NR 577 final test with verified solutions

More likely to cause hypoglycemia Insulin, sulfonylureas, meglitinides, amylin analogues Less likley to cause hypoglycemia Incretin mimetics, metformin, thiazolidneidiones, dpp-4 inhibitors Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:02 / 0:15 Full screen Brainpower Read More Biguanides metformin GLP-1 ozempic, trulicity, vitoza SGLT2-I Invokana, farxiga, jardiance DPP-4i Januvia, onglyza, tradjenta, nesina Thiazolinidenoiones Avandia, actos Sulfonylurea glyburide, glipizide, glimerpride Rapid acting insulin Humalog( Lispro) Novalog (Aspart) Apidra Rapid acting insulin onset 5-30 minutes duration 3-4hrs Short acting insulin Regular (Humulin R or Novalin R) Short acting insulin onset 30-60 minutes duration 3-7hrs Intermediate acting insulin NPH or Humulin N Long acting insulin Lantus, levimir Fixed combination insulin NPH/Reg 70/30, 50/50, 75/25, 70/30 Hypothyrodisim and skin Thick course dry skin Hyperthryodism and skin smooth silky What is the drug of choice for DM2 metformin MOA of metformin enhance tissue responsiveness to insulin. They are also less likely to cause hypoglycemia and help tx insulin resistance. Metformin facilitates insulin uptake by peripheral tissue especially muscle and liver and decrease hepatic gluconeogenesis and basal glucose output thus lowering fasting glucose levels. Dosing of metformin Starting 500mg QD then after one week 500mg BID then increase slowly over 1-2 wks before your at max dose between mg/QD Sulfonylureas (Glyburide, glipizide, glimepridie) MOA acutley increase the sensitivity of beta cells to gluocse and stimulate endogenous insulin release. This can lead to hypoglycemia Dosing of glyburide 2.5mg BID dosing of glipizide 5mg bID dosing of glimerpridie 1mg daily Prandial insulin control is controlling insulin before meals What is the somogyi phenomenon early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia How to recognize somogyi phenomoneon night sweats, poor sleep, nightmares, morning headaches. How to tx somogyi phenomoenon trail dose of insulin reduction slowly or if someone is on NPH switch the timing from evening dose of NPH to bedtime may resolve the nocturnal hypoglycemia issue. Or you can switch NPH to insulin glargine. Thiazolidineodiones MOA decreasing insulin resistance in peripheral tissues including fat, muscle and liver thus increasing glucose utilization and decreasing glucose production. MOA of gliptins prolong GLP-1 action by inhibiting the DPP-4 enzymes that inactive GLP-1 and other incretin hormones. this stimulates the insulin synthesis and secretion and suppresses glucagon secretion. SLGT2 MOA block reabsorption of glucose in kidney increasing glucose excretion and lowering BG levels