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Family med practice essentials > family med practice essentials > Flashcards

family med practice essentials Flashcards

1
Q

prostate cancer screening

A

aafp and uspstf recommends that digital rectum exam and PSA screening be individual decision; they recommend against screening in pts >70

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2
Q

criteria for diabetes

A

6.5 A1c; 126 fasting glucose, 200 random glucose plus symptoms of hyperglycemia (polydipsia, polyuria, weight loss), OR 200glucose 2h after oral glucose tolerance test X2

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3
Q

criteria for prediabetes

A

5.7-6.4 A1c; fasting glucose 100-125; 2 h prandial glc 140-199

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4
Q

prevention of diabetes

A
  • loss of 7-10% of body weight
  • 150min activity/week
  • technology assisted interventions
  • metformin for prediabetes especially if BMI>35, less than 60, and if woman with hx gestational diabetes
  • be careful bc longterm metformin use can lead to B12 deficiency! monitor B12 esp if anemia or peripheral neuropathy
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5
Q

screening for CVD recommended in pts with prediabetes

A

screening for CVD recommended in pts with prediabetes

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6
Q

people 2-64 with diabetes should receive which vaccines?

A

flu,
PPSV23 pneumococcal (higher risk of bacterial pneumonia and higher mortality rate!)
people with diabetes 18-59 should also get Hep B if they havent already gotten it

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7
Q

comprehensive physical exam for diabetics

A

height, weight BMI
BP, orthostatics if indicated
fundoscopic
thyroid palpation
skin (look for acanthosis nigricans, insulin injection site , lipodystrophy)
comprehensive foot exam : look for callus, skin integrity, foot deformity, ulcer, toenails, pedal pulses– refer for ABI if diminished, temp/vibration or pinprick sensation; 10g monofilament exam

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8
Q

what labs do you get for diabetics?

A 
A1c
lipid panel (LDL, HDL, triglycerides, total cholesterol)
liver function tests
spot urinary creatinine to alubumin ratio (detect small amount of protein in urine --> kidney damage)
serum Cr, estimated GFR
TSH if DM1
B12 if on metformin
[K+] if on ARBs, ACEi, diuretics
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9
Q

how often should you test A1c in DM pts who are meeting treatment goals and have stable glycemic control?

A

2x/year

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10
Q

how often should you test A1c in DM pt who have unstable glycemic control or who’s tx has changed

A

4x/year
remember A1c is not a perfect measure of glycemic control, isn’t going to show big deviations so you might want to monitor in other ways

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11
Q

A1c goals for nonpregnant adults

A

usually <7%
you can shoot for lower if you want and not big risk of hypoglycemia
if history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin, then it might be appropriate to shoot for <8%

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12
Q

A1c goals for ppl with shortened life expectancy, hx of severe hypoglycemia, advanced vascular complications, extensive comorbid conditions, longstandind DM where its been really hard to reach goal

A

<8%

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13
Q

hypoglycemia 1 range

A

<70

>54

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14
Q

hypoglycemia 2

A

<54

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15
Q

hypoglycemia 3

A

altered mental status

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16
Q

sx of hypoglycemia

A

Symptoms of hypoglycemia include, but are not limited to, shakiness, irritability, confusion, tachycardia, and hunger. Hypoglycemia may be inconvenient or frightening to patients with diabetes. Level 3 hypoglycemia may be recognized or unrecognized and can progress to loss of consciousness, seizure, coma, or death. It is reversed by administration of rapid-acting glucose or glucagon.
cognitive damage
The use of glucagon is indicated for the treatment of hypoglycemia in people unable or unwilling to consume carbohydrates by mouth. Those in close contact with, or having custodial care of, people with hypoglycemia-prone diabetes (family members, roommates, school personnel, childcare providers, correctional institution staff, or coworkers) should be instructed on the use of glucagon, including where the glucagon product is kept and when and how to administer. An individual does not need to be a health care professional to safely administer glucagon. In addition to traditional glucagon injection powder that requires reconstitution prior to injection, intranasal glucagon and glucagon solution for subcutaneous injection recently received U.S. Food and Drug Administration approval. Care should be taken to ensure that glucagon products are not expired.

