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Pharmacy Practice VI > Exam -1 (DM, HEENT) > Flashcards

Exam -1 (DM, HEENT) Flashcards

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1
Q

What is a diabetes care visit usually composed of?

A
  1. Assess for glycemic control
  2. Assess for comorbidities
  3. Reinforce healthy lifestyle choices
  4. Assess for barriers
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2
Q

What is a certified diabetes educator?

A

It is a license held by a health professional with at least 2 years of professional practice and at least 1,000 hours of diabetes/pre-diabetes, prevention, and management experience.

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3
Q

What is the average A1C loss for medical nutrition therapy?

A

.05-2% A1C reduction

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4
Q

What is the average A1C loss with exercise?

A

0.66%

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5
Q

What is the common dose of cinnamon for diabetes, and how effective is it?

A

1-3 g/day, grade C, may lower BG values but is a common allergen; use with caution. Avoid use with anticoagulants.

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6
Q

What is the common dose of prickly pear cactus (Nopal), and how effective is it?

A

100-600 g/day, may lower BG and cholesterol values. Likely safe, grade C. Avoid use with anticoagulants, anti platelets, and P450’s.

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7
Q

What is the common dose of alpha-lipoic acid, and how effective is it?

A

300-1600mg/day. Grade A. Assists with diabetic peripheral neuropathy and T2DM. Generally safe.

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8
Q

What is the B-cell centric model of diabetes?

A

It is a diagram that shows how different organs are affected by beta cell function or dysfunction, including insulin production and beta cell mass.

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9
Q

When would you use double therapy according to the guidelines? Triple therapy?

A

Use double therapy is A1C is greater or equal to 9%
Use triple therapy if it has been 3 months, and the A1C goal still has not been met.
Use combination injectable therapy if A1C is greater or equal to 10, or if blood sugar levels are at or above 300mg/dL.

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10
Q

Metformin counseling points

A 
GI SE's
Decrease hepatic gluconeogenesis and intestinal absorption, increase insulin sensitivity at cellular level
Lactic acidosis serious but rare
ER formulations and eating with meals may help SE's
Check vit B12 levels
eGFR restrictions
Does not promote weight gain
1st line
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11
Q

Sulfonylureas and Meglitinides (Secretogues) counseling points

A 
High A1C lowering effects
Hypoglycemia risk
Cheap
May only be able to be used for 1 year because of the Beta-cell destruction that they cause
Take 15-30 min ac, do not skip meals
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12
Q

Alpha-glucosidase inhibitors counseling points

A

Slows digestion of CHO’s
Gas, bloating, diarrhea, constipation SE’s
CI in IBS, bowel obstruction
Moderate efficacy
(acarbose hepatically metabolized, miglitol excreted renal unchanged)

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13
Q

TZD counseling points

A 
Efficacious
Can take w/o regard for meals
Insulin sensitizers
LFT needed every 3 months
Bone loss, weight gain SE's
CI in heart failure because of edema
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14
Q

DPP4 inhibitor counseling points

A

Moderate efficacy
Weight neutral
SE’s include nasal pharyngitis, joint pain, headaches
Heart failure possibly an issue; don’t understand
Renal adjustments for all except linagliptan

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15
Q

Amylin analog counseling points

A 
See more in T1DM, still in T2DM
SE's nausea and weight loss
CI's in gastrophoresis
Adjunct therapy ONLY
SQ injection to be taken with meals
Modulates gastric emptying, inhibits postprandial glucagon secretion, increases satiety
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16
Q

GLP-1 receptor agonist counseling points

A

Good efficacy
Weight loss
Increases satiety
Expensive
SE’s include nausea, diarrhea that should resolve with a few weeks (like metformin)
Gastroparesis, pancreatitis, C cell tumor links

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17
Q

SGLT-2 inhibitor counseling points

A

Moderate efficacy
Weight-loss
Expensive
Increase sugar in urine/inhibits reabsorption of glucose in the proximal tubule
SE’s: UTIs, genital mycotic infections, euglycemic DKA, renal adjustments, dehydration (symptoms generally resolve within 1st 24 weeks)

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18
Q

Insulin counseling points

A

Very efficacious
Hypoglycemia big risk
Weight gain
Short shelf life after opening
Different delivery systems (inhalers, pumps, injections from vials or pens)
Different types of insulin (rapid, short, intermediate, long, and mixed)

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19
Q

What drugs target fasting bg levels?

A

Basal insulin
TZDs
Metformin

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20
Q

What drugs target post-prandial bg?

A

DPP4
Alpha-glucosidase
Meglitinides
short-acting GLP-1’s

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21
Q

What drugs target both fasting and post-prandial BG?

A

Long-acting GLP-1s
SGLT-2
Sulfonylureas

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22
Q

What are microvascular complications of DM?

A

Retinopathy
Nephropathy (albumin - SCr ratio important)
Neuropathy

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23
Q

What are microvascular complications of DM?

