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PHRM 844 > Kania Exam 2 > Flashcards

Kania Exam 2 Flashcards

1
Q

__ of the population have diabetes

A

11.3%

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2
Q

what accounts for most deaths from diabetes?

A

heart disease and stroke

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3
Q

glucose uptake by brain is insulin ____

A

independent

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4
Q

glucose uptake by muscle and fat is insulin ____

A

dependent

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5
Q

effects of glucagon

A

increase in gluconeogenesis, increase in glycolysis, inhibition of insulin release

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6
Q

normal plasma glucose level

A

60-140 mg/dL

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7
Q

resorptive capacity of kidneys

A

180 mg/dL

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8
Q

effects of insulin

A

glucose removal, glycogen storage, fatty acid storage, protein synthesis

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9
Q

effects of glucagon

A

gluconeogenesis, glycogenolysis, inhibit insulin release

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10
Q

risky HDL and TG levels

A

HDL < 35 mg/dL
TG > 250 mg/dL

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11
Q

drug induced diabetes: increase hepatic glucose

A

glucocorticoids, sympathomimetics, niacin

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12
Q

drug induced diabetes: decrease insulin secretion

A

phenytoin, beta blockers, calcium channel blockers,immunosuppressant (cyclosporine, tacrolimis)

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13
Q

beta blockers can blunt the signs of

A

acute hypoglycemia

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14
Q

drug induced diabtes: increase insulin resistance

A

thiazide diuretics, glucocorticoids, oral contraceptives, antipsychotics

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15
Q

drug induced diabetes: toxic to beta cells

A

pentamidine

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16
Q

drugs that stimulate apetitie

A

phenothiazines, marijuana, androgens

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17
Q

HIV drugs

A

-avir

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18
Q

syndromes that could cause diabetes

A

Cushings, hyperthyroidism, acromegaly, cystic fibrosis, pancreatitis, CMV, rubella, Downs, Turners, Huntingtons

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19
Q

diagnostic criteria for diabetes

A

A1C >6.5%
fasting blood glucose >126
2h glucose test >200
random plasma glucose >200 w symptoms
NEED TWO POSITIVE CRITERIA

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20
Q

diagnostic criteria does not apply to what group

A

conditions with red blood cell turnover like sickle cell disease, pregnancy, blood loss/transfusion

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21
Q

normal levels of A1C / glucose

A

<5.7%
fasting <100
2 hour <140
random <200

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22
Q

autoantigens associated with type 1

A

GAD
IA-2 and IA-2B
ZnT8

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23
Q

what age should we test all adults for type 2

A

35

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24
Q

who should we test regardless of age

A

overweight BMI >25, one or more risk factors
overweight / risk factor women planning a pregnancy
HIV patients before therapy

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25
Q

how often should we retest if normal

A

every 3 years

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26
Q

people with prediabetes should be tested ___

A

annually

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27
Q

women with gestational should be tested ____

A

every 3 years for life

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28
Q

what age should we test kids who are fat

A

10 years

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29
Q

prevention of type 2 diabetes weight loss

A

7%

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30
Q

how much physical activity should we do to prevent

A

150 min / week

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31
Q

when should we start metformin for prevention

A

A1C 5.7-6.4
BMI>35
age less than 60
women with prior gestational

32
Q

what do we need to monitor in metformin takers?

A

B12 annually

33
Q

4 components therapy

A

meals, movement, medications, monitoring

34
Q

medical nutrition therapy

A

restrict 500-750 calories a day
weight loss 10-20 lbs
high fiber foods, monitor carbs
increase monosaturated fats
<300mg cholesterol

35
Q

alcohol limits men and women

A

2 drinks man
1 drink women

36
Q

UARC

A

urinary albumin to creatinine ratio

37
Q

normal UARC

A

<30 mg/g

38
Q

how often should we screen microalbuminemia in type 1

A

every year for pts who have had it for 5+ years

39
Q

need to screen for microalbuminuria twice a year for
UARC:
eGFR:

