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Practice Exams > 8/12/21: AKT Glace > Flashcards

8/12/21: AKT Glace Flashcards

1
Q

metformin adjustment in renal impariemtn

A

Renal Impairment: Reduce dose by 50% at eGFR 30-60. Contraindicated at eGFR <30

CrCl: 30-60 → 1g daily, >60 → 2g daily

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2
Q

SGLT2 inhibitors adjustement in renal impairment

A

Renal Impairment: Contraindicated at eGFR <45 (glycaemic lowering efficacy decreases)

Dapagliflozin 10mg PO Daily
Empagliflozin 10mg PO Daily
Ertugliflozin 5mg PO Daily

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3
Q

Sulonylurea adjustment in renal impairment. examples of sulfs.

A

Renal Impairment: Contraindicated if Creatinine Clearance <15 (Hypoglycaemia risk increases as eGFR declines)

Gliclazide IR 40mg Daily
Gliclazide MR 30mg Daily
Glipizide 2.5mg Daily
Glibenclamide 2.5mg PO Daily
Glimepiride 1mg PO Daily
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4
Q

Dpp4 inhibitors, renal impairment and dosing.

A

Renal Impairment: Safe with dose reduction in renal impairment but linagliptin can be used at all stages of renal impairment

Aloglitptin 25mg once daily
Linagliptin 5mg once daily (safe in all stages of renal impairment)
Saxagliptin 5mg once daily
Sitagliptin 100mg once daily
Vildagliptin 50mg BD
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5
Q

GLP1 Agonists, renal impairment, dosing.

A

Renal Impairment: Contraindicated in eGFR <30 (dulaglutide contraindicated at eGFR <15)

Dulaglutide 1.5mg Subcutaneously Once Weekly
Exenatide Immediate Release 5 microg BD subcutaneously OR Exenatide Modified Release 2mg subcutaneously weekly
Semaglutide 0.25mg subcutaneously once weekly
Liraglutide 0.6mg subcutaneously once daily for 1 week (not on PBS)

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6
Q

Risk Factors for GDM?

A 
prev GDM
migrant
ethnicity populations
prev big baby
prev preg loss
bmi >30
pcos
old
FHx of diabetes
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7
Q

If risk factors, when tested for GDM? If no risk factors, when tested for GDM?

A

no risk - 24-28 weeks OGTT

>1 risk factor -> first trimester OGTT

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8
Q

follow-up post-partum following diganosis of GDM?

A
  • conduct OGTT 2 hour test - 6-12 weeks post-partum
  • if normal - HbA1c every 3 years
  • if HbA1c >6 → further investigation and advice before next pregnancy
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9
Q

Definition of DKA

A

Diabetic BGL >11
ketonuria
acidosis pH <7.3

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10
Q

Risk factors of DKA

A 
infectin or illness
discontinuation of insulin
inadequate insulin
sglt2 - pregs, alcohol, low carb diet, surg (euglycaemic ketoacidosis)
new onset t1dm
drugs
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11
Q

Clincial features of DKA

A

evolves rapidly over 24 hours

  • Dehydration
  • Polyuria + polydipsia, polyphagia
  • Weight Loss - due to fluid loss and loss of muscle and fat
  • Weakness
  • Kussmaul’s Respirations → Hyperventilation of DKA
  • Nausea and Vomiting
  • Abdominal pain
  • signs of volume depletion + fruity odour to breath
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12
Q

Basic management of DKA

A

fluid replacement - aggressive
insulin therapy
iv glucose to suppress ketones to let acidosis correct itself

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13
Q

SGLT2 managment periop. surgery vs day procedure.

A
  • should be ceased at least 3 days prior to surgery including endoscopy/colonscopy to prevent DKA in the peri-operative period
  • however for gastroscopy and other day procedures → can cease the SGLT2 inhibitor for the day of the procedure. note that fasting should be minimised.
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14
Q

peri-operative manageemnt - all diabetic medication other than sglt2 inhibitors

A
  • continue medications until day prior to surgery

- withhold medication on the morning of the surgery → DOES NOT matter if on the morning of afternoon list

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15
Q

insuling management in peri-operative period. long-acting, short-acting vs mixed

A
  • long-acting - continue as normal
  • short-acting
    • morning - no insulin
    • afternoon - half dose before light breakfast
  • mixed - take half normal dose
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16
Q

when to recommence diabetic medication? sglt2 vs metformin?

