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mohd keystone exam 1 > Diabetes and Hyperlipidemia > Flashcards

Diabetes and Hyperlipidemia Flashcards

1
Q

Anion Gap

A

Measured cations minus measured anions

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2
Q

Total Daily Insulin Dose =

A

1/2 Basal insulin dose +

1/2 Meal insulin dose

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3
Q

Causes of relative Insulin deficiency (DKA)

A

Acute Stress:
Infection
Inflammation
Infarction

(4-I’s)

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4
Q

Metformin mechanism

A

decreases gluconeogenesis in liver, raises blood levels of lactate

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5
Q

Lab Findings in T1DM

A 
High glucose
Ketones present
Low bicarbonate
High Anion Gap
Electrolyte (K) loss
Increased BUN, creatinine --> fluid depletion
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6
Q

12 hour half life insulin

A

Detamir, NPH

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7
Q

Regions most at risk for mircovascular injury

A

eyes, kidneys, small nerves

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8
Q

Metformin side effects

A

Nausea, abd pain, bloat, diarrhea

lactic acidosis (?)

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9
Q

24 hour half life insulin

A

Glargine

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10
Q

What drug should every Type 2 diabetic patient receive?

A

metformin

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11
Q

Untreated T2DM can result in

A

HHS - hyperosmolar hyperglycemic states

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12
Q

Symptoms of HHS

A
  • Thirst/polyuria: glycosyria/dehydration
  • Fatigue: hyperglycemia/dehydration/electrolyte disturbance
  • Muscle cramps: electrolyte disturbance, dehydration
  • Neurologic symtoms: dehydration
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13
Q

Short acting Insulins

A

Aspart, Lispro, Glulisine, Regular

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14
Q

Acarbose (Alpha glucosidase inhibitor)

A

–> inhibits upper GI enzymes that convert complete polysaccharide carbs into mono –> slow absorption of glucose

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15
Q

Every non-insulin agent drops HbA1c by approximately

A

1%

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16
Q

Pioglitazone (Thiazolidinediones) mechanism

A

lower blood glucose by enhancing glucose effects, enhance fat storage

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17
Q

Signs of HHS

A
  • Dehydration
  • Tachycardia
  • Hypotension
  • Impaired consciousness/coma
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18
Q

If HbA1c is greater than _____% then begin insulin

A

10%

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19
Q

Only drugs with proven CHD morbidity/mortality benefits

A

Statins

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20
Q

Causes of HHS

A

New diagnosis
Therapy Stopped
Acute stress (4-I’s)

21
Q

Sulfonylureas (Glipizide, glimmepiride, glyburide) mechanism

A

depolarlize the cell –> calcium influx –> insulin release (irrespective of glucose presence)

22
Q

GLP-1 agonists (exenatide, liraglutide, -tide) mechanism

A

enhance insulin secretion but reliant on glucose to initiate insulin secretion

23
Q

Type 1 diabetes can be treated with oral drugs or insulin therapy.

A

False - T1DM is only treated with insulin.

24
Q

Classes of drugs to treat peripheral neuropathy

A

Anticonvulsants (gabapentin, pregabalin)

Antidepressants (TCA, duloxetine)

25
Q

Statin Benefit Group

A 
ALL diabetics (40-75, LDL >70)
atherosclerotic CVD
LDL >190
age 40-75 w LDL >70 + DM
age 40-65 w LDL >70 - DM - CVD + 10yatheroCVD>7.5%
26
Q

DPP-IV inhibitors (-liptin) mechanism

A

make endogenous GLP-1 last longer

27
Q

At what levels should triglycerides be lowered and why?

A

over 500-1000, in order to prevent pancreatitis

Therapy: fibrates, niacin, fish oil

28
Q

most common form of primary hypercholesterolemia

A

polygenic hypercholestorolemia

29
Q

moderate intensity statins

A

decrease LDL by 30-50%

30
Q

Acarbose (Alpha glucosidase inhibitor) side effects

A

flatulence, diarrhea

31
Q

Mechanism of the PCSK9

A

LDL receptors with PCSK9 attached get broken down, cannot take in and clear LDL –> high LDLemia

32
Q

Sulfonylureas/meglitinizes mechanism

A

depolarlize the cell –> calcium influx –> insulin release (irrespective of glucose presence)

33
Q

Causes of monogenic hypercholesterolemia

A

LDL receptor mutation affecting LDL clearance
Familial defective apolipoprotein
PCSK9 or apoB100 mutation

34
Q

high intensity statins

A

Decrease LDL by >50%

35
Q

Types of secondary hypercholesterolemia

A

Hypothyroidism

Aromatase inhibitor therapy

36
Q

SE of statins

A

myopathy, rarely rhabdomyolysis

37
Q

Biguanide (metformin) action

A

insulin sensitizer

acts on liver to decrease gluconeogenesis

38
Q

GLP-1 agonists (exenatide, liraglutide)

A

insulin secretagogues

–> glucose dependent

39
Q

thiazolidinediones

A

insulin sensitizer

PPAR Y agonist in muscle and adipose tissue

40
Q

Sulfonylureas (glipizide, glyburide, glimerpiride)

A

insulin secretagogues
(acts on SUR on beta cell membrane)
–> glucose independent

41
Q

DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin)

A

Insulin secretagogues
(inhibit DPP-IV, make endogenous GLP-1 last)
–> glucose dependent

42
Q

Which drug has concerns for coronary artery disease?

A

Pioglitazone (thiazolidinediones) –> not used much anymore

43
Q

Meglitinides (repaglinide, nateglinide) mechanism

A

insulin secretagogues

44
Q

This drug has side effects including flatulence and diarrhea

A

Acarbose (Alpha glucosidase inhibitor)

45
Q

SGLT2 inhibitor (canagliflozin)

A

increase urinary glucose excretion

46
Q

These drugs help with weight loss

A 
GLP-1 agonists (exenatide, liraglutide)
SGLT2 inhibitors (canagliflozin)
47
Q

Which drugs can cause hypoglycemia?

A

sulfonylureas (glipizide, glyburide, glimerpiride)

meglitinides (repaglinide, nateglinide)

48
Q

How do you treat both DKA and HHS?

A

fluids
insulin
electrolyte (potassium) replacement

49
Q

Do not use these drugs in patients with a history of pancreatitis

A

GLP-1 agonists (exenatide, liraglutide)

DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin)

mohd keystone exam 1 (14 decks)

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