Diabetes

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Author:
aja28
ID:
74639
Filename:
Diabetes
Updated:
2011-03-22 23:00:00
Tags:
Diabetes
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Description:
Family Medicine Diabetes
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  1. What should be the order of priority in managing DM pt's
    • HTN
    • Lipid
    • Vasculopathic load
    • Microalbuminemia
    • Glucose
  2. What is the greatest cause of mortality in DM2 pt's
    athersclerotic vascular dz
  3. DM have ___x greater risk for CVD
    2-4
  4. DM pt's have ___x risk of stroke
    3
  5. DM have increased risk of MI independent of prior MI. T/F
    T
  6. 3 ways of diagnosis
    Sx of diabetes (polydipsia, polyuria, unexplained wt loss) plus:

    • 1. fasting blood glucose >126
    • 2. random blood glucose > 200
    • 3. 2-hr OGTT glucose >200
    • 4. HgbA1C > 6.5
  7. Definition of insulin resistance
    Normal glucose and High insulin
  8. Name 2 drugs that act at GI tract
    • Alpha glucosidase inhibitors
    • Incretin mimetics
  9. Name 1 drug that act at adipose tissues
    TZD's
  10. Name 4 drugs that act at pancreas
    • Incretin mimetics
    • DPP3 inhibitors
    • Sulfonylurease
    • Meglitinides
  11. Name 2 drugs that act at liver
    • Metformin
    • TZD
  12. Name 2 drugs that act at muscle
    • Metformin
    • TZD
  13. What does that ACCORD trial say about intensive glucose control
    increases risk of death
  14. What does ADVANCE trial say about intense glucose control
    works
  15. For pt's uncontrolled w/ metformin and lifestyle changes, what drugs should be used in next step
    Insulin or Sulfonylurease
  16. Name two benefits of glargine compared w/ NPH
    • 1. Less wt gain
    • 2. Less nocturnal hypoglycemia
  17. Name 4 actions of mechanism of incretin
    • 1. Increase insulin production
    • 2. Decrease glucagon secretion
    • 3. Delay gastric emptying
    • 3. Increase satiety
  18. What is the goal of HTN for Diabetics
    <130/80
  19. Name effects of Niacin on LDL, HDL, TG, HgbA1c
    • Dec LDL
    • Inc HDL
    • Dec TG
    • No effect on HgbA1c
  20. Can niacin be used in diabetics?
    yes
  21. Diabetes is a CVD equivalent risk which means what %
    20%
  22. Ramipiril has what other actions outside of lowering BP
    anti-atherosclerotic, vasculoprotective effect
  23. What drugs in the PROGRESS trial was shown to reduce stroke by 43% in diabetic pt's
    Perindopril and idipamide
  24. What are 3 benefits of ARB's in DM pt's
    • 1. Reduce microalbuminuria
    • 2. Reduce devel of diabetic nephropathy
    • 3. reduce preogression to dialysis or transplant
  25. What drug is 1st line agent for pt's w/ DM who have HTN and renal dz
    ACEI
  26. What drug may be useful in pt's who still have proteinuria after tx w/ ACEI
    Spironolactonw
  27. What are current goals of DM: BP, A1C, LDL, urine albumin, TG
    • BP < 130/80
    • LDL < 100
    • TG < 150
    • A1c < 7
    • Urine albumin < 30 mg/24hr
  28. What drug is almost solely used for DM1
    Amylin analog
  29. alpha-glucose inhibitors
    Mech of action
    Advantages
    SE
    • Prevent carb breakdown
    • Wt neutra; no hypoglycemia
    • GI SE
  30. Metformin: what SE do you have to be really careful about? And how do you look out for this?
    Lactic acidosis; so don't gave if Cr > 1.4 (F) and 1.5 (M)
  31. DDP4 inhibitors mech of action and contraindication
    • Inhibits the enzyme which degrades incretin
    • C/I in gastroparesis
  32. GLP1 agonist mech of action and advantage
    • = incretin mimetic
    • Stim pancreatic insulin synt
    • Suppress glucagon secretion
    • Slow gastric emptying
    • Promote satiety
    • Promote Bcell inc
    • Advantage: wt loss
  33. Glitinides mech of action and SE
    • stim pancreatic insulin secretion short term
    • SE: wt gain
  34. Sulfonylureas mech of action and se's
    • stimulate pancreatic insulin secretion
    • Wt gain and hypoglycemia
  35. TZD's mec of action and SE
    • Dec insulin resistance at peripheral tissue
    • Fluid retention and wt gain so be cautious of CHF
  36. If a patient wants to lose weight what are 2 drugs?
    • Byetta - incretin mimetic
    • Metformin

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