A

Coronary artery disease
Peripheral artery disease
Cerebrovascular disease

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24
Q

How often should screening for nephropathy occur?

How do you treat it? What about with albuminuria?

A

Annually in T2DM, T1DM after 5 years, and w/ comorbid hypertension.
Treat with ACE or ARB. W/o albuminuria, can use TZD or dihydropyridine CCB instead or in addition to ACE/ARB

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25
How often should you screen for peripheral neuropathy in DM? | What is the lifetime risk of developing a foot ulcer with DM?
At least annually. At least 25%
26
How would you reduce CV risk in a DM patient?
``` Aspirin Statin ACE/ARB if hypertensive Empagliflozin or liraglutide In patients with a prior MI, BB at least 2 years after the event ```
27
EXCEL
Exenatide trial of CV lowering
28
SUSTAIN and PIONEER trial
Semaglutide once weekly and once daily oral
29
What combination of drugs are in the phase III trials?
GLP-1 RA and SGLT-2 I
30
Currently, what does the US rank in number of DM cases?
Third, at 24.4 million
31
What is the number of DM cases expected to jump to by 2035?
To 37.3%... a third of the US population
32
Which guideline is stricter, ADA or AACE?
AACE
33
What did the 2017 update of the ADA conclude, briefly?
Delivering a 9lb baby was no longer a risk factor Risk tool Positive correlation between sleep quality and glycemic control VB12 levels with metformin use Noninferiority data with combo therapy Footware recommendations and neuropathic care
34
Diagnosis criteria of DM:
A1C >/= 6.5% (pre is 5.7-6.4) Fasting >126 mg/dL (pre is 100-125) 2 hour fasting >200 (pre is 140-199) random >200
35
When should you start testing for DM?
At age 45 BMI >25 w/ 1 additional risk factor Repeat at min of 3 years if normal results
36
What level of HDL and TG are modifiable risk factors for DM?
HDL < 35 | TG > 250
37
When should you consider metformin?
BMI >35 Women < 60 Rising A1C despite lifestyle interventions
38
What does a comprehensive DM medical evaluation encompass?
History Exam Lab Referrals
39
Patient Care Process
``` Collect Asses Plan Implement Follow-up ```
40
What labs are important to do during a DM visit?
``` A1C Fasting lipid profile Liver function test Albumin-to-creatinine ratio (AUC) eGFR TSH ```
41
When should you have more stringent goals for DM?
Younger patient New to diagnosis No complications Long life expectancy
42
When should you have less stringent goals for DM?
``` Older patient Less life expectancy Hypoglycemic risk CVD complications/comorbidities Uncontrolled DM despite interventions ```
43
1. BP is >140/90 2. BP is >120/90 3. BP is >160/100
1. Lifestyle mods + single BP meds 2. Lifestyle mods only 3. Lifestyle mods + combo therapy
44
What type of statin should you use for a DM patient?
If ASCVD is present, then high intensity (unless over 75) If no ASCVD and 10 yr-risk is less than 7.5, then moderate intensity statin. If no ASCVD but 10-yr risk is >7.5% then high intensity
45
What additional cholesterol med can you add if there is high LDL?
Ezetimibe
46
What are the high-intensity statins?
Atorvastatin 40-80 | Rosuvastatin 20-40
47
When should you use aspirin in DM?
Primary prevention in DM with 1 risk factor (family history, HTN, smoking, dyslipidemia, albuminuria. Not increased risk of bleeding) Secondary prevention in DM (w/ ASCVD)
48
When should you not be on aspirin therapy?
Over 75 Bleeding risk Aspirin intolerance Use plavix instead of aspirin if allergic
49
When should you decrease your intake of protein?
When there is kidney disease.
50
How can you increase satiety?
Increase protein consumption
51
What should you limit salt content to in DM?
2,300mg per day
52
What is the general strategy for MNT?
Carb counting/reduction of intake
53
1 serving of carbs = ? grams
15g
54
What is an example of 15g of carbs?
``` 1 slice of bread 1 6-inch tortilla 1/3 cup pasta or rice 1/2 cup pinto beans/starchy vegetable 2 small cookies 1/2 cup fruit juice ```
55
DD
Diabetes Distress: emotional burdens and worries about managing chronic DM. 18-45% prevalence
56
MDD
Major Depressive Disorder
57
Each time there is some transition in a DM patient's life, what should happen?
DSME
58
IS it more important to check BG pre- or post-prandially?
Pre-prandially it is most often checked.
59
At what BG level would you administer glucagon? Eat fast-acting carbs?
Glucagon at 70mg/dL | Fast-acting carbs at 54 mg/dL
60
When is metabolic surgery indicated? For Asian/Americans?
BMI >30, or >27 for Asian Americans
61
When should you start weight loss medications with DM?
With BMI over 27 Benefits outweigh risks If <5% weight loss in 3 months, then DC Weight loss meds as adjunct to DM meds
62
How do you start basal insulin?
