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therapeutics 2 > exam 2: diabetes complications > Flashcards

exam 2: diabetes complications Flashcards

1
Q

microvascular diseases

A
  • diabetic kidney disease nephropathy
  • ocular complications
  • neuropathy
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2
Q

diabetic kidney disease

A
  • persistent proteinuria
  • decreased eGFR
  • increased arterial BP
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3
Q

normal UACR

A

<30mg/g

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4
Q

normal eGFR

A

> 60mL/min/1.73m2

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5
Q

microalbuminuria screening

A

UACR and eGFR

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6
Q

check UACR and eGFR annually in:

A
  • patients with T1DM for 5 or more years
  • all patients with T2DM
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7
Q

check UACR and eGFR twice anually if:

A

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

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8
Q

which class of medications is strongly recommended for non-pregnant patients with UACR >300mg/g or eGFR <60mL/min/1.73m2

A

ACEI or ARB

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9
Q

how should you optimize glucose control in patients with T2DM and kidney disease?

A

preferably use SGLTI with evidence of decreased CKD progression if
eGFR >20mL/min/1.73m2 and
UACR >200mg/g (also recommended if UACR is normal

use GLP-1RA with proven CVD benefit if SGLT2I is not tolerated or is contraindicated

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10
Q

what is the goal BP for patients with diabetic kidney disease?

A

<130/80
*do not discontinue ACEI or ARB therapy for small increases (<30%) in SCr

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11
Q

what class of medications should you use for CV risk reduction in people with T2DM and CKD?

A

SGLT2I if eGFR >20mL/min/1.73m2

GLP-1RA

nonsteroidal mineralocorticoid receptor antagonist (finerenone) if eGFR >25mL/min/1.73m2

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12
Q

if patients have UACR >300mg/g, goal is a ______ reduction

A

30%

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13
Q

limit protein intake to ______for non-dialysis patients with T2DM and CKD

A

0.8g/kg/day

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14
Q

ocular complications

A
  • blurred vision
  • cataracts
  • glaucoma
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15
Q

what factors should you optimize for ocular complications in patients with diabetes?

A
  • glycemic control
  • blood pressure
  • lipid management
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16
Q

when should patients with T1DM have an initial eye exam?

A

within 5 years after onset of diabetes

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17
Q

when should patients with T2DM have an initial eye exam?

A

at time of diabetes diagnosis

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18
Q

after initial screening, if there is no evidence of retinopathy for one or more annual exams and glycemia is controlled, how often should eye exams be conducted?

A

every 1-2 years

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19
Q

if retinopathy is present, how often should you assess?

A

at least annually

20
Q

what are the treatment options for ocular complications in patients with diabetes?

A
  • photocoagulation therapy
  • anti-vascular endothelial growth factors (aflibercept, ranibizumab)
21
Q

what are the different types of neuropathy that can occur from microvascular disease?

A
  • peripheral neuropathy
  • gastrointestinal neuropathies
  • urinary retention
  • postural hypotension (orthostasis)
  • erectile dysfunction
22
Q

when should peripheral neuropathy be assessed?

A
  • at time of diagnosis for T2DM
  • within 5 years of diagnosis for T1DM

*annual monofilament testing

23
Q

what medications are recommended as initial therapy for peripheral neuropathy?

A
  • pregabalin
  • duloxetine
  • gabapentin
24
Q

what are other medications for management of peripheral neuropathy?

A
  • tricyclic antidepressants
  • venlafaxine
  • carbamazepine
  • tramadol
  • lamotrigine
  • lacosamide
  • capsaicin
  • tapentadol (use as last resort)
25
Q

what are the types of gastrointestinal neuropathies?

A
  • gastroparesis
  • diarrhea/constipation
  • fecal incontinence
26
Q

what is postural hypotension?

