Endo Flashcards
Renal complication of DM that have propensity for hyperkalemia and acidemia. Exacerbated by ACEI, ARBS and Aldo-antagonists
Type IV RTA
Hyporeninemic Hypoaldosteronemic
2 factors for diabetic kidney disease
Albuminuria + decreased GFR <60ml/min
In DM is associated with increased risk of cardiovascular disease
Albuminuria
Pathogenesis related to chronic hyperglycemia
Angiotensin II
GF
ENDOTHELIN
AGEs
Spot urinary albumin to CREA ratio
Albuminuria
Interventions effective in slowing progression from micro albuminuria to macro albuminuria
- Improve glycemic control
- Strict Bp
- Administration of ACE-I or ARBs
BP goal in patients with DM nephropathy with risk of CVD and CKD
<130/80
BP goal in patients with DM nephropathy with proteinuria
125/75
Protein intake in Diabetic kidney disease
0.8 mg/kg/day
Referral for transplant evaluation once GFR is
<20ml/min
Major risk factors for diabetic neuropathy
Increased BMI
Smoking
Most common form of diabetic neuropathy
Distal symmetric polyneuropathy
DSPN
Major risk factors for foot ulceration sand falls
LOPS Loss of protective sensation
DSPN Distal symmetric polyneuropathy
Most prominent Gastric complication in CM by parasympathetic dysfunction
Delayed gastric emptying (gastroparesis)
Altered small and large bowel motility
( constipation and diarrhea)
DM RELATED GI autonomic neuropathy
Nocturnal diarrhea alternating with constipation
If with known CHD with DM
Ace-I or ARBS, statin and Aspirin
DM AND POST MI
Beta blocker
Dm and CHF
Avoid THIAZOLDINEDIONES (pioglitazone) due to edema Use metformin instead if with good renal fx
What drug is recommended for primary prevention in DM patients with increased CV risk (>50 years old, at least 1 risk factor -HTN, DYSLIPIDEMIA, smoking, albuminuria and family history)
Aspirin
Use of moderate intense statin
Age 40-75 without additional risk,
<40 y/o but with additional risk,
All with DM + Age >75years oks
Intensity of statin if DM + atherosclerotic CVD disease
High intensity statin therapy
Combo statin + fenofibrate is not recommended except if
- With recent ACS
2. If LDL remains >70mg/dL in an individual with diabetes and CVD on a statin
If LDL remains >70mg/dL in an individual with diabetes and CVD on a statin
Add ezetimibe
Bp goal for most patients with DM and with hypertension
<140/90
Bp goal of YOUNGER DM px or with increased cardiovascular risk
<130/80
Dm foot ulceration is most commonly at the
PLANTAR FOOT SURFACE
Most common pathogen in infected ulcer
AEROBIC GRAM POSITIVE COCCI
Staph
MRSA
Group A and B STREP
Most specific modality for infected ulcer
MRI
Interventions with demonstrated efficacy in diabetic foot wounds
- Off loading
- Debridement
- Wound dressing
- Appropriate use of antibiotics
- REVASCULARIZATION
- Limited amputation
Antibiotics Severe infection in infected ulcer
Vancomycin + BLAC INHIBITOR
OR
VANCOMYCIN + QUINOLONE + metronidazole
Rare infection seen exclusively in DM
- RHINOCEREBRAL MUCORMYCOSIS
- EMPHYSEMATOUS INFECTIONS OF THE GALL BLADDER
- “Malignant” or invasive OTITIS MEDIA
sec to pseudomonas aeruginosa
SERM approved for Osteoporosis
RALOXIFENE
SERM USED IN BREAST CA AND FOR OSTEOPOROSIS
Tamoxifen
SERM combined with conjugated estrogen
BAZEDOXIFENE
Drug for osteoporosis that suppresses osteoclasts activity by direct action on osteoclasts calcitonin receptor
Calcitonin
Strongest antiresorptive that Benefit among postmenopausal women with osteoporosis to reduce fracture over 3 years
DENOSUMAB
Most common cause of pituitary hormone hyposecretion and hypersecretion syndromes in adults
PITUITARY ADENOMA
Feature of type A insulin resistant syndrome
Affects young women
Severe hyperinsulinism
Features of hyperandrogenism
Classic triad of pheochromocytoma
Profuse sweating
Headache
Palpitation
+ hypertension = diagnosis
Dominant sign of pheochromocytoma
Hypertension
Disorders of Male reproduction that have hypogonadotrophic hypogonadism
Kallman’s syndrome
Adrenal congenital hypoplasia ACH
Gnth receptor mutation
Most common location of primary hyperparathyroidism
Inferior parathyroid glands
Increase giant multinucleated osteoclasts in scalloped areas of the surface of the bone (HOWSHIP LACUNAE) and a replacement of the normal cellular and marrow elements by fibrous tissue
Sec to primary hyperparathyroidism
OSTEITIS FIBROCA CYSTICA
Definitive therapy for primary hyperparathyroidism
Surgical excision
Bone disease seen in patients with secondary hyperparathyroidism and CKD
Renal osteodystrophy
Glucocorticoids May be of benefit to the ff for controlling hypercalcemia
Vitamin D and A intoxication
Hypercalcemia of Granulomatous disease
Most common cause of primary adrenal insufficiency
Autoimmune adrenalitis
