Therapeutics Tutoring Sarah Darby shodge7@uthsc.edu November 2, 2017

Lectures Covered Diabetes continued ARDs CF

Diabetes Which of the following is not a rapid acting insulin? Lispro Detemir Glulisine Aspart

Diabetes Which is not an advantage to using rapid- acting analog insulin over regular insulin? More rapid onset of action Convenient administration Less variation in absorption Less expensive

Diabetes Which product has no peak of its action? Glargine Lispro Detemir

Diabetes Which of the following is false about rapid- acting analog insulin? It should be given 30 minutes before a meal. It should be clear and colorless. It can be mixed with NPH in the same syringe. Pens are stable at room temperature for 28 days.

Diabetes Which patient should not use Afrezza? Lung cancer History of VAP Asthma Smoker of ½ PPD

Diabetes Which pair is not matched correctly? Tresiba = degludec Lantus = glargine Levemir = detemir Toujeo = liraglutide

Diabetes Where can insulin be safely injected? Outer thigh Abdomen Back of arm Love handles All of the above

Diabetes PK (56kg) is starting insulin therapy with 4 injections daily. If we want his total daily dose to be 0.5 units/kg/day, what should his basal insulin dose be? 7 units HS 14 units HS 28 units HS 56 units HS

Diabetes KM (84kg) still has an A1C of 9.2% after being adherent on multiple oral medications. How do you start glargine? 4.2 units HS 12 units HS 22 units HS 25 units HS

Diabetes KM (84kg) still has an A1C of 9.2% after being adherent on multiple oral medications. He started insulin glargine 12 units daily at his last visit. His BG diary shows fasting glucose levels of 140-160mg/dl. What do you recommend? Increase 2-4 units. Maintain therapy. Decrease 2-4 units. Discontinue.

Diabetes WH (60kg) has been taking detemir for the past 3 months and has controlled her fasting blood glucose levels. However, she now needs to start before meal insulin. What do you recommend? 2 units TID AC 6 units TID AC 12 units TID AC 18 units TID AC

Diabetes FT (60kg) has an A1C of 11.2% and is starting basal/bolus insulin along with metformin. Calculate his: Total daily dose (0.5 units/kg/day): Basal dose: Bolus dose per meal:

Diabetes Basal Bolus Start 0.1-0.2 units/kg/d or 10 units 0.1 units/kg or 4 units Adjust Inc. 2-4 units or 10-15% Inc. 1-2 units or 10-15% Hypoglycemia Dec. by 4 units or 10-20% Dec. by 2-4 units or 10-20%

Diabetes Expected A1C changes Metformin 1-2% Sulfonylureas ~1-2% Thiazolidinediones 0.5-1.4% DPP-4 inhibitors 0.5-0.9% SGLT-2 inhibitors 0.7-1.0% GLP-1 agonists 1-1.5% Insulin 1.5-3.5%

Diabetes Which of the following is not a sign of hypoglycemia? Diaphoresis Tachycardia Abdominal pain Dizziness

Diabetes HT has T2DM and complains of feeling weak and shaky. He feels similar to previous episodes of hypoglycemia. What should he do? Eat a high carb containing meal Drink a can of diet soda Check his blood glucose Take an extra dose of metformin

Diabetes HT has T2DM and complains of feeling weak and shaky. He feels similar to previous episodes of hypoglycemia. His BG is 64 mg/dl. Eat 15g (snack) of carbs and recheck his BG in 15 minutes Eat 15g (snack) of carbs and take a nap Eat 65g (dinner) of carbs and recheck his BG in 15 minutes Eat 65g (dinner) of carbs and stop using insulin.

Diabetes 3-4 glucose tablets 1 Tbsp of peanut butter 1 cup of milk Which is an inappropriate choice for correcting hypoglycemia? 3-4 glucose tablets 1 Tbsp of peanut butter 1 cup of milk ½ cup of apple juice

Diabetes RD has long-standing T2DM and uses MDI of insulin. His wife discovers him to be unconscious on the couch. This has happened before because RD no longer recognizes s/s of low BG. Which is treatment option is appropriate? ½ cup of orange juice 3 peppermint candies 3-4 glucose tablets Glucagon injection

Diabetes Which of the following is not an acute complication of diabetes? DKA HHS Hypoglycemia Peripheral neuropathy

Diabetes A patient has had T2DM for 10 years and has recently developed numerous UTIs due to a high post-void residual volume. This is an example of autonomic neuropathy. True False

Diabetes Which of the following is false regarding diabetic peripheral neuropathy? Pts with T2DM should be screened at diagnosis Pts with T1DM should be screened 10 years after diagnosis The screening test should be performed with a 10g monofilament Tight glycemic control can slow the progression of neuropathy

Diabetes Which agent has a level A recommendation for the treatment of diabetic peripheral neuropathy? Gabapentin Amitriptyline Pregabalin Tramadol

Diabetes Which of the following patients should be taking an ACE inhibitor or ARB? 33 yo female, T2DM, 2nd trimester of pregnancy 54 yo male, T2DM, no HTN 49 yo female, T2DM, no HTN, urine albumin 150mg/day 58 yo female, T2DM, HTN, urine albumin 320mg/day

Diabetes When this is elevated… Change this… BG before breakfast Adjust nightly basal dose BG before lunch Adjust morning bolus dose BG before dinner Adjust lunch bolus dose BG before bedtime Adjust dinner bolus dose

CF Which of the following organs is not affected by cystic fibrosis? Lungs Musculoskeletal Pancreas Skin

CF Which of the following is not appropriate for chronic infection suppression in cystic fibrosis? Inhaled tobramycin Inhaled azithromycin Inhaled aztreonam PO azithromycin

CF Which of the following is true regarding antibiotic suppressive therapy? It is usually cycled 28 days on and 28 days off. Inhaled vancomycin is the DOC Antibiotics have reduced clearance and should be used at lower doses. E.coli is a common cause of respiratory infections in CF

CF Which is false regarding pancreatic enzymes? Dosing is based on amylase. They should be given with meals and snacks. High doses may cause colonic strictures. Side effects include cramping and diarrhea.

CF Which statement is false? Ivacaftor increases the time the CFTR channel is open Ivacaftor corrects the CFTR folding defect Lumacaftor/Ivacaftor reduces pulmonary exacerbation rates. The F508del causes misfolding and premature degradation of CFTR.

ARDS Which of the following is not a risk factor for ARDS? Pneumonia Near drowning Anticholinergic use in COPD Inhalation injury

ARDS Which of the following is not an indirect risk factor for ARDS? Sepsis Pancreatitis Drug overdose Immunizations

ARDS Which of the following is not present during the acute exudative phase of ARDS? Pneumonia Hypoxemia Bilateral infiltrates on chest x-ray Hyperventilation

ARDS Which agent showed some mortality benefit in ARDS in studies? IV alprostadil Cisatracurium Antioxidants Low dose methylprednisolone

Therapeutics Tutoring Questions? Sarah Darby shodge7@uthsc.edu November 2, 2017