Unit 5+6 Flashcards Preview

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Flashcards in Unit 5+6 Deck (99):
1

At what waist circumference is a man thought be at medium risk

94-102cm

2

What waist cirumference is a woman thought to be at medium risk

80-88cm

3

What are adipokines

signalling agents found in WAT which influence processes like coagulation, appetite regulation

4

What is metaboliv syndrome

Cluster of conditions that cause an increased risk of DM and Cardiovascular related mortality

5

What do you need to to be diagnosed with MS

BMI over 30, central obesity
raised triglycerides
Reduced HDL cholesterol
Raised BP
Raised fasting blood glucose

6

What do triglycerides need to be over in MS

More than 150mg/dL

7

What does HDL need to be less than in Metabolic syndrome

Less than 40mg in males and 50mg in women

8

What does Raised BP need to be more than in Metabolic syndrome

more than 130/85

9

What does fasting glucose need to be more than in Metabolic syndrome

more than 5.6mmol/L

10

What is the main function of BAT

Thermoregulation- produces heat by oxidation of fatty acids

11

Whats the importance of UCP1 in BAT

Acts as a proton channel- diverts pool of protons in the mitochondiral intermembrane space away from ATP synthase- more heat produced less ATP

12

Where is BAT found on the body

Upper back and chest

13

Where is WAT found in the body

Subcutaneous in buttocks, hips, abdo regoins and
visceral fat- around organs

14

WHich type of WAT are women more likely to get

Subcutaneous- around hips, buttocks and abdomen

15

Why is Visceral fat good to be surrounded by organs

Contains macrophages + WAT derived signalling agents e.g. adipokines- sent to liver

16

What are the 6 types of Adipose derived signalling molecules

Adiponectin,,Free-fatty acids, IL6,leptin, Resistin,TNFa

17

Whats the role of Adiponectin in Diabetes

its a antiinflammaory and antiatherosclerosis,
Increases insulin sensitivity
Lower adiponectin fatter people ,

18

Role of free fatty acids in diabetes

Elevated FFA stimulate insulin secretion
Chronic elevation stops insulin production
Visceral FFA are deposited into liver, increasing hepatic gluconeogenesis and production of VLDL

19

What does the chronic inflammation of FFAs cause

Impairs the stimulation of insulin, damages beta cells and so no pancreatic insulin

20

How are beta cells involved in diabetes

Beta cells produce insulin

21

What happens to the levels of IL6 in diabetes

IL6 increases as weight does, its a pro-inflammatory cytokine
IL6 causes lipolysis which produces FFAs and increases leptin

22

How does leptin work in diabetes

Leptin is a satiety hormone, in obesity there is leptin resistance so you can't tell when you're full

23

How does resistin work in diabetes

Associated with insulin resistance, visceral produces 15x the amount of resistin than subcutaneous

24

How does TNFa work in diabetes

pro-inflammatory
Increases leptin, lipolysis, lipogenesis in adipocytes and imapirs insulin signalling

25

In low carb diets what is the max carb you're allowed

20g, then increase to 100g when you've reached weight loss

26

What is ketosis

Fatty acids coverted to ketone bodies which are used for energy

27

How does high protein keep you satiated for longer

Decreases the expression for neuropeptide Y

28

How do low GI foods keep you satiated for longer

Digested more slowly

29

What are the health consequences associated with obesity

CVD
decreased life expectancy
T2DM
ARTHRITIS, INFERTILTIY

30

What are 3 symptoms associated with T1DM

Unexplained weight loss, polyuria, polydipsia

31

What does your HBA1c , random, fasting and 2 hr plasma conc need to be over to be diagnosed with DM

HBA1c: over 48mmol/mol
Random- less than 11.1mmol/mol
Fasting: less than 7

32

Name the rapid acting insulin

Aspart, glulisine, lispro
Onset is 15 mins
Peaks- 1-2hrs
Duration 4-6hrs

33

Short acting insulin

ActRapid
30-60mins
Peak- 2-4 hrs
Duration- 6-8

34

Name a long acting insulin analogue

Detemir
Glargine
Degludec- Tresiba

35

Name some intermediate acting analogue

Aspart (Novomix30) and Lispro

36

How often should blood glucose be monitored in T1DM in adults and children

Adults- QDS
Children- 5 capillary blood tests a day

37

When are you allowed to be on CSII

When HBA1c is 69mmol/mol despite on Multiple injections
Older than 12: Tried MDI but still get hypoglycemia

38

Where should you inject insulin

Fatty tissue, stomach, side of thigh or buttocks

39

Why should you leave a gap every time you inject insulin

Hard lumps called lipose are formed which stop insulin being absorbed

40

How should you inject insulin

prime pen so inlin leaking
Insert at 90 degree angle, count to 10

41

Which is the longest duration of action of insulin

Glargine- 20-24hrs
Detemir- 12-24 hrs

42

To manage T2DM how long do they have to try dietary and lifesyle advice

3 months before medication

43

What is the MOA of metformin

Increases peripheral uptake of glucose
Reduces hepatic gluconeogenesis

44

Side effects of metformin

GI disturbances, weight loss, lactic acidosis, reduces b12 absorption

45

What are the symptoms of hypoglycaemia

Sweating, dizziness, nausea and confusion

46

MOA of sulphonylureas

Increase insulin secretion

47

Side effects of sulphonylureas with examples of them

Gliclazide, Glimepride, Glipizide, Gilbenclamide
Hypoglycemia, weight gain, hypersensitivity

