deck 5 Flashcards
problem with Roux-en-Y gastric bypass
complications common, occurring with about 40% of cases.
indications for bariatric surgery
BMI greater than 40 or 35 if obesity-related comorbidities present
OCPs and osteoporosis?
no evidence that use increases risk
common cause of accelerated bone loss..
hyperthyroidism
interpreting DEXA scans
T-score (the number of standard deviations above or below the mean matched to YOUNG controls) and a Z-score (the number of standard deviations above or below the mean-matched to age-matched controls). Z-scores are of little value to clinicians. A T-score more than 2.5 standard deviations below the mean (a score of —2.5 or lower) indicates osteoporosis.
osteoporosis drug with analgesic qualities
calcitonin
other distinguishing feature between AN and bulimia
bulimics sense a lack of control over eating during episodes of binging, while anorexics often feel a strong sense of control. This is a characteristic that may help distinguish the two.
labs to order when working up ADHD
Blood chemistries, a thyroid stimulating hormone, and a lead level.
substance abuse risk with stimulants for ADHD kids?
There is a decreased risk of substance abuse in adolescents treated for ADHD
hashimoto’s presentation
- enlarged thyroid that is tender in middle aged woman.
most common symptom of hyperthyroidism
fatigue
subclinical hypothyroidism
elevated TSH + normal free T4
management of subclinical hypothyroidism
monitor at yearly intervals
primary hypothyroidism lab profile
TSH elevated, free T3/T4 low
isolated systolic hypertension
systolic elevated, diastolic normal
stage 1 HTN
140-159, or 90-99
stage 2 HTN
greater than 160, or greater than 100
hypertensive urgency vs. emergency
both greater than 180/20, emergency indicates end-organ damage
when to treat HTN
systolic greater than 140 or diastolic greater than 90
for AA’s initial therapy for HTN should be…
thiazide or CCB
HTN drug of choice for patients with CKD and elevated creatinine
loop diuretics
combined therapy for ACEI and ARB?
- increased adverse effects and no improvement in outcome.
HTN drug for patients with CAD
b-blockers (decrease cardiovascular mortality)
HTN drug for patients with asymptomatic ventricular dysfunction and HF
ACEiI’s
HTN drug for patients with CVA
ACEI + thiazide diuretic
diuretics contraindications
gout
drug for systolic HTN
diuretics
b-blocker contraindications
asthma, COPD, heart block
ACEI’s indications
HF, LV dysfunction, post-MI
testing for all patients with BMI greater than 25
1) fasting blood glucose or hba1c,
2) creatinine
3) fasting lipid panel
reasonable weight loss goal per week
0.5-1.0 lb per week
when drug therapy is indicated for obesity
- BMI greater than 30.0
- BMI greater than 27.0 + comorbidities
problem with orlistat
hepatotoxic
complications of bariatric surgery
severe GERD, N/v< band erosion, stomal obstruction
how to prevent diabetes?
- meds are effective in pre-diabetic patients but less so than lifestyle modification
when to screen for diabetes?
1) USPSTF –> asymptomatic adults with sustained BP greater than 135/80
2) ADA –> patients overweight + risk factors (HTN, dyslipidemia, triglyceridemia, PCOS, first degree relatives with diabetes).
labs to order once diabetes is diagnosed
Screen for complications with fasting lipid profile, serum electrolyte panel, UA, ECG
microvascular complications of T2DM
retinopathy, nephropathy, neuropathy
target hba1c for patients with history of hypoglycemia, advanced microvascular complications, or limited life expectancy
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