Start at 10u/day or 0.1-0.2 U/kg/day Adjust 10-20% or 2-4 units once or twice weekly If hypo, address reasons, then lower by 4 units or 10-20%
63
When do you use the rule of 450? Rule of 500?
450 with regular insulin 500 with rapid insulin Divide this by the TDD of insulin Result is how many grams of carbs are covered by 1 unit of insulin (insulin-to-carb ratio)
64
How do you calculate mealtime coverage dose?
Take the expected carbs, and divide by the insulin-to-carb ratio to get the amount of insulin you need to cover that meal
65
How do you calculate insulin sensitivity factor? Rule of 1500 Rule of 1800
Use if BG is above pre-meal target Rule of 1500 (regular) Rule of 1800 (rapid) Divide this by TDD, and get the BG that will decrease with 1 unit of insulin
66
How do you calculate correction dose?
Premeal reading - goal Divide by insulin sensitivity factor Get the amount of insulin needed to be given in order to get to the goal, and add to the scheduled prandial dose.
67
What is the total bolus dose?
The sum of the scheduled injection plus the correction
68
When is sliding scale used?
Usually in inpatient over outpatient
69
What are some primary headaches?
Migraine Tension Cluster
70
What are some examples of secondary headaches?
``` Sinus Rebound Refraction Glaucoma Hemorrhage Neoplasia Meningitis Post-concussion ```
71
What other questions would you want to ask about the head?
``` Headache (primary/secondary) Trauma Melanoma (ABCDE) Lice Sun damage ```
72
What are the headache red flags?
``` SNOOP Systemic symptoms/secondary risk factors Neurologic Onset (like a thunderclap) Older (40 or older) Positional/prior/papilledema ```
73
What are the questions you would want to ask about eyes?
``` History Allergy (single - infection, both eyes = allergy) Watch for red flags (sudden loss of vision, floaters, pain, red eye) ```
74
What are the questions that you would want to ask about the ears?
``` History of infections Pain/drainage Onset Noise/quiet words Understanding of spoken words Tinnitus Med rec ```
75
What meds do you want to watch ototoxicity with?
Neomycin, gentamycin, vancomycin, salicylates, quinine, furosemide
76
Grave's disease is associated with...
hyperthyroid
77
Sensitivity to high temperatures/sweaty is associated with...
hyperthyroid
78
Weight gain, constipation, and heavy periods are associated with...
hypothyroid
79
Strep throat symptoms and signs:
``` Symptoms: Fast onset pharyngitis fever HA abdominal pain N/V ``` Signs: Enlarged thyroid and lymph nodes Positive culture and rapid strep test People can be carriers and not be affected... do not treat them.
80
What is sensorineural hearing loss?
Having to do with the inner ear, cochlea, or auditory nerve. Neurological.
81
What is conductive hearing loss?
Cerumen impaction, middle ear fluid, or ossification.
82
What is presbycusis?
Loss of hearing at higher frequencies, in crowded rooms, tinnitus, associated with aging. High risk vaccination schedule.
83
What is Kiesselbach's plexus associated with?
Anterior nose bleeds
84
With nasal trauma, what should you always consider?
Broken bones
85
What can Hib cause in HEENT?
Epiglottitis, which can be life-threatening
86
What are the five criteria for pharyngitis?
This is strep!! 1. Sore throat without cough 2. Fever 3. Tonsillary exudates 4. Swollen lymph 5. Age less than 14 (-1 for over 45) 0-2 No strep, don't treat 3-4 Rapid strep test, treat?
87
What eye condition can be caused from rapidly going from a bright day outside to a dark movie theater?
Acute closed-angle glaucoma | Cornea has steamy look
88
What should you do if someone comes in with what looks like blood pooled under their iris?
it is probably hyphema. Monitor for increased pressure, but otherwise let it resolve. Don't use NSAIDs.
89
What condition can an irritating contact lens or herpes cause on the eye?
Keratitis/corneal ulcer (white of the eye looks all red/has been stained blue and can see a tree)
90
What conditions should you refer?
``` Viral/bacterial conjunctivitis (antibacterial) Uveitis (steroids) Acute angle-closure glaucoma Keratitis/corneal ulcer Scleritis subconjunctival hemorrhage in babies Pterygium/pinguacula Entropion (may need surgery) Cellulitis Epiglottitis Possibly strep if 0-2 points Peritonsillar access Oral herpes outbreak ```
91
What form of cellulitis can be life-threatening?
Orbital rather than peri-orbital/pre-septal
92
What eye conditions can be treated at home without a primary care visit, or are self-limiting?
``` Allergic conjunctivitis Subconjunctival hemorrhage in adults Dacrocystitis Allergic rhinitis Epistaxis (unless broken bones) Possibly strep if 3-4 points Mouth ulcers, unless extreme ```

Pharmacy Practice VI (4 decks)

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