Final Flashcards
(54 cards)
Risk factors of Osteoporosis
Smoking Alcohol Rheumatoid Arthritis Disease states (IBD, other malabsorption syndromes, chronic hepatic disease) Advanced age Low body weight History of fractures (including family history of hip fracture) History of steroid treatment Vitamin D and calcium deficiency
Role of estrogen in preventing osteoporosis
Decreased osteoclast activity (osteoclasts break resorb bone) and increased osteoblast activity
(osteoblasts build bone)
What are the side effects of estrogen and under what conditions is it beneficial?
Cardiac problems if taken 10+ years after menopause, breast CA, DVT, gallbladder, stroke
Women within 10 years of menopause can take estrogen to decrease risk of osteoporosis w/o increased
risk of cardiac problems
Indicated for postmenopausal osteoporosis, hot flashes, colon cancer, vasomotor issues during
menopause
What are the side effects of bisphosphonates and what should you look for in patients who have taken them for a long period of time?
ADR’s: ulcers, esophagitis, osteonecrosis of the jaw when administered intravenously in cancer patients,
Patients taking drug for ~10 years: rare atypical fractures with minimal impact preceded by dull aching
pain in the the thigh and groin
How often should a patient with Type 1 diabetes check their blood glucose level.
6 - 10 times daily (Preprandial, 2 hr postprandial, pre-bedtime, pre-exercise, before critical tasks such as
driving, when suspecting and after treating hypoglycemia, middle of night {once a month})
Where are the injection sites for insulin? What activities should be avoided after insulin injection? What increases absorption of insulin?
Injection sites → Upper lateral arms, abdomen, buttocks, upper lateral thighs
Avoid exercising muscles or massage in the area of the injection (Guest slides)
Increase absorption → heat (ambient or local), abdomen > leg and arm, exercise in general and/or exercising muscles near injection site (Gladson slides)
Name the different types of insulins and when would each be used.
Ultra short acting: take 5 min before meal, duration 3-5 hours, peaks at one hour (Lispro, Aspart)
Regular insulin: take 30 min before meal, duration 6-8 hours. Often used with intermediate. Peaks in 2
hours
Intermediate: NPH (neutral protamine hagedo insulin); Onset is 1-4 hours, peaks in 6-12 hours, duration
14-24 hours.
Peakless-long acting : mean onset of action is within 1 hour with a duration of close to 24 hr; has no peak
and instead mimics continuous infusion of rapid-acting regular insulin from a pump (Glargine)
Inhaled insulin (hard to regulate how much of drug you are inhaling so hard to tell how effective it is)
Ultra short acting
5 min before meal
3-5 hours
Peaks 1 hr
Lispro, Aspart
Intermediate
NPH (neutral protamine hagedo insulin)
1-4 hours
Peaks 6-12
Duration 14-24
Regular insulin
30 mins before meal
Duration 6-8 hours
Peaks in 2 hours
Often used with intermediate
Peakless long acting
Mean onset 1 hour
Duration 24 hours
No peak (mimic continuous infusion of rapid- acting reg insulin from pump)
Glargine
Inhaled insulin
Hard to regulate how much you are inhaling
Describe the different insulin regimens: Split and mixed, split and mixed with bedtime intermediate, multiple pre-meal injections with bedtime long acting
Split and Mixed: regular or short-acting insulin mixed with intermediate, given before breakfast and
dinner (2 injections)
Split and mixed with bedtime intermediate: For purposes of improving morning fasting reading control
the second intermediate-acting insulin can be held until bedtime (9:00PM) (3 injections-1 at breakfast, 1
at dinner, 1 intermediate at bedtime)
Normal glucose level is 80-120
If next morning blood glucose is 60 (low), need to decrease insulin dose at bedtime
If next morning blood glucose is 150 (high), need to increase
Multiple pre-meal injections and Bedtime Long Acting: good for maintaining blood glucose level (best is
continuous insulin pump) (The more injections the person takes, the more controlled blood glucose
should be)
What are the adverse effects of insulin?
