Diabetes, COPD & CKD Flashcards
What’s COPD?
Chronic obstructive pulmonary disease
Damage to lungs (commonly by cigarettes) resulting in a mixture of bronchitis and emphysema
Clinical features of COPD? Signs too!
SOBOE
Chronic cough, clear sputum
Wheeze
Apnoea
Fatigue, weight loss
Recurrent chest infections
Hyper-resonance (due to hyperinflation)
Wheeze
Reduced air entry
Risk factors for COPD?
SMOKING
Occupational: working with dust, flour, fumes etc.
Genetics
Pathophysiology of COPD?
Bronchitis: inflammation of bronchi causing oedema, mucus, obstruction. Air can’t get down to alveoli as easily
Emphysema: alveoli lose elasticity, they can’t expel air as well, air stagnant in alveoli, so poor oxygen exchange
Investigation of COPD? What results would you see?
Spirometry would show obstructive pattern
CXR
What spirometry results would you expect to see in COPD?
Obstructive pattern
FEV1 80% or less than predicted
FEV1: FVC ratio less than 0.7 (because they have full lungs but can’t expel it quickly)
What are FEV1 and FVC?
What’s the normal range of FEV1: FVC ratio?
If its too low what does it mean?
FEV1: forced expiratory volume in 1 second
FVC: forced vital capacity (full volume you can breathe out)
0.75-0.85
Obstructive lung disease
How is COPD staged?
Gold criteria
1 - Mild: FEV1 > 80%
2 - Moderate: FEV1 50-80%
3 - Severe: FEV1 30-50%
4 - V severe: FEV1 < 30%
MRC: based on how breathlessness impacts function
Management of COPD long term?
Non-medical:
Pulmonary rehab
Stop smoking
Flu and pneumococcal vaccine every year
- SABA or SAMA
Decide if asthmatic features or not
No asthmatic features:
2. LABA + LAMA
Asthmatic features:
- LABA + ICS
- LABA + ICS + LAMA
Extras:
- mucolytics if productive cough
- theophylline if struggles with inhalers
- if cor pulmonale, loop diuretic
- LTOT
Management of an exacerbation of COPD?
ABCDE
High flow oxygen
Neb salbutamol 2.5-5.0mg
Neb ipratropium 500mg
Oral prednisolone 30mg
Or IV hydrocortisone 100mg
If this not working call for help
Amninophylline, BiPAP
Antibiotics if positive sputum sample
What infections commonly cause exacerbations of COPD?
H. influenzae
S. pneumoniae
Maroxella catarrhalis
Describe pathophysiology of type 1 and 2 diabetes?
- Autoimmune destruction of beta cells in islets of Langerhans in pancreas
they stop producing insulin - insulin resistance and reduced effectiveness of endogenous insulin
Clinical features of diabetes?
Type 1: Weight loss Polydipsia Polyuria Fatigue Or in DKA
Type 2 often found incidentally
What’s DKA and how does it present?
Diabetic ketoacidosis
Lack of insulin means the person is unable to convert glucose into glycogen to store it. Cell mitochondria have to break down fatty acids to generate energy. The product of this reaction is ketones
High levels of ketone in the blood leads to acidosis and is very serious
Presents:
- abdo pain
- vomiting
- reduced consciousness
- poly dipsia and uria
- dehydration (tachyC)
Investigations for diabetes? And what would the results be?
Fasting glucose > 7mmol/l
Random blood glucose > 11.1mmol/l
HbA1c > 48% (6.5%)
What’s pre-diabetes?
Stage before diabetes 2
When blood glucose is higher than it should be but not high enough to classify as diabetes yet
Reversible, with lifestyle change
Management of type 1 diabetes?
Insulin: short and long acting
Annual review of renal function, eyes, feet, BP
Education and support from GP, ANP, dietician, counselling
Management of type 2 diabetes?
Lifestyle changes: diet, smoking, alcohol, exercise
Annual review of renal function, eyes, feet, BP
Drugs:
1. Metformin
- Add either a Sulfonylurea, SGLT2 inhibitor, DPP-4 inhibitor (-gliptins) or pioglitazone
- Insulin
Give an example of a sulfonylurea. How do they work?
Gliclazide
Bind to beta cell receptors and stimulate insulin release, only effective if you have some beta cells left
Give an example of a DPP-4 inhibitor? How do they work?
-gliptins, sitagliptin
Inhibits glucagon secretion
How does pioglitazone work?
Improves insulin sensitivity, increases adipogenesis
Give an example of a SGLT2 inhibitor? How do they work?
-fozins, dapaglifozin
Block renal reabsorption of glucose, so more is lost in urine
What type of drugs are these?
- dapaglifozin
- gliclazide
- sitagliptin
- pioglitazone
- metformin
Which ones have weight gain as a side effect?
SGLT2 inhibitor
Weight LOSS
Sulfonylurea
Weight GAIN
DPP4 inhibitor
Weight neutral
Pioglitazine
Weight GAIN
Metformin
Weight neutral
How does metformin work?
Side effects?
Increases insulin sensitivity, hepatic gluconeogenesis and GI absorption of carbohydrates
GI upset
What is CKD?
Chronic Kidney Disease
Gradual loss of kidney function over time (months, years)
Clinical features of CKD? What’s the cause of most of these symptoms?
Anorexia Vomiting Restless legs Fatigue, weakness Bone pain Oedema Pruritus
Men: impotence
Women: amenorrhoea
Caused by uraemia
Risk factors of CKD?
Hypertension
Diabetes
Age
Glomerulonephritis
SLE
Polycystic kidney disease
What are the stages of CKD?
- No CKD
- Mild
3a. Moderate
3b. Moderate - Severe
- Kidney failure
Determined by GFR
Complications of CKD?
Anaemia HTN Hyperkalaemia Hyperparathyroidism Dyslipidaemia
Management of CKD?
Limit progression: treat HTN
Symptom control: iron for anaemia, diuretics for oedema
Diet: avoid high potassium and phosphate foods
If very severe, dialysis
What reverses warfarin and NOACs?
Warfarin: Vit K
NOAC: beriplex
After you’ve done spirometry with your COPD patient, what other investigation would you do that would help figure out prognosis and management?
BODE
Body-mass index
(Airflow) Obstruction
Dyspnoea
Exercise
A multidimensional scoring system and capacity index to help predict outcomes
What should you measure before starting LMWH?
Weight
LFTs
Platelet count
U+E
How does warfarin work?
Vitamin K antagonist
Prevents formation of factor 2, 7, 9, 10
How does unfractionated heparin work?
Activates anti-thrombin III
How does LMWH work?
Enhances action of antithrombin
To help it antagonise factor Xa quicker and better
