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Medical Screening II > Lecture 6 > Flashcards

Lecture 6 Flashcards

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USMLE® Step 1 flashcards
1
Q

Diabetes

A
  • Type 1 diabetes
  • Type 2 diabetes
  • Gestational diabetes
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2
Q

Symptoms - undiagnosed or poorly managed

A
  • Type 1: Unusual weight loss
  • Type 2: Tingling, pain, or numbness in the hands/feet * nerve problem
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3
Q

Diagnosis - Hemoglobin A1C

A
  • Average blood glucose level over the last 2-3 months
  • Does not require fasting
  • Once diagnosed: target A1C is less than 7%
  • Normal: less than 5.7%
  • Prediabetes: 5.7 - 6.5%
  • Diabetes: greater than 6.5%
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4
Q

Random Plasma Glucose Test

A
  • Diabetes: greater than 200 mg/dL
  • Performed without regard to timing
  • Also called casual plasma glucose test
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5
Q

Hypoglycemia

A
  • low level of glucose
  • can be no symptoms: Hypoglycemia unawareness
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6
Q

Hyperglycemia

A
  • High levels of glucose in the urine
  • Excessive urinary frequency (polyuria)
  • Excessive thirst (polydipsia)
  • Fruity-smelling breath
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7
Q

Insulin

A
  • Facilitates the movement of glucose out of the bloodstream and into the liver
  • Transport system to move the glucose molecule into skeletal muscle
  • Promotes storage of protein and lipid
  • Disturbances in insulin function affect storage
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8
Q

Glucagon

A
  • Hormonal antagonist to insulin
  • Increases blood glucose to maintain normal levels and prevent hypoglycemia
  • Rapid increase in glycogen breakdown in the liver
  • prolonged increase in glucose production
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9
Q

Control of insulin and glucagon release

A
  • Tightly control between too much and not enough blood glucose
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10
Q

Exogenous insulin

A
  • used in both type 1 and type 2 diabetes
  • Rapid acting: immediately before or after a meal
  • subcutaneous injection
  • Intermediate or long acting: can be daily
  • Biphasic option
  • IV in emergency situations
  • Inhaled version
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11
Q

Insulin pump

A
  • a pump delivers insulin to the body through a thin, flexible tube called an infusion set
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12
Q

Adverse effects of insulin therapy

A
  • Hypoglycemia
  • Symptoms worsen with lower blood sugar
  • May lead to loss of consciousness, convulsions, and death
  • Allergies and resistance: Pulmonary symptoms and skin reactions
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13
Q

Glucose tablets are used for?

A
  • hypoglycemia
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14
Q

Immune based therapies

A
  • imab/umad endings
  • IV infusions or shots
  • Body can build antibodies to them
  • Serious side effects profiles
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15
Q

TZIELD

A
  • delay the onset of Stage 3 type 1 diabetes
  • For adults and children 8 years of age and older who have Stage 2 type 1 diabetes
  • for people who have tested positive for 2 or more type 1 diabetes - related autoantibodies, have abnormal blood sugar levels, do not have type 2 diabetes
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16
Q

Drugs that stimulate insulin secretion and supply

A
  • Sulfonylureas
  • Meglitinides
  • Incretion based therapies: GLP -1 receptor agonists, DPP - 4 inhibitors
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17
Q

Insulin sensitizers

A
  • Biguanides: Metformin
  • Thiazolidinediones
18
Q

Other agents used in type 2 diabetes

A
  • Alpha-glucosidase inhibitors
  • Amylin analogs
  • Bile acid sequestrants
19
Q

Sulfonylureas

A
  • act directly on pancreatic beta cells and stimulate the release of insulin
  • inhibits glucose production in the liver
  • Best in early stages of the disease
20
Q

Meglitinides

A
  • Directly increase the release of insulin from pancreatic beta cells
21
Q

Incretion based therapies - GLP - 1 receptor agonists

A
  • sensitize pancreatic beta cells
  • greater amount of insulin released when there is a rise in blood glucose
22
Q

