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4152 rehash > clw 7 > Flashcards

clw 7 Flashcards

UTI, diabetes, palliative care, ckd

1
Q

is GGT specific to liver issues?

A

no. GGT is found also in the kidney and pancreas besides the liver.

Non-hepatic causes of increased GGT include: pancreatic disease, MI, renal failure, alcoholism, certain medications, COPD

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2
Q

what does hazy appearance of urine point to

A

possible presence of proteins, cells, casts

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3
Q

what is specific gravity of urine

A

A urine-specific gravity test compares the density of urine with the density of water. The test may help healthcare professionals identify dehydration, a kidney problem, or a condition like diabetes insipidus

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4
Q

pyuria hints at

A

UTI

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5
Q

A & O

A

alert and oriented

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6
Q

what does high urea and scr point to

A

dehydration / kidney problems

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7
Q

pyelonephritis symptoms

A

WBC cast present, fever, rigours, headache, nausea, vomiting, and malaise, flank pain, costovertebral tenderness (renal punch), or abdominal pain

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8
Q

cystitis symptoms

A

dysuria, urgency, frequency, nocturia, suprapubic heaviness or pain; gross hematuria

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9
Q

remember that elderly without fever does not mean no infection/sickness! watch out for?

A

delirium, confusion, urinary incontinence, loss of appetite

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10
Q

healthcare associated/nosocomial pyelo

A
  • Nosocomial – onset of UTI >48h post admission
  • Healthcare associated - patients who have been hospitalized or
    underwent invasive urological procedures in the last 6 months,
    has an indwelling urine catheter, etc
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11
Q

risk factors for uti

A

Female, Dehydration, Diabetes, presence of glucose in urine, Elderly

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12
Q

abx in uti

A

cephalexin, cotrimoxazole, augmentin, cipro

nitrofurantoin,fosfomycin (only cystitis)

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13
Q

abx for poor renal fx uti

A

cephalexin, augmentin, cipro

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14
Q

does amox clav cover MDR organisms? often found in nursing homes

A

amoxclav does not cover. fosfomycin preferred

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15
Q

abx for uti for pregnancy

A

fosfomycin, amoxclav

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16
Q

benefit of fosfomycin over other abx

A

one time dosing, improve patient adherence

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17
Q

abx of high resistance in sg

A

cipro, cotrimoxazole

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18
Q

aminoglycosides avoid in

A

kidney toxicity, otoxicity

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19
Q

need repeat culture for uti if positive response to tx?

A

no

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20
Q

GOT of uti

A

resolution of symptoms by 24-72h

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21
Q

when making a recommendation for drug therapy, what else to monitor besides improvement of sx?

A

list down side effects of drug therapy recommended

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22
Q

UTI non pharm

A
  • Rehydrate the patient (supervised hydration for pts with heart failure)
  • Scheduled voiding
  • Wear loose-fitting clothes and cotton underwear
  • After using the toilet, wipe from front to back (especially after a bowel movement). Keep genital area dry
  • time voiding
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23
Q

if pt has extensive comorbidities and hypoglycemic ep, and old age, treatment goal hba1c?

A

<8.0%

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24
Q

what happens if patient takes medicine for diabetes without eating? (eg. sulfonylureas)

A

hypogly ep!

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25
Q

glibenclamide pk

A

long acting SU with ACTIVE metabolites, can accumulate and cause hypogly

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26
Q

why avoid SUs with long t half

A

can accumulate in body and cause hypogly

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27
Q

when going thru an episode of hypogly in the hospital, how to reduce meds

A

Using both insulin glargine (basal insulin) and sulfonylurea → should either discontinue the sulfonylurea or decrease the dose by 50%

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28
Q

GOT of hypogly

A
  • Normalise blood glucose levels
  • Prevent future occurrence of hypoglycemia
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29
Q

how to tackle an episode of hypogly

A

15-15-15 → 15g of fast acting sugar every 15 minutes

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30
Q

diabetes what to TCU

A

Foot and eye exam, renal function, BP at every visit

hba1c q3m

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31
Q

metformin what to look out for

A

metabolic acidosis

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32
Q

what is the triple whammy causing AKI

A

combined use of diuretics, RAASi and NSAIDs

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33
Q

aspirin is only for primary prevention for stroke/ami. who qualifies?

