BBCS Notes Flashcards
What does diabetes increase risk of? What should be done to prevent this?
- Heart disease
2. Manage BP and cholesterol
How does insulin lower glucose?
- Glucose storage/through membranes
2. inhibit gluconeogenesis/lipolysis
Symptoms of DM1
- Polyuria
- Polydipsia
- Polyphagia
- Wt loss
Symptoms of DM2
- Can be none or
- Same as DM1 or
- Complications occur which lead to diagnosis
Racial distribution of DM1
More common in white
Racial distribution of DM2
More common in African American/Hispanics/Native Americans
Who should be checked for gestational diabetes?
All preg women after 24 weeks
Gestational diabetes put baby at risk for what?
- preeclampsia,
- fetal macrosomia (which can cause shoulder dystocia& birth injury),
- & neonatal hypoglycemia.
What does GDM put mothers at risk for?
DM2
Patho of GDM
- Placenta produces hormones’
- Hormones inhibit the functioning of insulin
- BS increased
Hypoglycemia patho
- Low BS
- Glucogon released from alpha cells of pancreas
- Liver releases glucose into blood
- Normal BS
Hyperglycemia patho
- High BS
- Insulin released from beta cells of pancreas
- Fat cells take in glucose from blood
- Normal BS
S&S of hypoglycemia
- Sleepy
- sweating
- pale/pallor
- lack of coordination
- irritable
- hunger
S&S of hyperglycemia
- dry mouth
- increased thirst
- blurred vision
- weakness
- headache
- frequent urination
Improper control of DM1 can cause
DKA (BS 300-400)
Improper control of DM2 can cause
HHKN (BS 600-900)
Children with DM1 are commonly diagnosed when?
After illness (usually viral)
What time of the day should a pt take latus?
- Whenever is convenient
2. Not when bolus is taken
For someone who was just diagnosed with DM1 what medication will they be started on?
Rapid
What insulin is most common?
Regular
What is HBA1C?
Average BS over 3 months
What do the differnt levels of HBA1C indicate?
- 7-6.4 (pre)
6. 5+ (diabetes)
What is the goal HBA1C for a pt with diabetes?
7
What labs should be checked when diagnosing a pt with DM2?
- BUN
- Creatinine
- Potassium
- Urinalysis
- HGB/HCT
- EKG
Pan of care for newly diagnosed pt with DM2
- Metformin
Pros of metformin
- low side effects
- does not increase wt
- cheap
Cons of metformin
- must d/c if getting a procedure w/dye
2. no alcohol
What medication should pts with DM2 be on for HTN? What not?Why?
- ACE
- NOT statins
- ACE help w/renal func.
What can low BS cause to occur?
Permanent brain damage
What is a GDM pt treated with?
Metformin or insulin
What is the “Gold standard” for DM therapy?
Insulin
TSH/T3/T4 levels in hypo and hyperthyroidism
hypo: increased TSH, decreased T3/T4
Hyper opposite
When might a preg women get tested before 24 wks?
if routine test shows high BS
What preparations are required for glucose challenge (tolerance) screening test in preg women?
none
no fasting
Normal glucose challenge (tolerance) screening test numbers
Fasting-about 95
1 hr- about 180
2 hr- about 155
3 hr- about 140
What drug is used to treat hypothyroid? Generic and Brand
Levothyroxine (Synthroid)
How long for Levothyroxine (Synthroid) to take effect? Why?
- Long time (weeks) long half life
What preg class is Levothyroxine (Synthroid)?
A
What does Levothyroxine (Synthroid) effect?
- Heart
2 Can cause depression
What must be done when first prescribing Levothyroxine (Synthroid)?
Check levels
1st check: 4-6 weeks
2nd check: 6-8 weeks
Once TSH is stable: once a year
Why MUST hyperthyroid be treated?
To avoid thyroid storm
What is the most common form of hyperthyroidism? prevelance?
Graves, 85%
How to describe hyperthyroidism to pt
feedback loop has failed and caused excessive hormones in the body
Most commonly used drug for hyperthyroid?
Methimazole (Tapazole)
What other drug is used to treat hyperthyroid
Propylthiouracil (PTU)
In which case would PTU be used over Methimazole?
If preg
Labs to monitor in pt treated for hyperthyroid? why?
- CBC- RBCs, WBCs, platelets
2. can cause agranulocytosis and aplastic anemia
Which hyperthyroid drug has BBW? What is it?
- PTU
2. liver failure
How long does hyperthyroid treatment usually last?
6 to 12 months
What is the function of “alpha” drugs?
Stim bone marrow to produce RBCs
What pt usually use alpha drugs?
- CKD
- Chemo
- HIV
- Surgery
- Dialysis
How are alpha drugs administered?
injection
Adverse effects of alpha drugs
- increase risk of clots
- seizures
- Heart problems
- anaphylaxis
- Skin reactions
Causes of iron def. anemia
- blood loss
- lack of dietary iron
- inability to absorb (GI disorder)
- preg (suppy mom and fetus)
Risk factors of iron def anemia
- Women
- infants/children
- vegetarians
- blood donors
Complications of iron def anemia
- Heart probs
- Preg probs
- growth prbs
What is iron def. anemia treated with?
Iron “ferrous” or “iron”
Drug interaction w iron
many meds decrease absorption
Adverse effect of iron
- gastric irritation
- constipation
- dark stool/teeth
- anaphylaxis
FOlate is found in what foods?
fruits and leafy green vegetables
Who may have folic acid def.?
- Sm intestine probs (celicac)
- drinkers
- certain drugs (anti-seizure)
- preg
B12 is in what foods?
meat, eggs and milk.
What most commonly causes B12 def?
- Lack of intrinsic factor (caused by immune system?)
2. B12 cant be absorbed w/o intrsinisc factor
Name of B12 anemia
Pernicious
Who is at increased risk of pernicious anemia?
- Autoimmune
- Diabetes
- Thyroid disease
