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Medicine > Endo & Metabolic Disorders > Flashcards

Endo & Metabolic Disorders Flashcards

1
Q

Dx diabetes

A

random gluc > 200 WITH SYMPTOMS
2 fasting gluc > 126
HbA1c > 6.5% – recheck once to confirm
2 hour post oral gluc challenge > 200

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2
Q

secondary prevention is…

A

minimizing impact of disease already occurred

preventing recurrences

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3
Q

Target BP, HbA1c, lipid levels to prevent symptoms and complications in diabetic?

A

BP v140/90
A1c v7%
just give a statin (unless hx myopathy, liver fail w synthetic deficiency, child bearing age (teratogenic)) no lipid target anymore

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4
Q

vaccs for diabetic?

A

flu annually
pneumovax 23 valent pneumococcal strep pneumo
booster prevnar 13 at age 65 if pnumovax > 5yo
can offer Hep B…

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5
Q

if monofilament exam is negative but a potentially undiagnosed diabetic or known diabetic still complains of peripheral nerve sensory changes (eg burning) what is a good next physical exam to perform?

A

vibratory sense (lost early)

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6
Q

prediabetic fasting glucose range is …

A

100-125

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7
Q

what treatment do you recommend for pre-diabetic? (fasting gluc 100-125)?

A

diet/exercise

5-7% weight loss prevents diabetes

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8
Q

in a prediabetic, how much weight loss is typically necessary to prevent diabetes?

A

5-7% of body weight loss

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9
Q

how does lifestyle change /diet / exercise treat diabetes?

A

inc insulin sns

dec hepatic gluc production

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10
Q

how much A1c dec can be achieved w diet/weight loss?

A

depends on dedication, starting point, but
1-2% avg
5-6% possible

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11
Q

another name for metformin

A

biguanides

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12
Q

how does metformin (biguanides) work?

A

inc insu sns

dec hep gluconeogenesis

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13
Q

how much A1c reduction expected w metformin (biguanides) ?

A

1-2%

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14
Q

how does metformin (biguanides) affect weight?

A

weight neutral

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15
Q

is metformin (biguanides) expensive?

A

nope. cheap.

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16
Q

does metformin cause hypoglycemia?

A

no
inc insu sns
dec hep gluconeogenesis
–diabetic drugs that cause hypoglycemia typically increase insulin

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17
Q

name 3 side effects of metformin (biguanides)

A

GI nausea, loose stool
B12 malabsorption (see GI SEs)
lactic acidosis
(CI renal insuff – Cr >1.4 F, >1.5 M, CrCl

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18
Q

5 CIs to metformin (biguanides)

A

renal insufficiency Cr >1.4 F, >1.5 M, CrCl

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19
Q

sulfonylurea MOA

A

inc insulin secretion… by blocking ATP gated K+ channels

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20
Q

expected A1c dec with sulfonylurea

A

1-2%

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21
Q

is the OA for sulfunylureas fast or slow?

A

rapid

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22
Q

3 disavantages of sulfonylurea use

A

weight gain
hypoglycemia
loss of efficacy over time
(sulfonylureas inc insu sec by blocking ATP gated K+ channels)

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23
Q

how do ATP gated K+ channels work in pancreatic beta cells

A

when open, K+ can leak out, keeping membrane polarized. With inc ATP, channels close, no leak, depolarize, release insulin

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24
Q

name one CI to sulfonylurea use

A

sulfa allergy

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25
Q

TZDs antidiabetes drugs stand for

A

thiazolidinidiones = glitazones

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26
Q

another word for glitazones

A

thiazolidinidiones = TZDs

antidiabetes drugs

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27
Q

how do thiazolidinidiones (TZDs, glitazones) work?

A

increase insulin sns

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28
Q

how much A1c dec expected with TZDs

A

0.5-1.5%

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29
Q

what is the advantage of TZDs

A

better lipid profile…

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30
Q

4 SEs of TZDs

A

fluid retention / weight gain
bone fractures (osteopenia)
bladder cancer
MI with rosiglitazone (Avandia)

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31
Q

give an example of a TZD

A

pioglitazone (Actos)

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32
Q

2 CIs to TZD use

A
  • symptomatic (stage III or IV) CHF – TZDs cause fluid retention
  • hx bladder cancer – TZDs cause bladder cancer
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33
Q

mechanism of alpha-glucosidase inhibitors

A

dec GI absorption of sugars eg in tx of DM

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34
Q

give an example of an a-glucosidase inhibitor

A

acarbose

dec GI absorb of sugars eg in tx of DM

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35
Q

expected A1c dec w a-glucosidase inhib

A

.5-.8

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36
Q

how do a-glucosidase inhib affect weight

A

weight neutral

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37
Q

how do TZDs (glitazones) affect weight?