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17
Q

hypoglycemia unawareness

A

deficient counterregulatory hormone release, especially in older adults, and a diminished autonomic response
you can break the cycle by loosening glycemic control for a few weeks

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18
Q

recommended weightloss goal for obese DM pts

A

5+% of body weight (and maintain it)
ADA recommends high intensity interventions (≥16 sessions in 6 months) and focus on dietary changes, physical activity, and behavioral strategies to achieve a 500–750 kcal/day energy deficit
For patients who achieve short-term weight-loss goals, long-term (≥1 year) weight maintenance programs are recommended when available. Such programs should at minimum provide monthly contact, as well as encourage ongoing monitoring of body weight (weekly or more frequently) and other self-monitoring strategies, including high levels of physical activity (200–300 min/week)

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19
Q

phentermine

A 
short term (less than 12 wks) weight loss
increases BP
don't use with MAOIs, (linezolid abx has maoi activity)
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20
Q

Orlistat

A

lipase inhibitor for long term weight loss
can cause malabsorption of fat soluble vitamins. in rare cases can cause liver damage. Side effects include kidney and gall stones, GI distress, headache, back pain

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21
Q

Lorcaserin

A

for longterm weight loss
Selective serotonin receptor agonist
increases BP! monitor for suicidal ideation , depression, liver and renal failure; theoretically could cause serotonergic syndrome like or neuroleptic malignant like issues if combined with other sertonergic/antidopaminergic agents

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22
Q

phertermine/topiramate combo

A

for longterm weight loss

teratogen!! increased BP! cognitive impairment, insomnia, acute angle closure glaucoma

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23
Q

naltrexone/bupropion

A

opioid antagonist/antidepressant combo for long term weight loss
BLACK BOX: SUICIDAL IDEATION
not for seizure pts!! not with opioid therapy; acute angle closure glaucoma

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24
Q

liraglutide

A

glucagon like peptide 1 receptor agonist for longterm weight loss
lots of GI side effects!
acute pancreatitis?, potential kidney injury
BLACK BOX: c cell thyroid cancer

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25
Q

preferred initial pharmacologic agent for the treatment of type 2 diabetes.

A

metformin
monitor B12
renal clearance; GFR>30
metformin has weight loss and cvd benefits

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26
Q

GFR for metformin

A

30

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27
Q

if A1c > 1.5-2% above goal, you start initial treatment on metformin combined with ______ according to VERIFY trial

A

vildagliptin

DPP-4 inhibitor

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28
Q

what should you add to metformin when you need to step up for a DM pt with ASCVD, ASCVD risk?

A 
liraglutide
semaglutide
albigultide
dulaglutide
(all glucagon like peptide 1 receptor agonists)
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29
Q

what should you add to metformin when you need to step up for a DM pt with HF or kidney disease?

A

canagliflozin
dapagliflozin
empagliflozin
ertugliflozin

(risk of UTIs)

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30
Q

what should you add to metformin when you need to minimize weight gain or promote weight loss?

A

GLP1ras: dulaglutide, liraglutide, exanatide, semaglutide, lixisenitide

SGLT2I (sodium glucose cotransporter 2 inhibitor)
dapagliflozin

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31
Q

JNC 8 cutoff for HTN tx

A

140/80

or 150/90 if >60 yo

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32
Q

initial tx for HTN

A

ARB, ACEi, thiazide or calcium channel blocker

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33
Q

initial tx for HTN in black pts

A

thiazide or calcium channel blocker

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34
Q

name 3 ca channel blockers

A

nifidepine
amlodipine
diltiazam

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35
Q

name side effects of calcium channel side effects

A

flushing, peripheral edema, reflex tachycardia, headaches, dizziness, worsened angina, gingival hyperplasia

