Harrisons Flashcards
What are the major features of metabolic syndrome
central obesity
hyperglycemia
hypertension
hypertrigylceridemia
low HDL level
what is the most challenging feature of metabolic syndrome
waist circumference
what is the greatest value of determining metabolic syndrome
predicting type 2 DM
to be diagnosed with metabolic syndrome, at least how many for the 5 major features should be fulfilled
at least 3 major features
central obesity in males vs females is defined as having waist circumference of ____ accdg to NCEP : ATPIII 2001 criteria
males: > 102 cm
females > 88cm
**for south Asians and Chinese accdg to another criteria (Harmonizing Definition)
males: 90cm or more
females: 80cm or more
the most accepted and unifying hypothesis to describe the pathophysiology of the metabolic syndrome is _____
insulin resistance
relationship of insulin resistance and fatty acids
insulin resistance –>
increased lipolysis –>
increased FA –>
FA impair insulin-mediated glucose uptake by modifying downstream signalling –>
insulin resistance (cycle continues)
effect of leptin on:
a. appetite
b. energy expenditure
c. . insulin sensitivity
reduces appetite
promotes energy expenditure
enhances insulin sensitivity
what is the effect of insulin on blood vessels and sodium reabsorption in the kidney under:
a. normal physiologic condition
b. in the setting of insulin resistance
Normally, insulin is a vasodilator and promotes sodium reabsorption in the kidney
In the setting of insulin resistance, insulin loses its vasodilator effect but still has sodium reabsorpition ability (via kidney)
Thus, the relationship between insulin resistance and HTN is well established
how can hyperuricemia contribute to hypertension
adverse effect of uric acid on NITRIC ACID SYNTHASE in the MACULA DENSA of the kidney and stimulation of the RENIN-ANGIOTENSIN ALDOSTERON SYSTEM (RAAS)
This is an anti-inflammatory cytokine produced exclusively by adipocytes. It enhances insulin sensitivity and inhibits many steps in the inflammatory process
adiponectin
what happens to the level of adiponectin in metabolic syndrome
decreased
what is the most common liver disease
NAFLD
how does NAFLD occur
increased FFA flux –>
decreased intrahepatic FA oxidation –>
increased TG biosynthesis and hepatocellular accumulation
what is the primary approach to tx of metabolic syndrome
weight reduction
what are the 2 major classes of weight loss drugs
appetite suppressants
absorption inhibitors
phentermine is an appetite suppresant drug that can only be used short term…. for how long
3 months
example of weight loss drug that inhibits GI absorption
Orlistat
common problem in taking orlistat
oily leakage per rectum
metabolic or bariatric surgery is an option for patients with metabolic snydrome who have BMI of
BMI 40 or more or…
> 35 BMI with comorbidities
a statin should be prescribed in all patients with diabetes age 40-79 with an LDL cholesterol between ____ mg/dL
60-189 mg/dL
for those patients with DM and ASCVD, the current evidence supports a high-intensity statin dose… a high intensity statin dose of atorvastatin is ______ while for rosuvastatin it is _____
atorvastatin 40-80mg/day
rosuvastatin 20-40 mg/day
What is the first and second choice medications to lower LDL cholesterol
1st: statins
2nd: ezetimibe
**ezetimibe localizes at the brush border of the small intestine and inhibits absorption of cholesterol via the sterol transporter NPC1L1
first line meds to lower LDL vs triglycerides
LDL: statins
TG: fibrates
patients taking Fibrates concomitantly with drugs metabolized by the 3A4 cytochrome P450 system increases the risk of what adverse effect
myopathy
what is the only currently available drug with predictable HDL cholesterol-raising properties
nicotinic acid
**however, there is no evidence that raising HDL cholesterol with nicotinic acid beneficially affects ASCVD events
in patients who have the metabolic syndrome without DM, the best choice for the initial anti-HTN medications is
ACEi or ARBs
both metformin and TZD enhance insulin action in the liver, muscle and adipose tissue.. True or false
false….
only TZD enhances insulin action in the liver, muscle and adipose tissue
metformin only enhances insulin action in the liver