A

weight gain

fluid retention, inc insulin sns

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38
Q

1 SE

2 inconveniences ofacarbose

A 
GI disturb (a-glucosidase inhib... mech = dec GI absorb of sugars...)
3x/day dosing
expensive
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39
Q

MOA meglitinides

A

inc insu sec

short acting, prandial use

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40
Q

1 example of a meglitinide

A

repaglinide (Pranding, Starlix)

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41
Q

pearl: use meglitinide if…

A

sulfa allergy prevents sulfonylurea use

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42
Q

2 SEs

2 inconveniences of meglitinides

A

weight gain
hypoglycemia
tid dosing
expensive

43
Q

are meglitinides fast or slow OA

A

rapid acting

44
Q

expected A1c dec w meglitinide

A

.5-1.5

45
Q 
expected A1c dec w
diet/exercise
metformin (biguanide)
sulfonylureas
TZDs (pioglitazone/Actos)
a-glucosidase inhib (acarbose)
meglitinides (repaglinide/Prandin/Starlix)
A 
diet/exercise 1-2
metformin (biguanide) 1-2
sulfonylureas 1-2
TZDs (pioglitazone/Actos) .5-1.4
a-glucosidase inhib (acarbose) .5-.8
meglitinides (repaglinide/Prandin/Starlix) .5-1.5
46
Q

this class of antidiabetics is commonly combined with insulin

A

sulfonylureas

47
Q

this class of antidiabetics is commonly used if healthier diet is unaffordable or impossible for some reason, can’t dec carb intake

A

a-glucosidase inhib (e.g. acarbose)

48
Q

this class of antidiabetics consists of short-acting insulin secretagogues

A

metglinides (eg repaglinide/Prandin/Starlix)

49
Q

what does DPP-4 stand for

A

dipeptidyl peptidase 4

50
Q

what does DPP-4 do?

A

–| incretins (GLP-1, GIP), which inhibit glucagon release and stimulate insulin release

so active DPP-4 reduces incretin inhibition of glucagon release

so active DPP-4 leads to more glucagon, less insulin, HIGHER blood glucose

51
Q

name 2 incretins and how they affect insulin and blood glucose levels

A 
GLP1, GIP
--| glucagon release
--> insulin release
--| gastric emptying
^ blood glucose
52
Q

Expected A1c reduction with gliptin / DPP-4I

A

.5-.8%

53
Q

how do gliptins / DPP-4Is affect weight

A

weight neutral
(other diabetic drugs that ^insulin more powerfully cause weight gain and hypoglycemia… think gliptins/DPP-4Is are just milder in effect)

54
Q

T/F hypoglycemia is a concern with gliptins/DPP-4Is

A

Fish
other drugs that ^ insulin (insulin, suflonylureas, meglitinides) do cause weight gain and risk hypoglycemia… however I think gliptins/DPP-4Is are milder in effect (A1c red .5-.8) and they are weight neutral with rare risk of hypoglycemia

55
Q

3 SEs and 2 other disadvantages of gliptins/DPP-4Is

A
  • GI nausea/diarrhea (incretins GLP1 and GIP delay gastric emptying… GI effects)
  • Headache (goes with nausea/diarrhea?)
  • Pancreatitis
  • long term safety not established
  • expensive
56
Q

CI to DPP-4/gliptin use

A

hx pancreatitis

SEs of DPP-4/gliptins include

  • GI nausea/diarrhea (incretins GLP1 and GIP delay gastric emptying… GI effects)
  • Headache (goes with nausea/diarrhea?)
  • Pancreatitis
57
Q

expected A1c dec w insulin

A

1.5-3.5

58
Q

2 SEs
3 inconveniences
of insulin therapy

A
  • weight gain
  • hypoglycemia
  • multiple daily injections
  • monitoring
  • long acting forms expensive
59
Q

exogenous insulin OA fast or slow?

A

rapid

60
Q

T/F no dose limit w insulin therapy

A

T

61
Q

name 2 GLP-1 agonists

A

exenatide Byetta

liraglutide

62
Q

how do GLP1 agonists work

A

^insulin
v glucagon
v gastric emptying
v blood glucose

63
Q

A1c red w GLP1 agonist

A

.5 to 1.0

64
Q

exenatide
liraglutide
examples of what drug class

A

GLP1 agonists

tx DM

65
Q

1 SE

3 other disadvantages of GLP1 agonists

A

GI SEs
injections multiple daily
long term safety unknown
expensive

66
Q

CI to GLP1 agonist therapy

A

gastroparesis

GLP1 delays gastric emptying

67
Q

pramlintide (Simlin) MOA

A 
(amylin mimetic)
slows gastric emptying
promotes satiety
-decreases post prandial glucose rise
also --| glucagon secretion
68
Q

what does amylin do

A

cosecreted with insulin
slows gastric emptying
promotes satiety
inhibits glucagon release

69
Q

what peptide hormone that is cosecreted with insulin is also deficient in diabetics?

A

amylin

  • slows gastric emptying
  • promotes satiety
  • inhibits glucagon release
70
Q

which antidiabetic drug is an amylin mimetic?