48

Examples of Meglinitides and which class of drug are they similar to

Regpaglinitide
Similar to Sulphonylurea as they increase isnulin but have shorter duration and rapid onset

49

Side effects of Meglinitides

Hypoglycemia, weight gain, hypersensivity, visual disturbances, abdo pain and diarrhea

50

MOA of Acarbose

Inhibitor alpha glucosidase, and decreases metabolism of carbs and sugars

51

Mechanism of Pioglitazone

PPARy agonist
Weight gain
Dont use in heart failure patients

52

Mechanism of DDP4 inhibitors

Gliptins
Increase incretins which stimualte insulin secretion

53

Examples of icnretin mimetics

Exanatide, Liraglutide

54

SGLT2I MOA

Inhibit reuptake of glucose and water so excreted in pee

55

Whats the intial treatment of DM

Add metformin

56

What if metformin is contraindicated in stage 1

Use Pioglitazone (PPYAR agonist)
Sulphonylurea or
DPP4I- liptins

57

What is first intensification

Dual therapy
Metformin +sulphonylurea
Metformin +pioglitazone
Metformin +DDPP4I

58

What is second intensification

Triple therapy
Metformin, DPP4I + sulphonylurea
Metformin, Pioglitazone +sulphonylurea
Start insulin therpay


59

When would you use a incretin mimetic (Glucagon-1-peptide)

in triple therpay with metformin, sulphonylurea when metformin and 2 other oral drugs don't work

60

When can you use an incretin mimetic, under what conditions

BMI over 35+ a problem associated with obesity
BMI under 35+ can't use insulin therapy, weight loss will benefit

61

When would you definitely give a Statin in TYPE 1 diabetes

Older than 40
Diabetes more than 10yrs
Have established nephropathy
Have other CVD risk factors

62

When would you give statin in T2DM

Give atorvastatin 20 to ppl who have a 10% or greater 10 yr risk of developing CVD

63

How do you find out CVD risk

use QRISK3 tool

64

When don't you use aspirin/clopidogrel in diabetes

Don't use it if they have T2 diabetes without CVD

65

What is the main cause of blindness in CVD

Diabetic nephropathy

66

How are the cells of the retina damaged

High blood glucose damages the blood vessels that supply the retina

67

What are the risk factors for retinopathy

Poor diabetic control, hypertension, renal disease and hyperlipidaemia

68

How should you manage diabetic nephropathy

Control BP and blood glucose , smoking cessation

69

What should be the BP for people with DM with nephropathy

Less than 130/80

70

What are the symptoms of peripheral neuropathy

Allodynia,leg cramps, numbness, pain, tingling

71

What drugs should be sued in peripheral neuorpathy

Amitriptyline,duloexetine, gabapentin or pregablin

72

What drug is used in acute rescue therapy

Tramadol

73

Which cream do you give for localized neuropathic pain

Capsaicin cream

74

What level of HBA1c should you avoid getting pregnant

above 86mmol/ml

75

Which long acting insulin should be used during pregnancy

Isophane insulin (NPH)

76

Which drugs should be discontinued in pregnancy with DM

Statins, ARBs, ACEIs

77

What range does hypoglycaemia start

Less than 4mmol/mol

78

What is thyrotoxicosis

syndrome where you've been exposed to elevated levels of thyroid hormones for a long time

79

Thyrotoxicosis is most likely to produce which disease

Graves disease

80

WHo is hyperthyroidism most common in

Women

81

What is graves disease

Abnormal IgE which occupies TSH receptor- so mimicks TSH causing cell division and stimulating thyroid hormone secretion

82

What are TRABs

Stimulatory Igs which inhibit TSH receptor

83

What levels are elevated in Nodular disease

Only T3

84

Which type of thyroidism has a gradual onset

Hypothyroidism

85

Which thyroidism do you get weight gain

Hypothyroidism

86

Which drugs alleviate symptoms of palpitations, tremor, anxiety in severe thyrotoxicosis

Non-selective beta blockers

87

MOA of carbimazole

Prodrugs, converted to methiazole, prevents thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, reduceing T3 and t4

88

How long is the treatment for graves disease

6-12 months

89

Name the anti-thyroid drugs

Thiamazole, carbimazole, propylthiouracil, thionamide

90

Which type of thyroidism does Hashimotos cause

Hypothyroidism

91

What is the most common side effect of anti-throid drugs

Rash and Arthropathy(inflammation of the joint)

92

Which 3 symptoms require urgent FBCs as a side effect of the Anti-thyroid drugs

Mouth ulcers, sore throat and pyrexia

93

Carbimazole
dose
Half life
biological effect


40-60mg
4-6 hrs for half life
Biological effect lasts up to 40 hrs

94

How often do you check t4 conc with carbimazole

Every 6 weeks until they're normalized

95

Which anti thyroid drug ispreferred in 1st trimester of pregnancy

Propylthiouracil over carbimazole

96

What drugs are reccomended for postutal hypotension

Fluodrocortisone 100-400mcg OD + can combine with flurbiprofen and ephedrine HCL

97

What drug can be used in gustatory sweating

Antimuscarinic Propantheline bromide

98

What are the symptoms of Thyroid crisis

Tachycardia, muscle weakness, hyperthermia, sweating and vomiting, anxious and psychotic

99

Drug management for thyroid crisis

Propylthiouracil oral +lugols iodine
IV glucocorticoids- inhibit deiodinase
IV BB-propanolol is preffered bc it inhibtis deiodinase