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Therapeutics 2 - Exam 2 > kania pt 1 > Flashcards

kania pt 1 Flashcards

1
Q

major cause of death in T1DM

A

diabetic kidney disease nephropathy

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2
Q

diabetic kidney disease nephropathy characteristics

A

persistent proteinuria
decreased eGFR
increased arterial BP

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3
Q

prevention of diabetic kidney disease nephropathy

A

screen for microalbuminuria annually in T1DM over 5 years and in T2DM; twice annually if UACR > 300 mg/g or eGFR <60mL

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4
Q

treatment of diabetic kidney disease nephropathy

A

ACEi or ARB if UACR > 300mg/g or eGFR <60mL/min
SGLT2I if eGFR > 20mL and UACR > 200mg/g wiht T2DM
GLP-1RA if SGLT2I is CI or not tolerated

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5
Q

finerenone

A

use to reduce CV risk if eGFR is <25mL/min

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6
Q

goal if UACR is > 300mg/g

A

30% reduction

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7
Q

ocular complications

A

blurred vision (likely due to decreased BP or BG)
retinopathy (if present screen 1x year), cataracts, glaucoma

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8
Q

treatment of ocular complications

A

photocoagulation therapy
anti-vascular endothelial growth factors (aflibercept or ranibizumab)`

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9
Q

peripheral neuropathy

A

annual monofilament test
initial treatment –> pregabalin, cymbalta, gabapentin

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10
Q

lsat resort of peripheral neuropathy

A

centrally acting opioid analgesic

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11
Q

ASCVD

A

atherosclerotic cardiovascular disease (coronary heart disease)
leading cause of morbidity and mortality

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12
Q

treatment of diabetes and CV complications

A

SGLT-2Is
GLP-1Ras

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13
Q

risk factors for CVD

A

obesity, HTN, HLD, smoking, and CKD
also metabolic syndrome

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14
Q

goal BP

A

< 130/80 for T2DM/T1DM
110 -135 / 85 for DM + pregnancy
maybe <140 for elderly patients

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15
Q

use of preferred antihypertensive agents for CV and diabetes

A

ACEis OR ARBs
use at max tolerated doses but not together due to risk of hyperkalemia, syncope, and renal dysfunction
if needed, add a second agent

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16
Q

other antihypertensive options

A

HCTZ
chlorothalidone
amlodipine
MRAs (spironolactone or eplerenone)

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17
Q

when to use none/moderate statin dose?

A

if patient is 20–39 with no ASCVD
monitor annually after

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18
Q

when to use moderate statin dose?

A

if patient is age 40-75 with no ASCVD

19
Q

when to use high intensity stain dose?

A

if patient is age 40-75 with over 1 risk factor
if patient has DM and ASCVd in all agents (also lifestyle modifications)
**decrease LDL by over 50% and taget LDL under 70

20
Q

statin use in over 75 yoa

A

if on a statin –> continue
if not on a statin –> moderate intensity after discussion

21
Q

when should ezemtimibe or a PCSK9 inhibitor be added?

A

when pt has DM + ASCVD and currently on a statin, if LDL is still elevated despite maximal tolerated statin dose

22
Q

target LDL level for DM + ASCVD

A

target decrease by greater than 50%
LDL under 55

23
Q

high intensity statins

A

atorvastatin 40-80mg
rosuvastatin 20-40mg

24
Q

moderate intensity statins

A

pitavastatin 1-4mg
rosuvastatin 5-10mg
atorvastatin 10-20mg
simvastatin 20-40mg
pravastatin 40-80mg
lovastatin 40mg
fluvastatin XL 80mg

25
Q

low intensity statins

A

simvastatin 10mg
pravastatin 10-20mg
lovastatin 20mg
fluvastatin 20-40mg

26
Q

prevention of muscle pain

A

often common with a statin
start at low dose of statin and generally work your way up

27
Q

what should a patient use if they are intolerant of statins to treat CV complications?

A

bempedoic acid

28
Q

antiplatelets

A

use aspirin as secondary prevention (clopidrogel if allergy, sometimes both)
hard to find a happy medium
aspirin plus rivaroxaban could be considered for pts with PAD and low bleeding risk

29
Q

antiplatelets for primary prevention

A

consider in m/f over 50yoa with one major risk factor
probably not if over age of 70
do not use if there are no major CVD risk factors (risk of bleeding outweighs benefits)

30
Q

different SMBG measuring times

A

intensive insulin regimens –> basically prior to everything also suspicion of hypoglycemia and after treatment
basal insulin/non-insulin medications –> once daily
non-insulin regimens –> prn

31
Q

ADA target fasting

A

80 to 130 mg/dL

32
Q

taret bedtime gluose

A

90 to 150 mg/dL

33
Q

A1C target

A

ADA –> under 7%, consider under 6% in pregnancy
AACE –> under or equal to 6.5%

34
Q

A1C

A

normal is 4-6%
average blood glucose concentration over 8-12 weeks
does not lie!

35
Q

diabetes control and complications trial (DCCT)

A

T1DM patients
60% reduction in microvascular complications and 40-55% in CV complications in intensive treatment

36
Q

UK Prospective Diabetes Study (UKPDS)

A

T2DM patients
every 1% drop in A1c –> 18% reduction in risk of CVD event
saw reductions in MI due to sulfonylureas, insulin, and metformin 10 years after

37
Q

Action to Control CV Risk in Diabetes (ACCORD)

A

CVD or 2+ major risk factors
study terminated early due to increase risk of mortality in intensively manage patinets
not statistically significant at termination

38
Q

Action in diabetes and vascular disease - preterax and diamicron modified release controlled evaluation (ADVANCE)

A

significant reduction in microvascular outcomes without a change in macrovascular events in intensively managed patients
no increase in CV mortality

39
Q

VA diabetes trial (VADT)

A

more CVD deaths in the intensive arm vs standard, but not statistically significant
severe hypoglycemia associated with increased CVD mortality

40
Q

When should A1C be targeted aggressively?

A

when a patient is newly diagnosed, no history of severe hypoglycemia, and no CVD
use in caution for patient with history of severe hypoglycemia, history of CVD or other extensive co-morbid conditions, and advanced disease where goal is difficult to achieve
***should be individualized regardless

41
Q

what does a 1% change in A1C signal?

A

a 25 to 35 mg/dL change in mean blood glucose (eAG)

42
Q

advantages of A1C

A

can be measured without fasting
levels are not subject to acute changes in insulin dosing, exercise, or diet

43
Q

disadvantages of A1C

A

does not replace SMBG or CGM
remember –> its an average of all numbers
conditions that affect red blood cell turnover may impact result

44
Q

when to measure A1C?

A

twice a year if meeting treatment goals
quarterly if therapy has changed or not meeting treatment goals

Therapeutics 2 - Exam 2 (10 decks)

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