A

pramlintide (Simlin)

prAMLINtide (siMLIN)

71
Q

expected A1c dec w pramlintide

A

.5-1.0

72
Q

what is the commercial name for pramlintide

A

Simlin

73
Q

what is the generic name for Simlin

A

pramlintide

74
Q

how does pramlintide (Simlin) affect weight?

A

weight loss

amylin mimetic – slows gastric emptying, promotes early satiety

75
Q

2 SEs

4 inconveniences of pramlintide

A 
GI upset
hypoglycemia
tid injections
expensive
long term safety not known
only approved if also taking insulin
76
Q

1 CI for pramlintide

A

gastroparesis

amylin mimetic – slows gastric emptying

77
Q

-agliflozin suffix is what kind of drug

A

SGLT2 inhibitor

aGLiflozin sGLt2

78
Q

name 2 SGLT2 inhibitors

A

dapagliflozin

canagliflozin

79
Q

how do SGLT2Is treat DM

A

^ renal excretion of glucose

80
Q

expected A1c dec w SGLT2I

A

.5-.7

81
Q

3 advantages of canagliflozin & dapagliflozin use to tx DM

A

(SGLT2Is)
weight loss
v BP
rare hypoglycemia

82
Q

T/F hypoglycemia is a common SE of canagliflozin and dapagliflozin use

A

Fish

SGLT2Is rarely assoc w hypoglycemia

83
Q

4 SEs of canagliflozin and dapagliflozin use

A 
(SGLT2Is)
UTI
vulvovag candidiasis
dehydration
DKA
84
Q

2 CIs to canagliflozin & dapagliflozin use to tx DM

A

(SGLT2Is)
eGFR v60 mL/min
active bladder cancer (don’t want to feed it?)

85
Q

this drug is often used to combat weight gain of insulin

A

pramlintide (Simlin)

-amylin mimetic, v gastric emptying, ^ satiety

86
Q

these drugs treat DM via inducing kidney diuresis of glucose

A

dapagliflozin

canaglifloizin (SGLT2Is)

87
Q

2 most notable aspects of bulimic dental erosion

A

short teeth

gaps between teeth

88
Q

how do anorexia and bulimia differ in respect to menstrual effects?

A

anorexia - amenorrhea

bulimia - dysmenorrhea

89
Q

literary name for obesity hypoventilation sydrome

A

Pickwickian syndrome

Pickwick was a fat boy in a Dickens novel who would fall asleep with his finger on the doorbell

90
Q

Pickwickian syndrome

A

Obesity hypoventilation syndrome
severely overweight people fail to breathe rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide (CO2) levels

91
Q

lipid goals for prevention of CAD from obesity

A

total CH v200
HDL ^40
LDL v100 primary prevention, v40-60 secondary prev.

92
Q

glyburide is what class of drug

A

sulfonylurea

stims panc beta islet cell to release insulin by blocking ATP gated K+ channels

93
Q

3 categories for etiology of DKA

A

all have to do with insulin defic / resist and/or glucagon excess:
T1DM
T2DM
-extreme stress (infection, CV emergency, trauma)
-noncompliance
KPD (Ketosis Prone Diabetes)
-B islet cell dysfunction/depletion of reserve

94
Q

what is the mechanism underlying DKA

A

no insulin, more glucagon
gluconeogenesis ^
glycogenolysis ^
uptake by tissues v

95
Q

how does stress cause DKA in T2DM

A

Cortisol, CCs, GH –| insulin action
v GLUT4 peripheral glucose uptake
^ glycogen synth (glycogenesis)

96
Q

Cortisol function

A

BIG FIB

  • BP ^ (upreg a1 for ^ epi sns)
  • Insulin resist (diabetogenic.. more gluc for brain)
  • Gluc ^ (gluconeogen, lipolysis, proteolysis)
  • Fibroblast activity (striae)
  • Inflammation and Immune response v (–| LTs, PGs, IL-2, WBC adhesion - neutrophilia, mast cell H release, eos)
  • Bone formation v (–| OB activity)
97
Q

4 elements of Tx for DKA

A
  • fluid replacement, stabilize CV status
  • K+ repletion (KCL) IMMEDIATELY if v5.3 (usually will be)
  • Insulin AFTER K+ repleted (don’t want to drive K+ into cells and induce an arrhythmia)
  • Bicarb (NaHCO3) if arterial pH v6.9
98
Q

2 complications of DKA

A

cerebral edema

non-cardiogenic pulm edema

99
Q

diffuse toxic goiter =

A

graves disease

100
Q

most common cause of hyperthyroidism

A

graves disease (diffuse toxic goiter)

101
Q

Graves disease

  • alternative name
  • pathogenesis
  • epidemiology
  • common disease association
  • radioodide scan shows
A

diffuse toxic goiter
AI thyroid-stimulating IgG binds TSH receptors
younger women
other AI disorders
diffuse uptake – every thyroid cell affected

102
Q

multinodular toxic goiter =

A

plummer disease

103
Q

diffuse toxic goiter =

multinodular toxic goiter =

A

graves disease

plummer disease

Medicine (13 decks)

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