Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 844 > Diabetes (Kania) > Flashcards

Diabetes (Kania) Flashcards

1
Q

diabetic kidney disease nephropathy signs

A
  • persistent proteinuria
  • decreased eGFR
  • increased arterial BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

normal urinary albumin-to-creatinine ratio

A

< 30 mg/g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

normal eGFR

A

> 60 mL/min/1.73 m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When to screen for microalbuminuria in T1DM patients

A
  • ≥5 years after initial diagnosis
  • if UACR > 300 mg/g and/or eGFR < 60 mL/min/1.73m2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when to screen for microalbuminuria in T2DM patients

A
  • annual following diagnosis

-if UACR > 300 mg/g and/or eGFR < 60 mL/min/1.73m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

treatment for microalbuminuria

A
  • ACEI or ARB
  • non pregnant
    -if UACR > 300 mg/g and/or eGFR < 60 mL/min/1.73m2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

glucose control for patients with T2DM + kidney disease (UACR 200 mg/g)

A
  • SGLT2I with evidence of decreased CKD progression if eGFR > 20 mL/min/1.73 m2
  • recommend this if UACR is normal
  • use GLP-1 with proven CVD benefit if SGLT2 is not tolerated or contraindicated
  • can add ACE/ARB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

blood pressure goal for T2DM

A

< 130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

treatment for T2DM + DKD nephropathy + HTN

A
  • do not discontinue ACEI/ARB for < 30% increase in SCr
  • use non-steroidal MRA to decrease CKD progression and CV events if at risk for CV events
  • limit protein intake to 0.8 mg/kg/day for non-dialysis patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

if patient’s have a UACR ≥ _____, goal is a _______% reduction

A

300 mg/g, 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

_____ is the most common ocular complication

A

retinopathy (most frequent cause of blindness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

for ocular complications, it is important to manage:

A
  • glycemic control
  • blood pressure
  • lipid management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when should a T1DM patient screen for ocular complications

A

have an initial eye exam within 5 years after onset of diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when should a T2DM patient screen for ocular complications

A

have an initial eye exam at the time of diabetes diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

after screening, if no evidence of retinopathy for one or more annual exams and glycemia is controlled, may extend exams to ________

A

every 1-2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

if retinopathy present,

A

assess at least annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

treatment for ocular complications

A
  • photocoagulation therapy
  • anti-vascular endothelial growth factor
  • ranibizumab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when to asses for peripheral neuropathy in T2DM patients

A

at the time of diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when to assess for peripheral neuropathy in T1DM patients

A

within 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

recommended treatment for peripheral neuropathy

A
  • pregabalin
  • duloxetine
  • gabapentin
  • start with low dose, titrate up to reduce risk of CNS adverse effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

other neuropathy complications

A
  • GI neuropathies (gastroparesis, diarrhea/constipation, fecal incontinence)
  • urinary retention
  • postural hypotension
  • erectile dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the leading cause of morbidity and mortality in T2DM patients

A

atherosclerotic cardiovascular disease (ASVD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

treatment for diabetes if patient also has ASCVD and/or HF

A
  • SGLT-2 (empagliflozin, canagliflozin, dapagliflozin)
  • GLP-1RAs (liraglutide, semaglutide, dulaglutide)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

cardiovascular risk factors

A

-obesity
- htn
- hld
- smoking
- ckd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

ADA BP goal in T2DM or T1DM patients

A

< 130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ADA BP goal in DM + pregnancy

A

110-135/85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ACC BP goal for patients with diabetes

A

< 130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

acceptable SBP for elderly who are at risks for falls

A

< 140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

preferred antihypertensive agents for diabetics with htn

A

ACEIs or ARBS

use at maximally tolerated doses

30
Q

other antihypertensive options

A

-HCTZ
- chlorthalidone
- amlodipine
- spironolactone (MRAs)

31
Q

statin dose for patients 20-39 yoa with no ASCVD risk considerations

A

none or moderate basked on risk factors

32
Q

monitoring for primary prevention of lipid disorders for those age 20-39 with no ASVD risks

A

annually or as needed based on adherance

33
Q

statin dose for patients 40-75 yoa with no ASCVD but ≥ 1 risk factor

A
  • moderate intensity
  • high intensity, decreased LDL by ≥ 50%, and target LDL < 70
34
Q

monitoring for primary prevention of lipid disorders for those age 40-75 with no ASVD and ≥ 1 risk factor

A

annually and as needed to monitor for adherence

35
Q

DM + ASCVD in all ages treatment

A

high intensity statin therapy and life style modifications

36
Q

target goal of LDL in DM + ASCVD patients

A
  • decrease LDL by ≥ 50%
  • goal LDL < 55
37
Q

if LDL elevated despite maximally tolerated statin dose, add

A

ezetimibe or PCSK 9 inhibitor

38
Q

ACC/AHA recommendation for primary prevention of CV events in patients with diabetes

A

moderate-high intensity statin depending upon risk factors

39
Q

ACC/AHA recommendatin for secondary prevention of CV events in patients with diabetes

