Block 1 Family Med

Question 1

What can an isolated elevation of BUN indicate?

Answer 1

GI bleed

Question 2

MOA of Metformin

Answer 2

Unknown, but many theories

Overall, reduces gluconeogenesis in the liver, decreases glucose absorption in GI, increases insulin sensitivity

Question 3

Glucophage generic name

Answer 3

Metformin

Question 4

Why is Metformin so effective in treating DM and therefore first-line Tx choice?

Answer 4

Average person with DMII has 3X rate of gluconeogenesis than normal.
Metformin can reduce this production by over one-third

Question 5

Most common SE’s of metformin

Answer 5

Diarrhea, nausea, abdominal pain

Low risk of hypoglycemia

Question 6

Glyburide generic name

Answer 6

Glibenclamide

Question 7

Glyburide drug class

Answer 7

Sulfonylurea

Question 8

MOA of sulfonylureas

Answer 8

Binds to and inhibits the K+ ATP channel in the Beta cells of the pancreas, this leads to increased Ca influx and increased release of insulin.
Acts to increase beta cell sensitivity to all secretagogues at all blood glucose levels.
May also act to increase tissue sensitivity to insulin, but clinical relevance thought to be minimal.

Question 9

Name the second generation sulfonylureas

Answer 9

Glipizide, Glyburide, Gliclazide, Glimepiride

Question 10

How much do sulfonylureas tend to lower blood glucose levels and A1c?

Answer 10

Blood glucose lowered by 20%

A1c lowered by 1-2%

Question 11

Sulfonylureas are most likely to be effective in what patients?

Answer 11

Patients with normal or slightly increased weight.

Question 12

What patients should be given insulin to control their DM?

Answer 12

Patients who are underweight, losing weight, or ketotic despite adequate caloric intake. Be careful because these patients can actually be type I diabetics

Question 13

Chlorpropamide

Answer 13

1st generation, long-acting sulfonylurea

More side effects than other sulfonylureas and its use is no longer recommended

Question 14

What is the most common SE of sulfonylureas? What increases their risk?

Answer 14

Hypoglycemia
Higher risk:
after exercise, missed meal, longer acting drugs (glyburide), undernourished or abuse alcohol, concurrent therapy with salicylates, sulfonamides, gemfibrozil, warfarin, after being in hospital

Question 15

What are the three main types of photosensitivity reactions?

Answer 15

Phototoxicity: exaggerated skin reaction mostly from a drug leading to increased tendency to sunburn and blister, quinolones, sulfonamides, tetracyclines, water pills, tranquilizers, oral diabetic drugs, some cancer drugs
Photoallergy: itching rash on exposure to sunlight, can lead to chronic skin changes like lichen planus from scratching, many cosmetic and perfume agents can cause this, PABA in sunscreens used to cause it
Polymorphous light eruption: resembles photoallergy in that creates intensely itchy rash, different in that decreases with increased sun exposure so tends to be worse in the Spring, tends to be fair skinned people

Question 16

What is xeroderma pigmentosum?

Answer 16

Hereditary disease with a defect in repair mechanisms that accelerates skin damage from sunlight

Question 17

What type of malnutrition can lead to increased skin sensitivity to sunlight?

Answer 17

Niacin deficiency leads to pellagra

Question 18

HIV positive patients can become photosensitive. What other features of the disease can increase the risk for photosensitivity?

Answer 18

African American

HAART

Question 19

What is C-Reactive Protein?

Answer 19

Acute phase reactant released by the liver in response to IL-6. Indicator of inflammation in the body.

Question 20

What is the significance of elevated homocysteine levels?

Answer 20

Elevated levels are associated with atherogenesis and therefore ischemic injury. Can increase risk for CAD, stroke, thrombosis
May also be associated with neuropsychiatric illness, fractures, and microalbuminuria

Question 21

When are homocysteine levels often found to be elevated?

Answer 21

Levels increase with age, so the elderly are more likely to have increased levels
Also increase with low vit B6 as this is a cofactor needed to convert homocysteine into cysteine

Question 22

What are the ACS screening guidelines for breast cancer?

Answer 22

40-44 yr: patient discretion
45-55 yr: annually
Over 55: biennially

Question 23

What are the USPSTF screening guidelines for breast cancer?

Answer 23

Under 50: patient and doc discretion
Over 50: Biennially
Over 75: assess based on health and 10 year life expectancy

Question 24

What are the ACS guidelines for cervical cancer screening?

Answer 24

Start at age 21
21-29: pap q 3 yr without HPV testing
30-65: pap + HPV testing every 5 years, or pap only every 3 yr
Over 65: If normal testing and results for last 10 years can stop testing, if Hx of serious cervical pre-cancer should continue to be tested for 20 years
After total hysterectomy: if no Hx of cancer or pre-cancer then no need to test

Question 25

What is Cymbalta?

Answer 25

Duloxetine

SNRI

Question 26

What are the most common uses for Duloxetine?

Answer 26

MDD (not first-line because of cost and not increased efficacy)
GAD
Fibromyalgia
Neuropathic pain
Found by some studies to be helpful for diabetic neuropathy
In other countries like the UK it is used for stress urinary incontinence though it failed approval for this in USA

Question 27

What is the first-line treatment for neuropathy caused by chemotherapy?

Answer 27

Duloxetine

Question 28

What are the primary SE’s of Duloxetine?

Answer 28

Nausea, somnolence, insomnia, dizziness

Question 29

What is a common SE of all drugs that inhibit re-uptake of serotonin?

Answer 29

Sexual dysfunction
Usually involving a lack of interest, anorgasmia, anhedonia
Think of this for all SSRI’s and SNRI’s

Question 30

What is the major use of Citalopram, its class and trade names?

Answer 30

Most commonly used for MDD
SSRI class
Celexa, Cipramil

Question 31

What are the most common SGLT2 inhibitors? (trade and generic names)

Answer 31

These are all gliflozins
Invokana (canagliflozin)
Jardiance (empagliflozin)
Farxiga (dapagliflozin)

Question 32

What class is Tradjenta?

Answer 32

DPP-4 inhibitor

Also called Linagliptin

Question 33

MOA of DPP-4 inhibitors

Answer 33

Inhibits the enzyme DPP-4 which breaks down incretins. Higher incretins causes increased insulin and decreased glucagon.

Question 34

Name the DPP-4 inhibitors

Answer 34

The gliptins
Sitagliptin = Januvia
Linagliptin = Tradjenta