memoriy Flashcards
what are indications to treat on osteoporosis drug?
postemenopausal F or M over age 50 with prior vertebral or hip fracture
post menopausal F or M with T score lower than ?2.5 in hip or spine
post men F or M over 50 with T score between ?1 and ?2.5 at hip or spine if prob of hip fracture is 3% or 10 year probability of any major fracture is >20%
what is the MOA of
clompihene?
tamoxifen?
raloxifene?
clomiphene: fertility drug?? anti estrogen effects at hypo/pituitary, pro estrogen effects as uterus and breast
tamoxifen (breast CA): anti?estrogen at hypo/pit, pro estrogen at uterus, bone serum lipids
raloxiefene? anti osteoporosis: works on bone serum lipids
how do bisphoshonates work??
alendronate, risedronate, ibandoronate, zoledronic acid
long term inhibitors of bone resorption, binds to hydorxyapatite, inhibits osteoclast aciton, long skeletal retention and duration of action
how does calcitonin work?
fast acting inhibitor of bone resportion?? subcutaneous or intransala admin, rapid onset and offest, binds to specific receptors on osteoclasts to reduce activity
which drugs inhibit RANK ligand?
osteoprotegerin (promotes increase in BMD)?? its an endogenous peptide produced by osteoblasts and acts as a decoy receptor for RANKL, prevents binding of RANK
denosumab: monoclonal Ab against rANKL, prevents activaiton of RANK
PTH 1?34 (teriparatide)?? anabolic agent promoting new bone formation, binds to receptors on osteoblasts, inc osteoblast number and new bone formation
what does a T score tell you?
how do you interpret it?
for every 1 SD the score increases, the risk of fracture doubles
T score of 3= risk 8x normal
greater than 2.5 is osteoporosis
between 1 and 2.5 is osteopenia
what are incretins?
stimulate insulin release from beta cell?? like warning signs that the blood glucose will be rising
what is the requirement for screening for diabetes in adults?
all adults who are overweight (BMI>25) and have 1+ additional risk factor
all adults over age 45
if results normal, should be repeated at least every 3 yrs
what are the requirements for screening asymptomatic children?
overweight (BMI>85th%ile), plus 2 risk factors
screening should begin at age 10 or at onset of puberty, repeat every 3 yrs
diagnostic criteria for diabetes
A1c>6.5%
fasting plasma glucose>126 mg/dl?? no food for 8 hr
2 h plasma glucose>200 during
patient with classic symptoms of hyperglycemia with a random plasma glucose of >200 mg
numbers for pre?diabetes?
impaired fasting glucose (100?125)
impaired glucose tolerance (140?149 after 75 g glucose load
at risk A1c: 5.7?6.4%
intervention for pre diabetic states
5.7??5.9% or IFG or IGT: lifestyle intervention, follow up at 1 yr
>6% or IFG/IGT +other features?? lifestyle interventions and/or metformin, f/u 6 mo
diabetes: lifestyle intervention + metformin, follow up in 3 mo
what was the dietary fat goal for the diabetes prevention program?
amount of exercise?
<25% of calories from fat, calorie intake 1200?1800 kcal/day
150 min/week of exercise
how should you adjust your diet for exercise?
1 hr moderate exercise
BG<100: add 15 gCHO
100?180: add 10?15 g CHO
180?300? no food
2 hr 100?180: add 30?45
180?300: add 15 g CHO
what do sulfonylureas do?
what about meglitinides?
how much do they decresae A1C?
this class increases insulin secretion
sulfonylureas: glyburide, glipizide, glimepride
meglitinides: repaglinide, nateglinide (work quicker than sulfonyureas)
activate the K channels to close so you depolarize the cell, open Ca channels, allow for insulin release
MOA: stimulate basal and postprandial insulin secretion, they require functioning beta cells
can dec HbA1c: 1?2%
can cause weight gain, allergy, hypoglycemia
enhance physiological route of insulin delivery, initial response reate, no lag time prior to response, work in days to weeks
biguanides (metformin)
MOA
efficacy?
side effects?
increase insulin sensitivity
first line agent in diabetes tx
MOA: activation of AMPK in liver and muscle. insulin sensitizer (liver»muscle), depends on presence of insulin, reduces hepatic glucose production
efficacy: dec AIc 1?2%
sdie effects; diarrhea, nausea, dec B12, lactic acidosis
dont use if renal, cardiac, hepatic insufficiency, IV contrast
modest weight loss, advantageous lipid effects, no hypoglycemia, dec macrovascular complications in UKPDS
start it slow and titrate up
thiazolidinediones
piogliazone and rosiglatazone MOA: insulin sensitizer (muscle, adipose>>liver)? may preserve beta cell function dec hbA1C by 1?1.5% adverse effects: edema, weight gain congestive heart failure, liver toxicity
peripheral adipocytes inc their uptake of FFA, reducing fat stored in muscle, liver, visceral
no hypoglycemia
lipid effects?? pioglitazone better than rosiglitazone (inc LDL)
inc fracture risk, slow onset of action (weeks to months)
increased bladder Ca risk with pioglitazone
glitazones activate PPRAR gamma, mainly in fat cells, leading to secondary improvements in insulin sensitivity in other tissues (so peripheral adipocytes increase their uptake of FFA, reducing fat stored in muscle, liver, visceral fat)
secretion of adipokines is affected
alpha glucosidase inihbitor (acarbose, miglitol)
delay CHO absorption
depend on postprandial hyperglycemia
satiety: 0.5?1%
adverse events: flatulence, rare liver enzyme elevation
adherence poor, cost high, effect small
what does incretin do?
what happens during diabetes?
incretins: gut derived peptide hormones (glucagon like peptide and glucagon inhibitory peptide)
release is stimulated by nutrient intake
in type 2 diabetes, secretion of incretins is abnormal
incretin GLP?1: promotes satiety and reduction of appetite, inhibits glucoagon secreiton, stimulates beta secretion, slows gastric emptying
what kinds of drugs are exenatide, liraglutide?
what class is sitagliptin, linagliptin, saxagliptin, alogliptin?
increase incretin effect (mimetic GLP?1 receptor agonist)
? it is resistant to enzymatic degradation
binds to endogenous GLP?1 receptors in pancreas, ANS,
cause: 1. enhance insulin secretion 2. decrease postrandial glucagon 3. slow the rate gastric emptying 4. increase satiety
decrease HbA1C 1?1.5%
INJECTION twice daily
adverse events: nausea, pancreatitis
enhancer?? DPP IV inhibitor?? prolongs effect of endogenous incretins
expensive, but few side effects, lowers postpranidal glucose
what are functions of amylin in body?
amylin is cosecreted with insulin alpha cell: inhibits glucagon secretion beta cell: none CNS: promotes satiety and reduction of appetite stomach: slows gastric emptying in diabetes, it is deficient
what is pramlintide?
synthetic amylin analogue
pros: weight loss, used in type 1 and type 2
cons: injection with each meal, nausea initially, expensive
lowers HbA1C 0.5?1%
what is colesvelelam?
bile acid sequesterant
lowers A1c 0.3?.4 when added to metofrmin, sulonylurea or insulin
dont use it much for diabetes, often for hyperlipidemia
what is canagliflozin and dapaglifozin?
promotes renal excretion of glucose by blocking SGLT2 in proximal tubule
lowers A1C 0.5?1%
lowers BC
increased UTI and vulvovaginal candidiasis