A

<70 yo (bleeding risk vs prevention of stroke)

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34
Q

GOT of palliative care

A

meet nutritional needs,
keep patient comfortable

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35
Q

diuretic must stop if

A

dehydrated, AKI

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36
Q

end of life, how to monitor blood sugar

A

manage episodes symptomatically, do not need to track hba1c

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37
Q

insulin heavily bound to albumin

A

yes, extensive

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38
Q

rapid acting insulin

A

lispro, aspart, glulisine

39
Q

short acting insulin

A

regular

40
Q

intermediate acting insulin

A

nph

41
Q

long acting insulin

A

detemir, glargine

42
Q

how does ckd affect drug absorption

A
  • Decreased gastric acidity e.g. due to urea retention
  • Drug interactions e.g. with phosphate binders, antacids and vitamin supplements
43
Q

how does diabetes affect drug absorption

A

Delayed gastric emptying e.g. due to
gastroparesis

44
Q

how does ckd affect drug distribution

A

fluid imbalances affecting volume of distribution, hydrophilic drugs will be affected , where by Vd will increase due to the extra water in the body

45
Q

how does ckd affect drug metabolism

A

Accumulation of metabolites: Especially if route of elimination
of metabolite is via glomerular
filtration

46
Q

how is albumin affected in ckd

A

Albumin is decr in CKD → incr free drug fraction for drugs that are highly-bound to albumin → incr Vd of the drug

47
Q

how are cyp enzymes affected in ckd

A

CKD can alter function of transporters and CYP enzymes in the gut due to uremic toxins → accumulation of active metabolites in the body

48
Q

what is the sick day advice for sglt2i

A

when pt face acute illness assoc with nvd, causing decreased fluid intake, stop sglt2i temporarily

49
Q

sglt2i se

A

genitourinary infections, diabetic ketoacidosis (vomiting, ab pain, SOB)

50
Q

type 2 dm

A

Progressive loss of adequate β-cell insulin secretion on the background of insulin resistance

51
Q

top 3 s/sx of dm

A

excessive hunger, thirst, peeing

52
Q

GOT of diabetes

A

prevent microvascular (eg. neuropathy, retinopathy) and macrovascular (cardio) complications

53
Q

non pharm of diabetes

A
  1. Quit smoking
  2. Weight Reduction (7% loss of IBW)
  3. Exercise (150 minutes of moderate activity, 2 days per week of muscle strengthening abv 55yo)
  4. Diet
  5. DIABETIC FOOT ED
54
Q

avoid beta blockers with sulfonylureas

A

mask hypoglycemia

55
Q

metabolism of sulfonyureas

A

cyp2c9

56
Q

benefit of tzd

A

fatty liver disease

57
Q

tzd cannot be used in

A

heart failure esp nyha 2/3

58
Q

sglt2i c/i

A

dialysis, egfr<20

59
Q

What to do with oral therapies when starting injectables

A

Metformin: No change
SGLT2i: No change
SU: (If basal insulin initiated) Discontinue or reduce dose by 50%; (if mealtime insulin initiated) discontinue SU
TZD: Discontinue or reduce dose
DPP4: Discontinue if GLP initiated

