GI

Question 1

Where are the most common ulcers found?

Answer 1

duodenum

Question 2

What type of ulcers have a higher risk of malignancy?

Answer 2

Gastric ulcers

Question 3

What is the most common cause of peptic ulcer disease

Answer 3

H. pylori

Question 4

What OTC meds commonly cause PUD

Answer 4

NSAIDS

Question 5

Sulfonylureas such as Glipizide cause weight …

Answer 5

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.

Question 6

Thiazolidinediones cause weight….

Answer 6

GAIN d/t H20 retention

Question 7

GLP-1 agonists, such as Dulaglutide cause weight….

Answer 7

LOSS

Question 8

What is empagliflozin (Jardiance)’s class and MOA?

Answer 8

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.

Question 9

What are S/E of SGLT2 inhibitors? And who would they be bad for?

Answer 9

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.

Question 10

metformin’s mechanism of action?

Answer 10

decreases gluconeogenesis and decreases insulin resistance

Question 11

Hyperthyroid

Answer 11

Low TSH

High T3/T4

Question 12

positive Trousseau’s sign

Answer 12

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.

Question 13

Who would be a good candidate for an SGLT2? Who would be bad?

Answer 13

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.

Question 14

Hyperthyroidism is diagnosed with TSH is

Answer 14

<0.5 (normal is 0.5-5)

Question 15

Patients with active liver disease should avoid taking what diabetes medication? Also pts with heart failure, in established ASCVD should skip too!

Answer 15

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

Question 16

TZD’s have a black box warning for…

Answer 16

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.

Question 17

What do we see in labs with Addison’s disease?

Answer 17

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,

Question 18

classic symptoms of hyperparathyroidism

Answer 18

classic symptoms of hyperparathyroidism include abdominal pain, nausea, vomiting, fatigue, confusion, muscle weakness, and bone pain.

Question 19

Diabetes 
HgA1C
Fasting Glucose
2 hour oral glucose tolerance test
Random plasma glucose

Answer 19

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)

Question 20

Metformin can cause ___ deficiency

Answer 20

B12

Question 21

Prediabetes
HgbA1C:
Fasting Glucose:
2 hour oral glucose tolerance test:

Answer 21

HgbA1C: 5.7-6.4%
Fasting Glucose: 100-125
2 hour oral glucose tolerance test: 140-199

Question 22

highest risk for hypoglycemia, cheap drug, can lead to wt gain, avoid in elderly d/t fall risk

Answer 22

Sulfonureas (-“ide”, ex. glipizide/Glucotrol, glimepiride/Amaryl, glyburide/DiaBeta)

MOA: insulin secretagogues, resulting in the release of insulin for pancreatic beta cells

Question 23

Avoid this diabetes drug class in severe renal impairments and pancreatitis

MOA

Answer 23

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

Question 24

What class must be taken with the first bite of a meal?

Answer 24

alpha glucase inhibitors (Arcabose)

Question 25

Preferred tx for those with gestational diabetes?

Answer 25

insulin only

Question 26

Which 2 classes are cardioprotective?

Answer 26

SGLT2 inhibitors and GLP-1 agonists

Question 27

Which class would you NOT prescripbe to the elderly and whose with frequent UTI’s or incontinence issues?

Answer 27

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

Question 28

With this class the pt has to tx hypoglycemia w/ true glucose tabs

Answer 28

alpha glucadase inhibitors

Question 29

what class is contraindicated in those w/ thyroid ca or pancreatitis or gastroparesis? What is their MOA?

Answer 29

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

Question 30

What meds do we avoid with wt gain?

Answer 30

sulfonureas - true wt gain

TZD’s - H20 wt gain

Question 31

Metabolic Syndrome
Waist Circumference (men, women):
Triglycerides:
HDL: (men, women)
BP:
Fasting Glucose:

Answer 31

Waist Circumference 
(men 40cm+, women 35cm+)
Triglycerides: 150+
HDL: (men <40, women <50)
BP: 130/85
Fasting Glucose: 110mg/dL +