June 7th Flashcards
Standard DKA tx
IV fluids, IV insulin and K+ replacement
DKA DDx
Infection Serious medical illness (MI/Stroke) Nonadherence to insulin Drugs/Alcohol Dehydration
Standard tx for DM1
Insulin
Standard Tx for DM2
Low carb diet
Weight loss
Oral hyperglycemic drugs (Metformin)
Insulin
DM 2 Drug with lactic acidosis risk
Metformin
DM 2 Drug with most common side effect hypoglycemia
Sulfonylureas
DM 2 Drug recommend first line
Metformin
DM 2 Drug not safe in symptomatic CHF
TZDs (Pioglitazone & Rosiglitazone)
DM 2 Drug not to use in abnormal kidney function
Metformin
SGLT-2 inhibitors
TZD (Pioglitazone & Rosiglitazone)
DM 2 Drug weight neutral/weight loss
Metformin
GLP-1 analog (Exenatide, Lirafgutide)
SGLT-2 inhibitor (Canaglifozin)
DPP-4 inhibitors (Linagliptin, Saxagliptin, Sitagliptin)
DM 2 Drug metabolized by liver can be used in renal dysfunction
TZDs
DM 2 Drug MOA of closing K channel on B cells > cell deploy > Ca influx > Insulin release
Sulfonylureas
Meglitinides
DM 2 Drug MOA inhibiting alpha glucosidase at intestinal brush border
Acarbose
Miglitol
DM 2 Drug agonist at PPAR-y»_space; improved target cell response to insulin
TZD
DM 2 Drug decreased hepatic gluconeogneeis
Metformin TZDs
DM 2 Drug decreased glucose resorb in renal tubules
SGLT-2 inhibitors
DM 2 Drug used in organ failure
DDP-4 inhibitors
Metformin Class
Biguanide
Glimepiride, Glipizide, Glyburide Class
Sulfonylureas
Pioglitazone and Rosiglitazone Class
TZDs
Exenatide Lirglutide Class
GLP-1 analogs
Linagliptin, Saxagliptin, Sitagliptin Class
DPP-4 inhibitors
Pramlintide Class
Amylin analogs
Canagliflozin
SGLT-2 inhibitors
Acarbose, Miglitol Class
alpha glucosidase inhibitors
Number needed to harm
1/Atrributable Risk
Antibiotics inhibiting prokaryotic DNA topoisomerase
Fluroquinolones
Where is leptin produced?
Adipocytes
What two hypothalamic nuclei does leptin affect?
Lateral hypothalamus
Venteromedial nuclei
What is leptin’s effect on the lateral hypothalamus?
With stimulation»_space; hunger
With leptin/lesion/inhibiton»_space; anorexia
What is leptin’s effect on the ventromedial nucleus?
With stimulation/leptin»_space; satiety
With inhibition/lesion»_space; hyperphagia
What is leptin effect on each nuclei?
Leptin stimulates venteromedial
Leptin inhibits lateral
5 criteria for Metabolic Syndrome
Need 3/5 Abdominal circumference Triglycerides HDL Blood pressure Fasting serum glucose
Liver disease associated with obesity?
Non-Alcoholic Steatohepatitis (NASH)
BMI of underweight, normal, overweight and obese
Underweight 30
What inhibits RNA polymerase II in eukaryotes causing liver damage?
Alpha-amantin found in death cap mushrooms
Three functions of Vit D
Increased gut resorption of Ca & P04
Increased bone turnover
How is bone affected by PTH?
Increased bone turnover
PTH receptors located on osteoblasts which then secreted RANK ligand which activates osteoclasts
PTH functions
Increased bone turnover
Increased Ca resorption at kidney at DCT
Increased PO4 excretion at kidney
What cell types produce PTH and calcitonin
PTH = chief cells of parathryoid Calcitonin = Parafollciular C cells of thyroid (neural crest derivative)
Most common causes of hyperparathyroidism?
1) Paraythyroid adenoma
2) Parathyroid hyperplasia
Causes of hypocalcemia
Acute pancreatitis
Vit D deficiency
Chronic renal fialure
Hypoparathyroidism DiGeorge and accidental removal
Most common cause of hypercalcemia
Hyperparathyroidism
