Anesthesia Pharmacology Chapter
23: Co-Existing Disease: Diabetes Practice Questions
Second generation sulfonylurea antidiabetic drug:
- chlorpropamide (Diabinese)
- Tolbutamide (Orinase)
- glipizide (Glucotrol)
- A & C
- A, B & C
Clinically use(s) for glucagon:
- management of severe hyperglycemia
- beta adrenergic receptor poisoning
- diagnostic uses
- B & C
- A & C
Major manifestations of diabetes:
- metabolic disorders
- inappropriate hyperglycemia
- both
- neither
Insulin-dependent diabetes mellitus:
- Type I
- Type II
Characteristics of Type I diabetes:
- typically adult onset
- low plasma glucagon
- insulin nearly absent
- pancreatic B cell is responsive to insulinogenic stimuli
In a patient with Type I diabetes, exogenous insulin is required to:
- prevent ketosis
- reverse hypoglucagonemia
- reverses catabolic state
- A & C
- A, B & C
Symptoms Secondary to Hyperglycemia in a Type I Diabetic Patient
- polyuria
- polydipsia
- polyphagia
- A, B & C
- none of the above
Cause(s) of metabolic effecct(s) associated with Type I diabetes:
- relative or significant glucagon excess
- an increase in glucagon/insulin ratio
- excessive insulin concentration
- A & B
- A, B & C
IDDM: typical age of onset
- less than 40 years of age
- greater than 40 years of age
Acute complication: NIDDM
- ketoacidosis
- hyperosmolar coma
Plasma insulin concentration: NIDDM
- low to absent
- normal to high
IDDM: response to sulfonylurea drugs:
- unresponsive
- responsive
Characteristic(s)of Type II diabetes:
- Group of milder forms of diabetes
- Occurs mainly in children
- Obesity: common risk factor
- A & C
- A, B & C
Clinical presentation: NIDDM
- usually developed ketoacidosis
- exhibits volume excess
- CNS symptoms
- exhibits hypo-osmolality
Hyperosmolar, nonketotic coma:
- caused by sustained hyperglycemia diuresis when patients cannot drink enough water to keep up with urinary fluid loss
- complete manifestation occurs when volume depletion decreases urine output
- both
- neither
Treatment of hyperosmolar coma states
- large amounts of IV fluids
- insulin
- potassium salts
- sodium bicarbonate
- all the above
Type II diabetes treatment --
- weight reduction
- diet
- insulin
- sulfonylurea drugs
- all the both
Clinical use for short-acting insulin
- IV treatment for diabetic ketoacidosis
- management of rapidly changing insulin requirements
- both
- neither
Tight glycemic control recommended:
- for patients with advance renal disease
- elderly
- children under the age of seven years
- none of the above
Most common complication of insulin treatment
- excessive appetite
- tachycardia, palpitations -- sympathetic overactivity
- hypoglycemia