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Therapeutics P2 > Exam 2 Lecture 4 > Flashcards

Exam 2 Lecture 4 Flashcards

1
Q

What is the major cause of death in T-1 DM pateints

A

Diabetic kidney disease (nephropathy)

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2
Q

What are the 3 microvascular complications in diabetics

A

Diabetic kidney disease
Eye disease
neuropathy
(also urinary retention, diziness, erectile dysfunction)

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3
Q

Symptoms for diabetic kidney disease

A

Persistent proteinuria, decreased GFR, Increased BP

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3
Q

How to screen for diabetic kidney disease

A

screen for microalbuminuria
(-UACR and eGFR)
check annually for T1 DM pts

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4
Q

goal UACR

A

less than 30

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5
Q

When to screen twice for nephropathy in diabetes pts

A

UACR>300
eGFR<60

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6
Q

What drugs do we use when UACR and eGFR levels are bad

A

ACE-I and ARB (when UACR>300 or eGFR<60)

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7
Q

other than ACE-I and ARB, how do we reduce proteinuria

A

Optimize blood sugar
reduce Blood pressure

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8
Q

What are drugs other than ACE-I and ARBs that help with proteinuria

A

SGLT-2 inhibitors and GLP-1

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9
Q

why does high BP affect proteinuria

A

Increased BP squeezes the small arteries going to kidney which lower perfusion, causing damage

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10
Q

do not dx ACE-I or ARB for less than _______ increase in Scr

A

30%

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11
Q

protein intake should be limited to______ in nephropathy pts

A

0.8 g/kg/day

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12
Q

What is the most common ocular disorder in diabetes pts

A

Retinopathy
(others include blurred vision, cataracts, glaucoma)H

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13
Q

How to slow down eye disease in DM pts

A

Blood sugar and BP under control
lipid management

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14
Q

What are the different types of neuropathies in DM pts

A

Peripheral neuropathy
Gastrointestinal neuropathy

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15
Q

Drugs to treat peripheral neuropathy

A

Pregabalin, duloxetine, gabapentin

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16
Q

What are sx of gastrointestinal neuropathies

A

Gastroparesis- slow down of gastric process
diarrhea, constipation

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17
Q

What is ASCVD?

A

atherosclerotic cardiovascular disease (ASCVD)

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18
Q

Leading cause of death i n T2 diabetes

A

ASCVD

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19
Q

What disease states comprise ASCVD

A

coronary heart disease, cerebrovascular disease, peripheral arterial disease

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20
Q

T/F HF hospitalizations triple in diabetics

A

False, doubles

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21
Q

What drugs to use in pts with ASCVD and/or HF

A

SGLT-2 inhibitors
GLP-1

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22
Q

Name some SGLT-2 inhibitors

A

Empagliflozin, canagliflozin, dapagliflozin

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23
Q

Name some GLP-1 RAs

A

Liraglutide, semaglutide, dulaglutide

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24
Q

What are CV risk factors

A

Obesity, HTN, HLD, smoking and CKD

25
Q

What does metabolic syndrome comprise of

A

obesity, HTN, HLD

26
Q

BP goal for T1 and 2 DM pts

A

less than 130/80
(110-135/85 for pregnant women)
<140 acceptable for elderly

27
Q

treatment option for HTN in T2 DM

A

ACE-1 or ARBs

28
Q

Can we combine ACE-1s and ARBs? why or why not?

A

Never used in combination due to risk of hyperkalemia.

29
Q

What does for ACE-I and ARBs

A

Max tolerated dose (use other drugs in conjunction if it is not enough)

30
Q

What other drugs can be used in conjunction with ACE-Is and ARBs

A

HCTZ, amlodipine, spironolactone

31
Q

primary vs secondary prevention

A

Primary- have not had an event yet
secondary- they have had a cardiovascular event before

32
Q

primary prevention in 20-39 year olds

A

Do not give them a statin unless that have risk factors (LDL>100, HTN, smoker, CKD)

33
Q

primary prevention in 40-75 year olds

A

use moderate intensity statins. If they have atleast one risk factor (LDL>100, HTN, smoker or CKD)

34
Q

Target LDL for primary prevention

A

Less than 70
(target-reduce LDL by 50%)

35
Q

secondary prevention strategies

A

High intensity statin + LSM

36
Q

What is the goal LDL in secindary orevention

A

<55,

target- reduce by 50%

37
Q

What do we do if LDL is still high after using high intensity statins

A

Add ezetimebe or PC5K9 inhibitors

38
Q

Name high intensity statins and doses

A

Atorvastatin (40-80)
Rosuvastatin (20-40)

39
Q

Name moderate intensity statins

A

Atorvastatin (10-20)
Rosuvastatin (5-10)
Simvastatin (20-40)

40
Q

Can diabetes affect teeth?

A

Yes, called periodontal disease

41
Q

What is an antiplatelet agent

A

Aspirin

42
Q

Use of aspirin

A

Can be used in primary and secondary prevention in diabetes and CVD pts

43
Q

What to use if aspirin allergy

A

clopidogrel

44
Q

can we use clopidogrel and aspirin together?

A

Yes, for upto a year

45
Q

When to consider aspirin for primary prevention

A

> 50 yo patient with major risk factors (CHF, ASCVD, HTN, HLD, smoking or CKD)

46
Q

When can we never use aspirin

A

Do not use if at risk of bleeding. So do not use aspirin for low CVD pts

47
Q

bedtime glucose goal

A

90-150

48
Q

When to check blood glucose when taking intensive insulin

A

prior to meals and at bedtime
before snacks/activity
suspicion of hypoglycemia

49
Q

When to check BG when taking basal insulin

A

once daily

49
Q

Goals for glucose monitoring for CGM

A

(continuous glucose monitoring)
TIR (time in range)- >70%
TBR (below)- <5%
TAR (above) <25%

time active>70%

50
Q

glucose monitoring goals for high risk hypoglycemic pts CGM

A

TIR>50%
TAR>49%
TBR<1%

51
Q

normal A1c

A

4-6%

52
Q

diabetic A1c target

A

7%

53
Q

What does A1c reflect

A

avg blood glucose over 8-12 weeks

54
Q

For every 1% reduction in A1c,

A

18% reduction in CVD risk

55
Q

consider aggressive therapy for high A1c in

A

newly diagnosed patients with no history of hypoglycemia

56
Q

Advantages of A1C

A

can be measured without fasting (not subject to acute changes)

57
Q

Disadvantages of A1c

A

Does not replace SMBG or CGM
conditions that affect the blood cell turnover impacts A1c

58
Q

IF A1c is high, which one do we fix first?

A

fasting blood glucose

59
Q

If A1C is <7.3 what do we fix

A

Post prandial (post meal) glucose

Therapeutics P2 (41 decks)

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