A

high intensity statin and goal LDL < 70

40
Q

high intensity statin dosage

A
  • atorvastatin 40-80 mg/day
  • rosuvastatin 20-40 mg/day
41
Q

prevention of stroke in patients with DM and ASCVD

A

keep BP under control and smoking cessation

42
Q

prevention of peripheral vascular disease

A

correct risk factors, exercise, surgery (amputation, bypass)

43
Q

use of anti-platelet agents in patients with diabetes

A

use aspirin (75-162 mg/day) as secondary prevention in those with diabetes and history of CVD

44
Q

for patients with aspirin allergy, what is the recommended anti-platelet agent to use for patients with CVD and diabetes

A

clopidogrel (75 mg/day)

45
Q

when should you consider aspirin for primary prevention

A
  • men or women ≥ 50 years old with once major risk failure who are not at increased risk of bleeding
46
Q

do not use aspirin for these patient populations

A
  • low CVD risk
  • men or women < 50 yo with no major CVD risk factors
  • risk of bleeding (already has had a bleed)
47
Q

signs and symptoms of diabetes

A
  • polyuria
  • polydipsia
  • polyphagia
  • weight loss
  • fatigue
  • recurrent uti
  • ketoacidosis
  • blurred vision
48
Q

goal fasting blood glucose (ADA)

A

80-130 mg/dL

49
Q

goal fasting blood glucose (ACCE)

A

<110 mg/dL

50
Q

random or postprandial blood glucose level (measure 1.5-2 hours after eating)

A

ADA <180 mg/dL
ACCE < 140 mg/dL

51
Q

when to check blood glucose levels for patients on intensive insulin regimens

A
  • prior to meals and snacks
  • at bedtime
  • postprandially
  • suspicion of hypoglycemia and after treatment
52
Q

when to check blood glucose levels for patients on a basal insulin ± non insulin medication

A

once daily (fasting blood glucose)

53
Q

when to check blood glucose levels for patients on non-insulin regiments

A
  • as needed
  • can use in times where there is a suspicion of hypoglycemia
  • effect of diet, activity, or medication change
54
Q

CGM use

A
  • can decrease hypoglycemia and improve A1C readings
  • real time continuous glucose monitoring
55
Q

Glycosylated hemoglobin

A

non-enzymatic irreversible glycosylation of hemoglobin A circulating in blood; amount formed is related to degree of hyperglycemia

56
Q

normal A1c

A

4-6%

57
Q

ADA target A1c

A

< 7% (consider <6% in pregnant patients)

58
Q

AACE target

A

≤ 6.5%

59
Q

Diabetes Control and Complications Trial (DCCT)

A

reduction in microvascular complications, CVD outcomes, nonfatal MI, stroke or CVD death in type I patients

60
Q

UK Prospective Diabetes Study (UKPDS)

A
  • 25% reduction in microvascular complications in intensively treated type II diabets
  • every 1% drop in A1c, 18% reduction in risk of CVD events
  • after 10 years of follow up, reduction in mortality and CVD events
61
Q

Action to Control Cardiovascular Risk in Diabetes (ACCORD)

A
  • patients had known CVD or 2+ major cardiovascular risk factors
  • study terminated early due to increase risk of mortality in intensively manage patients (A1c < 6%)
  • incidence of cardiovascual events reduced in intense group, but it was not statistically significant
62
Q

Action in Diabetes and Vascular Disease - Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE)

A
  • significant reduction in microvascular outcomes without a change in macrovascular events in intensively managed patients (A1C < 6.5%)
  • no increase in cardiovascular mortality
63
Q

VA Diabetes Trials (VADT)

A
  • more CVD deaths in intensive vs standard, not SS
  • duration of diabetes < 15 years had mortality benefit
  • > 20 years of diabetes had higher mortality
64
Q

when to use < 7% A1C goal for diabetic patients

A
  • patients with short duration of diabetes
  • no h/o severe hypoglycemia
  • no CVD
  • long life expectancy
65
Q

when to use less stringent A1C goals

A
  • frequent or history of severe hypoglycemia
  • limited life expectancy
  • significant vascular disease
  • extensive co-morbid conditions
  • long-standing uncontrolled diabetes
66
Q

advantages of A1c

A
  • can be monitored without fasting
  • levels are not subject to acute changes in insulin dosing, exercise, or diet
67
Q

disadvantages of A1c

A
  • does not replace SMBG or CGM
  • it is an average
  • conditions that affect RBC turnover may impact results
68
Q

when to measure A1c

A
  • twice a year if meeting treatment goals
  • quarterly if therapy has changed or not meeting treatment goals
69
Q

post-prandial glucose impact on A1c

A

-PPG effects A1c at lower A1c ranges
- once patients achieve tighter control, assess PPG and utilize PPG medications to maintain lower A1c

70
Q

_______ blood glucose level impacts A1c more at higher A1c levels

A

fasting

PHRM 844 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions