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Endo II Exam 2 > Diabetic Cases Pales > Flashcards

Diabetic Cases Pales Flashcards

1
Q

glyburide

A

100% excreted by kidney

second gen sulfonylurea

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2
Q

side effect of sulfonylurea

A

hypoglycemia

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3
Q

meglitinides

A

short duration of action

close ATP dependent K channels of beta cells

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4
Q

incretin

A

injectable - GLP1
oral - DPP-IV inhibitor

no hypoglycemia

give after meals

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5
Q

metformin

A

biguanide

decreased glucose production by liver**

increased insulin receptor sensitivity

weight loss and no hypoglycemia**

lowers LDL and triglycerides

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6
Q

adverse of metformin

A

lactic acidosis

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7
Q

CI biguanides

A

renal and liver insufficiency

chronic hypoxia

past hx lactic acidosis

alcoholism

withold if pt getting iodinated contrast

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8
Q

significant weight gain

A

TZD

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9
Q

CHF

A

no TZD

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10
Q

SGLT-2 inhibitor

A

block reuptake of glucose in renal tubules

promote loss of glucose in urine

no hypoglycemia

new drug

yeast infection, dehydration, UTIs

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11
Q

morning hyperglycemia

A

either dawn phenomenon or samojyi effect

dawn - anti-insulin hormone in AM - tx increase meds

samojyi - night time low glucose - body tries to increase - tx decrease meds

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12
Q

50yo F, allergies and sleepy, N/V anorexia, sleeping and week, given prednisone for allergies

hypotension
HR elevated
T high
resp high
lethargic

feet cold and mottled

BUN/Cr elevated
glucose very high
lactic acid 5.2
ketone negative
pH 7.3
A

hyperosmolar hyperglycemic non-ketotic coma

renal failure

dehydrated

more likely DM II

tx - fluids

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13
Q

hyperosmolar hyperglycemia non-ketotic coma

A

more in DM II

tx fluids

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14
Q

DKA

A

more in DM I

tx insulin

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15
Q

prednisone

A

increases glucose

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16
Q

ACE inhibitor

A

dilates efferent arterioles

drops pressure in glomeruli - decreases filtration

17
Q

12yo M to ER with SOB and mental status change

increasing fatigue
weight loss
thirsty a lot
urinates at night
breathing deep and fast
thrush in mouth

glucose high
pH 7.05
high anion gap
BUN/Cr elevated

A

diabetic ketoacidosis

18
Q

path of DKA

A 
insulin deficienct
more lipolysis
more fatty acid to liver
increased ketogenesis
acidosis
19
Q

potassium elevated in DKA**

A

acidosis - shifts K out of cell

peeing out lots of K
body K low
serum K high

20
Q

tx of DKA

A

IV insulin

look at the anion gap
-this tells when you can switch to subQ insulin

21
Q

DKA age

A

younger

22
Q

NKHO age

A

older

23
Q

DKA mental status

A

alert

24
Q

NKHO coma

A

comatose confused

25
Q

renal failure

A

more common in NKHO

26
Q

metabolic problem

A

DKA acidosis

NKHO dehydration

27
Q

59yo M diabetic
mild burning of feet at times
has not taken glipizide
smokes 1/2ppd

glucose 185
LDL high
left vent hypertrophy
HbA1c 8.3%

done wrong by previous physician?

A

no metformin (does not cause hypoglycemia)

no follow up

28
Q

first thing to do with new diabetic patient

A 
HbA1c
physical exam
get PMH
lipid panel
assess knowledge of disease
give glucometer
ask to check blood sugar 4x/daily
29
Q

HbA1c

A

marker for control of diabetes

30
Q

test for peripheral neuropathy

A

monofilament test

31
Q

diabetes and HTN

A

atherosclerosis and renal failure

secondary HTN

32
Q

initial diabetes tx

A

metformin and diet/exercise mod

also statin if high lipids

also ACE inhibitor - DOC for diabetes and HTN

33
Q

ACE inhibitor side effect

A

cough

34
Q

when to check HbA1c

A

3 month later

35
Q

52yo F with DM II

worried about sugar too low - school bus driver

loses insurance - doesn’t come back for few years

very high glucose - 510

blurry vision, calf pain, urinary frequency, dizzy when stand up

A

blurry vision - reversible lens swelling

meds to start - insulin** bc very high glucose

36
Q

meds to avoid hypoglycemia

A 
metformin
TZD
DDP-IV
DLP-1 analog
alpha-1 glycosidase
37
Q

LDL goal for diabetic

A

70

if not - give statin

38
Q

what to check with peripheral vascular disease

A

look for atherosclerosis

do stress test

39
Q

complications improve with glycemic control

A

microvascular problems

Endo II Exam 2 (16 decks)

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