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36
Q

name three thiazides

A

chlorthalidone
hydrochlorothalizide
metolazone

37
Q

name side effects of thiazides

A

hypokalemia
increased calcemia
hyperglycemia

38
Q

why do thiazides cause hypokalemia

A

thiazides block NaCl transporter in DCT. that increases the sodium concentration in the lumen at the collecting duct, which gives the Na/K exchanger more work – so it takes up more Na and pumps out more K–> potassium loss. Additionally, the drop in BP caused by thiazides triggers the RAS system, so aldosterone further stimulates the Na/K exchanger in collecting duct…even more potassium loss even though overall the BP and Na is dropping

39
Q

hydrochlorothalizide

A

thiazide diuretic

40
Q

side effects of acei

A 
hyperkalemia (na/k exchanger in collecting duct isnt stimulated)
dry cough (increased bradykinin)
angioedema
41
Q

name three ACEi

A

enalapril
lisinopril
benazepril

42
Q

side effects of lisinopril

A

hyperkalemia
angioedema
dry cough

43
Q

name three ARBs

A

irbesartan
losartan
valsartan

44
Q

HTN control if hx MI

A

beta blocker + ACEi or ARB + aldo antag (spironolactorne or eplerenone)

45
Q

tx for HTN in pregnancy

A

nifedipine, methyldopa, labetelol

46
Q

tx for HTN if hx of stroke

A

ACEi + thiazide

47
Q

common causes of COPD exacerbation

A

viral and bacterial infection (get vaccines!)

air pollution

48
Q

Add what drug for for persistently symptomatic, NYHA class III-IV CHF, self-identified black patients?

A

hydralozine plus isosorbide dinitrate
addition of isosorbide dinitrate plus hydralazine (BiDil) to standard heart failure therapy reduces mortality in black patients with advanced heart failure

49
Q

what drugs to manage HF with reduced EF?

A

ACEi or ARB
plus
Beta blocker (carvedilol etc)
plus
Loop diuretic (furesemide, torsemide, etc.)
consider: dapagliflozin regardless of DM status
spironolactone, aldo antag if symptomatic and Cr isn’t crazy off the charts

50
Q

dapagliflozin

A

SGLT2i
reduces weight, decreases BP, rare hypoglycemia
**UTIs, pyelonephritis!! other genitourinary infections
increased LDL cholesterol
expensive

51
Q

canagliflozin

A 
SGLT2i
reduces weight, reduces BP, hypoglycemia is rare
**GENITOURINARY INFECTIONS
amputations and fractures!!
increased LDL cholesterol
expensive
52
Q

exenatide

A 
GLP1 receptor agonist
lowers weight
lowers CVD events and mortality
expensive
Ccell thyroid tumors! 
GI side effects, sometimes even acute pancreatitis
53
Q

liraglutide

A 
GLP1 receptor agonist
lowers weight
lowers CVD events and mortality
expensive
Ccell thyroid tumors! 
GI side effects, sometimes even acute pancreatitis
54
Q

semaglutide

A 
GLP1 receptor agonist
lowers weight
lowers CVD events and mortality
expensive
Ccell thyroid tumors! 
GI side effects, sometimes even acute pancreatitis
55
Q

ADA recommendations for diabetes screening

A

everyone over 45 should be screened every 3 years

56
Q

HIV screening

A

15-65 yo!
pregnant ppl
high risk

57
Q

uspstf aspirin recs

A

The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.

58
Q

triglyceride goal

A

<150

59
Q

LDL goal

A

<100

60
Q

total cholesterol goal

A

<200

61
Q

ezetimibe

A

add on to statin for lowering LDL in high risk pt, well tolerated, IMPROVE-IT study

62
Q

ear infection abx

A

augmentin (amoxicillin-clavulanate) 10 days

63
Q

VINDICATE differential dx mneumonic

A 
Vascular
Infectious/inflammatory
Neoplasm
Degenerative
Intoxication/iatrogenic
Congenital
Autoimmune/allergy
Trauma
Endocrine/metabolic
64
Q

Name 7 triggers of PVCs

A

premature ventricular contractions (no p wave, wide QRS, compensatory pause) triggered by

  • HTN
  • ischemia/MI
  • cardiomyopathy, heart failure
  • anxiety, catecholamines
  • drugs like cocaine, other stimulants
  • hyperthyroidism
  • low k, low mag, high Ca, other electrolyte probs
65
Q

PVCs increase overall mortality. Treating them ______ mortality in most cases. PVCs ______ mortality in HF. PVCs _____ prognosis in MI.

