GI Flashcards
Where are the most common ulcers found?
duodenum
What type of ulcers have a higher risk of malignancy?
Gastric ulcers
What is the most common cause of peptic ulcer disease
H. pylori
What OTC meds commonly cause PUD
NSAIDS
Sulfonylureas such as Glipizide cause weight …
GAIN due to the increase in insulin levels throughout the body. In addition, the weight gain associated with thiazolidinediones is largely due to fluid retention.
Thiazolidinediones cause weight….
GAIN d/t H20 retention
GLP-1 agonists, such as Dulaglutide cause weight….
LOSS
What is empagliflozin (Jardiance)’s class and MOA?
Drugs that end in -flozin, like empagliflozin, are SGLT2 (sodium glucose co-transporter 2 inhibitors. They work by blocking reabsorption of glucose in the proximal nephrons, thus clearing it from the body in the urine.
What are S/E of SGLT2 inhibitors? And who would they be bad for?
Major side effects include weight loss and hypotension. The SGLT2 inhibitors are not the best choice in patients with a history of UTIs or incontinence because of this glucosuria.
metformin’s mechanism of action?
decreases gluconeogenesis and decreases insulin resistance
Hyperthyroid
Low TSH
High T3/T4
positive Trousseau’s sign
Trousseau sign of latent tetany is a way to determine if an individual may have hypocalcemia. Trousseau’s sign is considered positive when a carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes.
Who would be a good candidate for an SGLT2? Who would be bad?
SGLT2 = sugar gets lost in the toilet
BAD: Patients with frequent UTIs, incontinence, yeast infections, those at risk for DKA, and patients at risk for amputations or with ulcerations should NOT be considered candidates to begin therapy with SGLT-2 inhibitors.
GOOD: Studies have shown that patients with cardiovascular disease can benefit from this class of medications.
Hyperthyroidism is diagnosed with TSH is
<0.5 (normal is 0.5-5)
Patients with active liver disease should avoid taking what diabetes medication? Also pts with heart failure, in established ASCVD should skip too!
thiazolidinediones (TZD’s; ex pioglitazone)
All pts on TZDs should have their ALT’s monitored periodically d/t 0.5% risk of hepatotoxicity
TZD’s carry edema risk and should not be used with HF pts
TZD’s have a black box warning for…
The thiazolidinedione drug class has a black box warning for those with various types of heart failure. This black box warning is due to increased sodium and fluid retention, which can lead to serious exacerbations in these patients.
What do we see in labs with Addison’s disease?
Addison’s disease, it is common to see issues with hyponatremia, hyperkalemia, and increases in blood urea nitrogen (BUN). It is more typical to see issues with hypoglycemia than hyperglycemia,
classic symptoms of hyperparathyroidism
classic symptoms of hyperparathyroidism include abdominal pain, nausea, vomiting, fatigue, confusion, muscle weakness, and bone pain.
Diabetes HgA1C Fasting Glucose 2 hour oral glucose tolerance test Random plasma glucose
HgA1C: 6.5% or more
Fasting Glucose: 126+
2 hour oral glucose tolerance test: 200+
Random plasma glucose: 200 w/ symptoms (polyphagia, polyuria, polydipsia, unexplained wt loss etc)
Metformin can cause ___ deficiency
B12
Prediabetes
HgbA1C:
Fasting Glucose:
2 hour oral glucose tolerance test:
HgbA1C: 5.7-6.4%
Fasting Glucose: 100-125
2 hour oral glucose tolerance test: 140-199
highest risk for hypoglycemia, cheap drug, can lead to wt gain, avoid in elderly d/t fall risk
Sulfonureas (-“ide”, ex. glipizide/Glucotrol, glimepiride/Amaryl, glyburide/DiaBeta)
MOA: insulin secretagogues, resulting in the release of insulin for pancreatic beta cells
Avoid this diabetes drug class in severe renal impairments and pancreatitis
MOA
DPP-4 (“-gliptins”) Ex. Sitagliptan (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptan (Nesina), vildagliptin (Galvus)
MOA: increases levels of insulin synthesis and release from pancreatic beta cells and decreasing release of glucagon from pancreatic alpha cells
What class must be taken with the first bite of a meal?
alpha glucase inhibitors (Arcabose)
Preferred tx for those with gestational diabetes?
insulin only
Which 2 classes are cardioprotective?
SGLT2 inhibitors and GLP-1 agonists
Which class would you NOT prescripbe to the elderly and whose with frequent UTI’s or incontinence issues?
SGLT2 inhibitors (-“flozins”) d/t sugar pee flozin out
MOA: excretes glucose through urine
Ex) canagliflozin (Invokana); dapagliflozin (Farxiga); empagliflozin (Jardiance)
Note: also associated with hyperkalemia
With this class the pt has to tx hypoglycemia w/ true glucose tabs
alpha glucadase inhibitors
what class is contraindicated in those w/ thyroid ca or pancreatitis or gastroparesis? What is their MOA?
GLP-1 agaonists (Ex. Exenatide (Bydureon, liraglutide (Victoza), dulaglutide (Trulicity), Lixisenatide (Lyxumia), albiglutide (Tanzeum)
Multiple MOA’s: slows gastric emptying; stimulates insulin production in plasma glucose, inhibits glucagon release
What meds do we avoid with wt gain?
sulfonureas - true wt gain
TZD’s - H20 wt gain
Metabolic Syndrome Waist Circumference (men, women): Triglycerides: HDL: (men, women) BP: Fasting Glucose:
Waist Circumference (men 40cm+, women 35cm+) Triglycerides: 150+ HDL: (men <40, women <50) BP: 130/85 Fasting Glucose: 110mg/dL +