Hypoglycemia-if amt of insulin is too high, missed meal, strenuous exercise.
Lipohypertrophy or lipoatrophy at injection site
Rebound hyperglycemia
Weight gain
Discuss the interaction between insulin and exercise and what type of exercise would have the least effect on glucose level?
What recommendations do you have for the newly diagnosed Type 1 patient who exercises every day
Exercise acts as insulin so take lower pre-exercise insulin dose and have a carb snack (40g) prior to
exercise
Aim for 150min aerobic exercise per week (non-consecutive days)
Blood sugar does NOT drop as much during sprint (less effect on glucose level) compared to aerobic
Hydrate during exercise
Check blood glucose levels before exercise and after
Might want to include 10s sprint at end of exercise to reduce post-exercise hypoglycemia
Exercise program must be individualized for particular pt
Pt must live a life of monotony (eat same food at same time of day, perform same exercises at the same time of day (helps pt predict/prepare for glycemic changes)
Always have simple sugar/glucose gel
Metformin
MOA
side effects
Metformin:
MOA: inhibits gene expression for gluconeogenesis (Improves glucose utilization in skeletal
muscle)
Side Effects: Modest weight loss; Does NOT cause hypoglycemia
Incretin Mimetics
Incretin Mimetics: glucagon-like peptide (GLP-1) analog, Protective effects on beta cells
Side Effects: nausea, vomiting, diarrhea, risk of mild to moderate hypoglycemia
Glitazones
MOA
side effects
Glitazones: Insulin sensitizers, Improves insulin resistance, Improves lipid and cholesterol levels (May alsodelay progression of disease)
○ Side Effects: Fluid retention, weight gain, inc risk of fxs
Pipeptidyl
MOA
Side effects
Pipeptidyl: competitively inhibit DPP-4 enzyme, slows incretin degradation-potentiating glucagon-like
peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP)
○ Side Effects: nasopharynigitis, nausea
What is the tx for hypoglycemia
- Eat 15 grams of carbohydrate
- Recheck glucose level in 15 min
- If reading is not above 70, eat another 15 g Test again in 15 min,
- if not above 70 consume another 15 g of CHO and call MD
- 15 grams = 4oz. Of juice or soda (not diet), 1Tbl of table sugar, honey, orange juice—any simple sugar
(non a complex CHO)
What confirms the diagnosis of diabetes?
Prediabetes: FBG 100-126, A1c 5.7-6.4%
Diabetes: FBG >126, A1C >6.5%
What is diabetic ketoacidosis?
Without insulin to shuttle sugar into cells for usage, the body breaks down fat as fuel, resulting in a
buildup of acid in the bloodstream called ketone, eventually leading to ketoacidosis; can be due to exercise because exercise decreases insulin release
What is the mechanism of action of commonly used antidepressants?
- Inhibition of serotonin re-uptake
- Inhibition of the re-uptake of both serotonin and norepinephrine
- Stimulation of nor-adrenergic and dopaminergic activity
- Alpha 2 antagonism of nor-adrenergic and serotonergic neurons.
What are the adverse effects of commonly used antidepressants-SSRIs vs. the TCAs?
SSRI ADRs: Insomnia, Sedation, Appetite Change, Nausea, Dry mouth, Headache, Sexual Dysfunction
TCA ADRs:
-Anticholinergic: dry eye, mouth, constipation, urinary retention, blurred vision, AMS
-Histaminic – sedation, weight gain
- Alpha -1 adrenergic blockade - orthostatic hypotension, falls
-Possible EKG changes, arrhythmias (prolonged QT and PR, AV block) * In OVERDOSE=widened
QRS
-Require diet modification to avoid HTN crisis (avoid tyramine containing foods)
-Cannot be combined with other antidepressants (risk of serotonin syndrome) or sympathomimetic drugs; avoid with cough syrup or Demerol
-SERIOUS RISK OF OD- even one week’s supply can be lethal!