Incretion based therapies - DPP - 4 inhibitors

A
  • prolong the effects of endogenous incretions
  • Increase the beneficial effects of these hormones on insulin release / glucose metabolism
23
Q

Metformin (glucophage)

A
  • acts on the liver to inhibit glucose production
  • increases the sensitivity of peripheral tissues to insulin
  • Cornerstone of diabetes management
  • Can cause GI problems
  • Rare side effect: lactic acidosis ( confusion, lethargy, shallow/rapid breathing, tachycardia)
24
Q

Thiazolidinediones (glitazones)

A
  • Decrease glucose production
  • Increases the sensitivity of peripheral tissues to insulin
  • take several months to take maximum effect
  • More side effects: hepatotoxicity, lactic acidosis, edema, weight gain, fractures
  • Rosiglitazone ( Avandia)
  • Pioglitazone (Actos)
25
Q

Alpha-glucosidase inhibitors

A
  • inhibit enzymes that break down sugars in the GI tract
  • delays glucose absorption
26
Q

Amylin analogs

A
  • Suppress glucagon secretion
  • Delay gastric emptying
  • Increase satiety
27
Q

Bile acid sequestracts

A
  • binds to bile and glucose in the GI tract
  • limits glucose absorption
28
Q

Non-pharmacological diabetes interventions

A
  • Weight loss
  • Diet strategies
  • Exercise
  • Tissue transplants
  • Gene therapy
  • Supplementation
29
Q

What can exercise do?

A
  • creates an insulin-like effect and change blood glucose levels
30
Q

Ideal blood glucose level

A
  • between 70 to 180 mg/dL
31
Q

Exercise contraindicated over

A
  • 240 mg/dL
32
Q

What structure senses levels of TSH (thyroid stimulating hormone) in the bloodstream?

A
  • Hypothalamus
  • Pituitary gland releases TSH
33
Q

Thyroid

A
  • T3, T4, & Calcitonin levels
34
Q

Parathyroid

A
  • Calcium regulation
35
Q

Treatment of hyperthyroidism

A
  • Drug that attenuates the synthesis and effects of thyroid hormone
  • Antithyroid drugs: inhibit thyroid hormone synthesis
  • Iodide: inhibits steps involved in thyroid hormone synthesis
  • Radioactive iodine: selectively destroys thyroid tissues
  • Beta blockers: treats cardiovascular side effects
36
Q

Treatment of hypothyroidism

A
  • Thyroid hormone replacement
  • T4 Levothyroxine (Synthroid)
  • T3
  • Combinations of T3 and T4 (Armour thyroid)
37
Q

Parathyroid

A
  • Calcium regulation
  • can be affected by autoimmune disease
  • Hypercalcemia: constipation, bone pain, kidney stones, fatigue, depression
38
Q

Drugs that regulate bone mineral homeostasis

A
  • Vitamin D: increases absorption of calcium and phosphate
  • Biphosphonates
  • Calcitonin: helpful adjunct to other treatments
  • Estrogen therapy: Increases bone mineral content & reduces fracture risk in postmenopausal people
39
Q

Biphosphonates

A
  • Primary treatment for osteoporosis
  • Alendronate ( Fosamax), Pamidronate ( Aredia)
  • Absorb calcium crystals in the bone and reduce bone resorption by inhibiting osteoclast activity
  • Increases bone mineral density
  • reduces risk of fractures
  • Some increased risk of osteonecrosis of the jaw
40
Q

If calcium levels too high

A
  • Thyroid releases CALCITONIN
  • Increase calcium deposition in bones
  • Decrease calcium uptake in intestines
  • Decrease calcium reabsorption from urine
41
Q

If calcium levels too low

A
  • Parathyroid releases PTH
  • Increases calcium release from bones
  • Increase calcium uptake in intestines
  • Increase calcium reabsorption from urine

Medical Screening II (9 decks)

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