A

UARC: >300 mg/g
eGFR <60 mL/min

40
Q

ACE or ARB recomended for:

A

non pregnant patients with UARC >300 or eGFR <60

41
Q

what should we use to decrease CKD progression in pts with diabetes and kidney disease

A

SGLT2 if eGFR >20

42
Q

if patients have a UACR >300 goal reduction is

A

30%

43
Q

if no retinopathy present for one or more annual exams, extend exams to every

A

1-2 years

44
Q

initial therapy of neuropathy drugs

A

gabapentin, duloxetine, pregabalin

45
Q

diabetes drugs for people with heart diease or failure optimal

A

SGLT
GLP-1

46
Q

BP goal type 1 and 2

A

<130/80

47
Q

BP goal pregnant and diabetes

A

110-135/85

48
Q

antihypertensive agents for patients with diabetes especially UACR >300

A

ACE - iprils
ARB - sartans
WANT MAX DOSE

49
Q

if BP still bad after ACE or ARB use:

A

HCTZ, chlorthiadone, amlodipine

50
Q

risk factors for statin tx

A

LDL >100, HTN, smoking, CKD, albuminuria

51
Q

age 20-39 years with no ASCVD

A

no statin needed, monitor annually

52
Q

40-75 years with no ASCVD

A

moderate intensity statin

53
Q

40-75 years with no ASCVD and 1+ risk factor
statin and goal/target

A

high intensity statin
goal: decrease LDL by 50%
target LDL <70

54
Q

DM and CVD all ages statin

A

high intensity statin and lifestyle

55
Q

DM and CVD target/goal

A

decrease LDL by 50% and target LDL <55

56
Q

LDL still high after high intensity statin drug options

A

Repatha and ezetimibe

57
Q

high dose statin

A

atorvastatin 40-80mg
rosuvastatin 20-40mg

58
Q

moderate dose statin

A

atorvastatin 10-20mg
rosuvastatin 5-10mg
simvastatin 20-40mg
pravastatin 40-80mg
lovastatin 40mg
fluvastatin 80mg
pitavastatin 1-4mg

59
Q

history of CVD secondary prevention

A

81mg aspirin
clopidogrel 75mg with allergy

60
Q

primary prevention aspirin use

A

over 50 with one risk factor
no increase in risk of bleeding

61
Q

who should we not use aspirin for

A

bleeding risk
less than 50 with no CVD risk

62
Q

fasting blood glucose target ADA

A

80-130 mg/dL

63
Q

random or post prandial glucose goal

A

ADA <180
AACE <140

64
Q

when to do blood gluose pricks with intensive insulin

A

before meals and at bedtime
before snack or activity
after meal
suspicion hypoglycemia

65
Q

when to do blood glucose pricks with basal insulin and a diabetes med

A

once a day, fasting

66
Q

goal time in range for most pts

A

> 70%

67
Q

goal time in range for hypoglycemic risk pts

A

> 50%

68
Q

goal time using device

A

> 70%

69
Q

normal A1C

A

4-6%

70
Q

ADA target A1C

A

<7%

71
Q

AACE target A1C

A

<6.5%

72
Q

Diabetes Control and Complications Trial
DCCT

A

intense 7% in type 1
successful micro and macro outcomes

73
Q

UK Prospective Diabetes Study (UKPDS)

A

intense 7% in type 2
successful micro and macro outcomes
every 1% drop in A1C is 18% decrease in CVD

74
Q

Action to Control Cardiovascular Risk in Diabetes (ACCORD)

A

intense 6.4% for pts with CVD risk
bad results increase mortality

75
Q

ADVANCE

A

intense <6.5%
reduction in microvascular

76
Q

VA Diabetes Trial (VADT)

A

be more intense early on <15 years
less intense 20+ years
intense 6.9% not intense 8.5%

PHRM 844 (16 decks)

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