CDE Exam Review Flashcards by Lolis Rocha

Q

Physical activity recommendations for children and adolescents

A

At least 60 minutes of moderate intensity physical activity daily

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Q

Large doses of aspirin, 4grams/day, can cause?

A

Increased basal and stimulated release of insulin

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Q

States of the Trans-theoretical model of behavior change

A

Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination

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Q

Trans-theoretical model of behavior change

Stage 1: PRECONTEMPLATION

A

The individual is not aware of the problem and has no intention of change the health behavior

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Q

Trans-theoretical model of behavior change

Stage 2: CONTEMPLATION

A

The individual is aware of the problem & intends to change the behavior, knows benefits of the behavior change and the drawbacks. Can be a state of ambivalence

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Q

Trans-theoretical model of behavior change

Stage 3: PREPARATION

A

The individual makes plans to facilitate the health behavior change

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Q

Trans-theoretical model of behavior change

Stage 4: ACTION

A

The individual is taking action to change the health behavior

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Q

Trans-theoretical model of behavior change

Stage 5: MAINTENANCE

A

The individual demonstrates the ability to sustain behavior

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Q

Stages of CKD

A

5 stages

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Q

CKD Stage 1

A

Stage 1 - Kidney damage with normal or elevated GFR

GFR >90

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Q

CKD Stage 2

A

Kidney damage with mild decreased in GFR

GFR 60-89

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Q

CKD Stage 3

A

Moderate decreased in GFR
GFR 30-59 - evaluate and treat complications
Metformin is contraindicated
if GFR <45 do not start metformin

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Q

CKD Stage 4

A

Severe decreased in GFR

GFR 15-29 - prepare for kidney replacement therapy

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Q

CKD Stage 5

A

Kidney failure

GFR <15 (or dialysis) Replacement if uremia present

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Q

Screening for CKD

A

Type 1: 5 years after diagnosis, annually after that

Type 2: At diagnosis and annually also during pregnancy.

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Q

Lipid medication contraindicated in dialysis

A

Statins

Q

Diabetes Medications contraindicated in Heart Failure

A

TZDs
Saxagliptin (Onglyza)
metformin
alogliptin (Nesina)

Q

Niacin

A

an alternative for statin-intolerant people
SE: Flusing, pruritis, rash, GI
Flushing resolves with use and better tolerated with meals
Minimize flushing by taking asa 30 min prior to niacin

Q

Triglyceride management

A

People with high TG need to normalize BG first before adding Omega 3, fibrates or niacin.
May need to start insulin if BG are too high
High TG contribute to increased insulin resistance

Q

St John’s Wort

A

Anti-depressive properties

Is thought to lower serum concentrations of other drugs

Q

GLP-1

albiglutide

A

albiglutide (Tanzium) does have the same wt loss as other GLP-1s. 0.6 kg compared to 2.2-3kg with others at 6 weeks.
Requires mixing and waiting 15-30 mins prior to injection.

Q

ASA recommendations

A

low dose asa is recommended in:
T1 and T2
>50 years old
10 year ASCVD risk >10%

Q

Insulin resistance

A

Abdominal fat is more metabolic active and turn over of free fatty acids (FFA)
In the liver FFA contributes to insulin resistance (lipotoxicity).
FFA may be used as a fuel source instead of glucose, they can contribute to hyperglycemia

Q

ADA 2016 B/P Guidelines for adults with T2D & HTN

A

<140/90

ADA 2016 B/P Guidelines for younger individuals

lower targets <130/80 are appropriate considering the potential duration of the disease

ADA 2016 B/P Guidelines in pregnancy

120/80 - 160/105 | Lower targets may impair fetal growth

ADA Guidelines for starting basal insulin

start basal insulin: - 10 units a day - 0.1 - 0.2 units/kg/day Adjust 10-15% or 2-4 units once or twice weekly to reach FBG target For hypo decrease dose by 4 units or 10-20% Post meal BG reflects efficacy

ADA Guidelines for starting meal insulin

``` start meal insulin at: - 10% of basal rate - 0.1 units/kg - 4 units Adjust in 1-2 units increments or by 10-15% of the dose For hypo decrease by 2-4 units or 10-20% Fasting BG reflects efficacy ```