A

type of cardiovascular autonomic neuropathy
- >20mmHg drop in SBP or >10mmHg drop in DBP upon standing

27
Q

macrovascular diseases

A
  • CV disease (ASCVD, HF)
  • stroke
  • peripheral vascular disease
28
Q

what class of medications should you use to treat patients with diabetes and ASCVD +/- HF?

A

SGLT2I
- empagliflozin, canagliflozin, dapagliflozin

GLP-1RA
- liraglutide, semaglutide, dulaglutide

29
Q

what CV risk factors should be assessed for patients with diabetes?

A
  • obesity
  • HTN
  • HLD
  • smoking
  • CKD

*assess anually

30
Q

what is the BP goal for patients with T1DM or T2DM?

A

<130/80

31
Q

what is the BP goal for patients with diabetes and are pregnant?

A

110-135/85

32
Q

what are the preferred antihypertensive agents for patients with diabetes and CV disease?

A

ACEI or ARB
- use at maximally tolerated doses, especially for patients with UACR >300mg/g

33
Q

what are other antihypertensive options if preferred options are not tolerated?

A
  • hydrochlorothiazide
  • chlorthalidone
  • amlodipine
  • MRAs
34
Q

what is the recommended statin usage for primary prevention if age 20-39 and no ASCVD risk?

A
  • none-moderate based on risk factors
  • monitor annually or as needed based on adherence
35
Q

what is the recommended statin usage for primary prevention if age 40-75 and no ASCVD?

A
  • moderate intensity
  • monitor annually and as needed for adherence
36
Q

what is the recommended statin usage for primary prevention if age 40-75 and > 1 risk factor?

A
  • high intensity
  • decrease LDL by >50%
  • target LDL <70
  • monitor annually and as needed for adherence
37
Q

what is the recommended statin usage for primary prevention in age >75 and on a statin?

A
  • continue statin
  • monitor annually or as needed
38
Q

what is the recommended statin usage for primary prevention in age >75 and not on a statin?

A
  • moderate after discussion
  • monitor annually or as needed
39
Q

what is the recommended statin usage for secondary prevention in patients with DM + ASCVD?

A

high intensity statin + lifestyle modification

  • target decrease LDL by >50% and goal LDL <55
40
Q

what is the recommended treatment for secondary prevention in patients with DM + ASCVD and LDL is elevated despite maximally tolerated statin dose?

A

add ezetimibe or PCSK9 inhibitor

41
Q

what is the recommended treatment for secondary prevention in patients with DM + ASCVD and statin therapy is not tolerated?

A
  • PCSK9 inhibitor with monoclonal antibody treatment
  • bempedoic acid therapy
  • PCSK9 inhibitor with inclisiran siRNA
42
Q

high intensity statin

A
  • atorvastatin 40-80mg/day
  • rosuvastatin 20-40mg/day
43
Q

moderate intensity statin

A
  • atorvastatin 10-20mg/day
  • rosuvastatin 5-10mg/day
  • simvastatin 20-40mg/day
  • pravastatin 40-80mg/day
  • lovastatin 40mg/day
  • fluvastatin XL 80mg/day
  • pitavastatin 1-4mg/day
44
Q

how should antiplatelet agents be used for secondary prevention in patients with diabetes and CV disease?

A

aspirin 75-162mg/day

if aspirin allergy, use clopidogrel 75mg/day

45
Q

when should combination therapy with aspirin + low-dose rivaroxaban be considered for secondary prevention in patients with diabetes?

A

for individuals with stable coronary and/or peripheral artery disease and low bleeding risk to prevent major adverse limb and cardiovascular events

46
Q

when should aspirin be considered for primary prevention in patients with diabetes?

A
  • age >50 with one major risk factor who are not at an increased risk of bleeding
  • age >70; risk may outweigh benefit
47
Q

when should aspirin not be used for primary prevention in patients with diabetes?

A

low CVD risk
- age <50 with no major CVD risk factors
- risk of bleeding offsets benefits

therapeutics 2 (8 decks)

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