60
Q

diabetic ketoacidosis sx

A

plasma glucose >13
urine ketone positive
anion gap >10 (acidosis)
alert

61
Q

hyperglycemic hyperosmolar state type 2

A

plasma glucose >33
urine ketone neg
anion gap <12
coma

62
Q

LDL goal for DM + risk factor, neuropathy etc or >10 y

A

<1.8mmol/l

63
Q

LDL goal for DM < 10 y

A

<2.6mmol/l

64
Q

when to treat TG in DM

A

> 4.5

65
Q

UTI complicated cystitis objectives

A
  • WBC >10 signifies pyuria
  • RBC >5/HPF signifies hematuria
  • Gram stain: bacterial or yeast infection
  • Leukocyte esterase activity in urine
66
Q

gout urate levels target

A

Urate level < 6 mg / dL

67
Q

gout GOT

A

Rapid and effective pain relief
Reduce future attacks
Prevent joint destruction, tophi formation

68
Q

when to start ULT

A

Start 2 to 3 weeks after acute attack

69
Q

when starting ULT add what

A

Initiation needs anti-inflammatory prophylaxis for 3-6 months
Colchicine 0.5mg OD

70
Q

signs of ckd

A

Fatigue, weakness, SOB, mental confusion,
N/V, bleeding, loss of appetite, itching, cold
intolerance, weight gain, neuropathy, uremic breath

71
Q

labs of ckd increased

A
  • SCr, urea, K, P, PTH, BP, glucose, lipids,
72
Q

decreased labs in ckd

A

GFR, CrCl, CO2 (metabolic acidosis), Hgb (anemia), iron stores (Fe deficiency), 25(OH)D (vit
D deficiency), albumin (malnutrition), glucose, Ca
(early stages of CKD), HDL

73
Q

raised levels of ckd, concern for hyper-?

A

K, Mg, P, uric acid

74
Q

ckd GOT

A
  • Slow down progression of disease and delay need
    for renal replacement therapy (RRT) – dialysis or
    transplantation
  • Maintain fluid and electrolyte homeostasis
  • Provide adequate nutritional and metabolic support
  • Prevent and treat extra-renal complications (anemia
    and bone disease)
75
Q

when can acei/arb be continued in aki

A

-Increase in SCr < 25-30% from baseline value
- Serum K≤ 5.5 mmol/L

76
Q

diuretics used in CKD with HTn

A

thiazide / loop (esp if reduced crcl)

77
Q

elimination of atenolol and bisoprolol

A

renal

78
Q

for ckd patients, need statin?

A

yes, do not need monitoring. Increased risk for atherosclerosis, CVD and mortality (regardless
of LDL levels)

79
Q

fibrates can use for ckd?

A

stage 1 to 3 only

80
Q

fluid intake for ckd

A

1-1.5 L/day

81
Q

salt restriction for ckd?

A

2g of Na aka one teaspn of salt

82
Q

what painkiller to avoid in ckd

A

nsaid (risk for nephrotoxicity)

83
Q

how do hydrophilic molecules like to travel by

A

Paracellular
Through the water-filled gap junctions between two cells, passive process via diffusion

84
Q

how do lipophilic, uncharged and low MW (<300Da) molecules like to travel by

A

Transcellular
absorption directly through the lipid bilayer of cells,

passive process via diffusion (down a conc gradient so will diffuse from lumen of intestine to blood)

85
Q

how do molecules in GIT travel by

A

In GIT, the paracellular route is v tight to prevent microorganisms frm food to get into the bloodstream easily → hence, via GIT, v little paracellular transport (most of the abspt occur via transcellular)

86
Q

do glicazide and glipizide have active metabolites

A

no

87
Q

what does high Vd tell us about the drug

A

Lphilic → distribute widely in tissues/conc somewhere else in the body → high V

88
Q

what does small Vd tell us about the drug

A

Hphilic, charged→ stay in plasma (cannot pass through via transcellular route to the tissues)→ small V

89
Q

enteric coating made up of

A

pH-sensitive polymers

90
Q

purpose of enteric coating

A

protect patient
protect drug

91
Q

ideal log p value for oral drug for good intestinal and oral absorption

A

log p<5, ideally 1.38-1.43b

92
Q

PK parameter used to quantify drug absorption

A

F
(fraction of administered dose that reaches systemic circulation)

93
Q

first line for esbl

A

carbapenem (imipenem)

4152 rehash (9 decks)

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