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PHARM 343 > Macrovascular Diabetes > Flashcards

Macrovascular Diabetes Flashcards

1
Q

Diabetes-Related Complications
- Macrovascular

A
  • Cardiovascular Disease (CVD)
  • Cerebrovascular Disease (Stroke)
  • Peripheral Vascular Disease (PVD)
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2
Q

Diabetes
- Cardiovascular Risk

A

Before diabetes was equivalent to cardiovascular risk

Nowadays diabetes is equivalent to someone aging around 15 years

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3
Q

Vascular Age vs Chronological Age

A

Diabetes leads to:
- Vascular Inflammation
- Accelerated vascular age (by 15 years)
- Increased risk of cardiovascular events

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4
Q

Cardiovascular Events

A

Stroke
Myocardial Infarction

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5
Q

Cardiovascular Complications

A

Heart Failure
Death

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6
Q

Blood Pressure, Cholesterol Profile, Blood Glucose
- Low to Normal affect on risk
- Elevated levels affect on risk

A

If values are low or normal
- Similar risk as general population

If values are elevated
- Vascular age accelerates more rapidly than chronical age

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7
Q

What lab values will affect vascular age

A

Cholesterol profile
Blood glucose
Blood Pressure

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8
Q

Recommendations for Vascular Protection

A

Reduce risk of CV events through:
- Achieve and maintain treatment targets through early detection and persistient follow up
- Multifaceted approach

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9
Q

Follow up for Vascular Protection

A

Check blood pressure every clinical visit
Chec lipid panel every 1 to 3 years
Follow ABCDESSS of diabetes care

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10
Q

ABCDESSS of Diabetes Care

A

A1c
Blood Pressure Targets
Cholesterol Targets
Drugs for CV and Cardiorenal Protection
Exercise goals and healthy eating
Screening
Smoking Cessation
Self-management, stress, sleep, other barriers

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11
Q

BP Control vs Glucose control

A

Focus on BP first (Will give larger benefits)
- Unless Glucose levels need desparate attention

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12
Q

A1c Targets

A

Less than 7.0%

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13
Q

BP Targets

A

< 130/80 mmHg

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14
Q

BP Targets
- Initial Agent

A

If risk of microalbuminuria, kidney disease, or cardiovascular risk in addition to hypertension and diabetes
- ACEi or ARB

If just hypertension and diabetes
- ACEi, ARB, Dihydropyridine CCB, Thiazide/Thiazide like diuretics

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15
Q

BP Targets
- Combination Therapy

A

Usually needs 2 to 3 antihypertensive drugs to reach therapy

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16
Q

BP Targets
- Adding on to initial therapy

A

Start with ACEi
- Then add amlodipine

17
Q

BP Targets
- Pharmacist Intervention

A

More people reach target when pharmacists intervene
- Even better effects in patients with elevated BP at baseline

18
Q

Cholesterol
- When to screen

A

Lipid Panel every 1-3 years

CV Risk Assessment every 5 years
- For people with diabetes
- For people aged 40-75 years

19
Q

Cholesterol
- Primary Prevention

A

Statin Therapy for patients:
- Older than 40 years old
- Older than 30 years old and has had diabetes for longer than 15 years
- Microvascular Diseases

20
Q

Cholesterol
- Secondary Prevention

A

Statin Therapy for patients with:
- History of atherosclerotic cardiovascular disease

21
Q

Cholesterol
- Treatment Target

A

LDL less than 2.0 mmol/L
OR
Reduction in 50% from baseline

22
Q

Cholesterol
- Pharmacist Intervention

A

Helps get closer to treatment target
- Subgroup with diabetes receives more benefit

23
Q

CV Assessment Tool Considerations

A

Is meant for treatment initiation
- Not used for monitoring as it is unknown how responsive it is

Hard to differentiate between high and low risk groups in younger patients

24
Q

Drugs for CV and Cardiorenal protection
- Vascular Protection

A

ACEi/ARB (Renal Protective, does not have to be used to lower BP)

25
Q

Drugs for CV and Cardiorenal protection
- Who benefits from Vascular Protection

A

Patients with diabetes and:
- Clinical Cardiovascular Disease
- Older than 55 years old with Cardiovascular risk factors or end organ damage
- Microvascular Complications

26
Q

Drugs for CV and Cardiorenal protection
- Atherothrombotic Rationale

A

People with diabetes have:
- Increased platelet turnover
- Enhanced aggregation
- Increased thromboxane synthesis

27
Q

Drugs for CV and Cardiorenal protection
- Atherothrombotic Treatment

A

High on treatment platelet reactivity
- Patients with diabetes have resistance to aspirin

If using aspirin use greater than 100 mg

28
Q

Drugs for CV and Cardiorenal protection
- Atherothrombotic Recommendations

A

Primary Prevention
- Should not be routinely used
- However, may be used if patient has multiple cardiovascular risk factors

Secondary Prevention
- Low Dose Aspirin (81-162 mg daily) should be used in patients with cardiovascular disease
- Can use Clopidogrel 75 mg is unable to tolerate aspirin

29
Q

Healthy Behaviour Interventions
- E

A

Exercise and Eating Healthy
- Moderate exercise is okay
- Well portioned meals
- Either maintain or loss weight

30
Q

Healthy Behaviour Interventions
- SSS

A

Smoking Cessation

Screening

Self-management, stress, and other barriers

31
Q

How well are people reaching targets

A

Lots of room for improvement (Only a quarter of Americans are reaching all targets)
- There is more ways to reduce CV than just glucose control

PHARM 343 (35 decks)

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