A

SGLT2 → when eating and drinking normally or close to discharge from hospital. if day surgery, reccomence when on full oral intake

Metformin → recommence 24 hours after major surgery

17
Q

Screening of diabetic retinopathy. When? I

A

at diagnosis

18
Q

if no diabetic retinopathy, how often do we screen? what does it depend on?

A

every year: long diabetes 15 years, systemic disease, hba1c >8, ATSI, nonEnglish.
every 2 years everyone else

19
Q

who is at high risk of CVD without absolute cvd risk calculator?

A
  1. Diabetes + Age >60yo
  2. Diabetes with microalbuminuria (urinary ACR >2.5mg in male and >3.5mg in female)
  3. Moderate or Severe CKD → persistent proteinuria or eGFR <45) → Chronic Kidney Disease (CKD)
  4. Previous diagnosis of Familial Hypercholesterolaemia
  5. Systolic Blood Pressure ≥ 180mmHg or Diastolic Blood Pressure ≥ 110 mmHg
  6. Serum Total Cholesterol > 7.5mmol/L
  7. Aboriginal or Torres Strait Islanders adults ≥ 74yo
20
Q

what should high risk patients be treated wtih?

A

lipid lowering and HTN meds

21
Q

who is considered high risk despite AUSDRISK? what does this mean practically?

A
  • People aged ≥40 years who are overweight or obese
  • People of any age with IGT or IFG
  • People with a first-degree relative with diabetes
  • All patients with a history of a cardiovascular event (eg acute myocardial infarction, angina, peripheral vascular disease or stroke)
  • People of high-risk ethnicity/background (eg Pacific Islands, Indian subcontinent)
  • Women with a history of GDM
  • Women with polycystic ovary syndrome (PCOS)
  • People taking antipsychotic medication
  • Aboriginal and/or Torres Strait Islander people - TESTED ANNUALLY FROM 18YO
22
Q

HbA1c number cutoffs and what does this mean?

A

<6 -> recheck in 3 years if indicated
6-6.5 -> retest in 1 year
>6.5 -> repeat Hba1c - likely diabetes

23
Q

Numbers of Fasting blood glucose cutoffs?

A

<5.5 - unlikely
5.5-6.9 - possible -> perform OGTT
>7.0 -> repeat FBG to confirm diabetes

24
Q

numbers for OGTT cutoffs and what does this mean?

A

Fasting Glucose + 2 hr Glucose:
<6.1 + <7.8 -> retest in 3 years
6.1-6.9 + <7.8 -> Impaired fasting glucose
<7.0 + 7.8 - 11.1 -> impaired glucose tolerance
>7 + >11.1 -> diabetes

25
Q

Diabetes Cycle of Care: 6 monthyl

A

BMI
Feet
BP

26
Q

Diabetes Cycle of Care: 2 years

A 
eyes
eyes are yearly if increased risk:
1. diabetes >15years
2. hba1c >8
3. ATSI
4. non-english
5. systemic disease
27
Q

Diabetes cycle of care: yearly

A 
Hba1c
Lipids
urine ACR
Complication prevention
non-pharm management
28
Q

TEsts for t1dm

A

Consider non-urgent confirmatory tests for glutamic acid decarboxylase (GAD) and/ or insulinoma antigen-2 (IA-2) antibodies.
consider -> plasma c-peptide level

29
Q

Nutritional Supplements following weight management surgery?

A
  1. multivitamin - folic acid, b12, thiamine, iron
  2. Ca
  3. Vit D
    Fe and b12 based on bloods
30
Q

1st trimester combined screening points.

A

between 11-14/40

  • papp-a
  • nuchal translucency
31
Q

2nd trimester screening poitns

A

triple test -> beta-hcg, alpha-feto protein, unconjugated estriol
quad test -> triple test + inhibin A

32
Q

Sick Day management points?

A
  • identify underlying cause - intercurrent illness or use of medications such as corticosteroids
  • increase SMBG → monitor 2-4 hourly or more frequently if BGL is low
  • consider insulin commencement for short period of time for persistent and extreme symptomatic hyperglycaemia → may require hospital admission
  • If nausea, vomiting and/or diarrhoea
    • consider ceasing metformin or GLP1 RA as these may aggravate symptoms. (also for SGLT2)
  • Increase fluid intake → to prevent dehydration (if BGL >15 - nonglucose drinks, if BGL <15 - oral rehydration solution)

Practice Exams (45 decks)

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