Amb Care

Question 1

Mechanism of metformin

Answer 1

Metformin

• inhibits liver gluconeogenesis
• enhances tissue insulin sensitivity

Question 2

Expected A1C change from metformin alone

Answer 2

Metformin monotherapy- 1.0-2.0% reduction in A1C

Weight neutral

Question 3

Who gets PCV-13?

Answer 3

Strep pneumo vaccines: get PCV-13 then PPSV23 sequentially in ppl over 65

Or ppl 19-64 who: nursing home residents, smokers, chronic heart disease (including HTN), chronic lung disease, chronic liver disease (cirrhosis), alcoholics, and diabetes

Question 4

Differentiate the two shingles vaccines

Answer 4

Recombinant zoster vaccine- for anyone without contraindications at or over age 50
2 doses 2-6 months apart
Preferred if any degree of immunosuppression

Zoster live vaccine: at or over age 60 without contraindications, single dose shot

Question 5

Explain how familial hyperTG would impact birth control options

Answer 5

Estrogen is associated w/ a 25% increase in TG- which for ppl w/ familial syndromes can put them in the danger zone for pancreatitis/other negative stuff

Sooo want to use birth control options w/o any estrogen (aka progesterone only stuff like the depot)

Question 6

Who should get DEXA screened?

Answer 6

All women over 65

Then post-menopausal women under 65 who have clinical risk factors for fracture: prior fracture, on steroids, low BMI, current smoker