. No regards to meal
  72. 72SEs of ExenatideSatiety
    Weight loss
    N&V
  73. 73General Starting Insulin doseNon-obese: 0.6 units / kg / d
    Obese: 0.8 units / kg / d
  74. 74Reduce A1c by < 1 %Metformin + Pioglitazone
    OR
    Metformin + Sitagliptin
    N.B. Basal insulin can be added
  75. 75Sign of Renal dysfunctionMale (Ccr >= 1.5 mg / dL)
    Female (Ccr >= 1.4 mg / dL)
  76. 76C/I to metforminRenal dysfunction
  77. 77Metformin toxicityMetallic taste
    Lactic acidosis
  78. 78Metabolic syndromeHigh BP + High blood sugar + Obese + High cholesterol
  79. 79Notes abt metforminRelatively cheap
    Helps weight management & improve lipid profile
    Addresses metabolic syndrome
  80. 80Alcohol & DMAlcohol may mask the symptoms of hypoglycemia (Hypoglycemia might be mistaken for drunkenness)
  81. 81Desired BPJoint National Commitee (JNC 8 guidelines):
    <140 / 90 mmHg
  82. 82Basal / Bolus Insulin Combination OptionsInsulin NPH + Short-acting insulin
    OR
    Long-acting insulin + Rapid-acting insulin
  83. 83Treat HHNS1) Vigorously rehydrate patient while maintaining electrolyte homeostasis
    - IV 0.9% saline stat
    N.B. Monitor hydration state
    -Potassium replacement
    N.B Monitor electrolyte levels q 2 h
    2) Correct hyperglycemia (Lower plasma glucose gradually):
    - Continuous insulin infusion (0.1 U / kg / h)
    - Monitor blood glucose q h. When stable for 3 hours: monitor q 2 hours and adjust infusion rate accordingly.
    - Goal (Type II DM): 80 - 120 mg / dL
    N.B. Switch to oral antihyperglycemic agent once glycemic control achieved after several weeks
    3) Identify & treat underlying disease(s)
    - Infection (Antipyretics, antiemetics, and antibiotics to control fever & vomiting)
    4) Monitor and assist cardiovascular, pulmonary, renal, and central nervous system (CNS) function

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Bachelors Clinical Pharmacy & Therapeutics I Fichas sobre Diabetes, creado por wade.barrett777 el 16/04/2015.
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