A

PVCs increase overall mortality. Treating them does not improve mortality in most cases. PVCs dont worsen mortality in HF. PVCs do worsen prognosis in MI.

66
Q

How would you work somebody up for PVCs?

A

Echo, Halter, Stress test if they are stable, BMP, troponin trend, TSH, Magnesium, calcium levels

67
Q

How do you treat PVCs

A
  1. tx underlying cause
  2. beta blocker (carvedilol) or calcium channel blocker (diltiazem)
  3. antiarrhythmic
  4. catheter ablation
68
Q

Afib findings on ECG

A

no p wave, saw tooth, rapid & irregular rate “irregularly irregular”, narrow QRS, ventricular rate 90-170

69
Q

Name 9 causes of Afib

A
  • age
  • alcohol (“holiday heart syndrome”)
  • MI, coronary artery disease
  • lung problems (PE, COPD)
  • stimulants
  • HTN
  • hypoxia
  • structural heart disease
  • hyperthyroidism
70
Q

what are complications of afib

A 
stroke! 
heart failure!
myocardial infarction!
palpitations!
reduced EF!
71
Q

when would you hospitalize somebody with afib

A

elderly, hemodynamically unstable, you’re worried they have acute coronary syndrome, you need to get the underlying condition under control, you can’t get their rate under control

72
Q

Afib workup

A

ECG, look for underlying cause (look for ischemia, electrolytes, thyroid, etc). Echo: look for LVH, valves, atria size. Always get CBC.

73
Q

Afib treatment

A
  1. rate or rhythm control. AFFIRM trial showed that either is fine it’s just rate control is easier
  2. ANTICOAGULATION you fool! Use CHA2DS2VAS. Everyone with score greater than 2 gets anticoagulation and if you have a score of 1 you might get it too. If you have valvular disease, you must get warfarin.
74
Q

What do you call:

fast rhythm originating in atria, rate 120-220 with narrow qrs?

A

supraventricular tachycardia (SVT)

75
Q

what are the effects of SVT?

A

syncope, heart failure, ischemia, really gotta watch if someone is hemodynamically unstable

76
Q

how do you treat SVT?

A

Short term: Valsalva manuever
IV adenosine rapid push (inpatient or ED)
IV nondihydropyridine calcium channel blocker (verapamil, diltiazem)
IV beta blocker (atenolol, propranolol, metoprolol)

Longer term: valsalva, beta blocker, nondihydropyradine, other anti arrhythmic, catheter ablation

77
Q

BMI formula (standard)

A

(weight (lb) * 703 )/ height (in)^2

78
Q

BMI (metric)

A

weight(kg)/height (m)^2

79
Q

screening tests for cardiovascular disease

A

bp and lipid panel

80
Q

lipid screening

A

men over 35, women over 45

anyone over 20 with increased risk

81
Q

abdominal aortic aneurysm screening

A

men 65-75 if ever smoked 1x ultrasound

82
Q

if using fecal occult blood testing to screen for colon cancer how often

A

every year

83
Q

if using flexible sigmoidoscopy to screen for colon cancer how often

A

3-5 yrs

84
Q

who should be screened for diabetes?

A

all adults 40-70 yo as part of cardiovascular risk assessment

85
Q

smokers, alcoholics, ppl with chronic cvd, pulmonary disease, renal or hepatic disease, diabetes, immunodieficency, asplenia should get which vaccine….

A

pneumococcal

86
Q

which vaccine should be given to health care workers, those exposed to blood products dialysis patients iv drugs users, ppl with multi sex partners, or recent STDs, msm

A

Hep B

87
Q

what vacine should be given to ppl who use clotting factors or msm?

A

Hep A

88
Q

how should you test for renal artery stenosis

A 
abdominal ultrasound
(think this if hx atherosclerosis, + htn +hypokalemia/hypernatremia , increased creation + increased BUN/Creatinine ratio

Family med practice essentials (1 decks)

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