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Unit 5+6 Flashcards

1
Q

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

A

94-102cm

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2
Q

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

A

80-88cm

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3
Q

What are adipokines

A

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

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4
Q

What is metaboliv syndrome

A

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

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5
Q

What do you need to to be diagnosed with MS

A 
BMI over 30, central obesity 
raised triglycerides
Reduced HDL cholesterol
Raised BP
Raised fasting blood glucose
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6
Q

What do triglycerides need to be over in MS

A

More than 150mg/dL

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7
Q

What does HDL need to be less than in Metabolic syndrome

A

Less than 40mg in males and 50mg in women

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8
Q

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

A

more than 130/85

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9
Q

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

A

more than 5.6mmol/L

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10
Q

What is the main function of BAT

A

Thermoregulation- produces heat by oxidation of fatty acids

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11
Q

Whats the importance of UCP1 in BAT

A

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

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12
Q

Where is BAT found on the body

A

Upper back and chest

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13
Q

Where is WAT found in the body

A

Subcutaneous in buttocks, hips, abdo regoins and

visceral fat- around organs

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14
Q

WHich type of WAT are women more likely to get

A

Subcutaneous- around hips, buttocks and abdomen

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15
Q

Why is Visceral fat good to be surrounded by organs

A

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

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16
Q

What are the 6 types of Adipose derived signalling molecules

A

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

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17
Q

Whats the role of Adiponectin in Diabetes

A

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

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18
Q

Role of free fatty acids in diabetes

A

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

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19
Q

What does the chronic inflammation of FFAs cause

A

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

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20
Q

How are beta cells involved in diabetes

A

Beta cells produce insulin

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21
Q

What happens to the levels of IL6 in diabetes

A

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

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22
Q

How does leptin work in diabetes

A

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

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23
Q

How does resistin work in diabetes

A

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

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24
Q

How does TNFa work in diabetes

A

pro-inflammatory

Increases leptin, lipolysis, lipogenesis in adipocytes and imapirs insulin signalling

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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

NMR (3 decks)

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