memoriy Flashcards
what are indications to treat on osteoporosis drug?
postemenopausal F or M over age 50 with prior vertebral or hip fracture
post menopausal F or M with T score lower than ?2.5 in hip or spine
post men F or M over 50 with T score between ?1 and ?2.5 at hip or spine if prob of hip fracture is 3% or 10 year probability of any major fracture is >20%
what is the MOA of
clompihene?
tamoxifen?
raloxifene?
clomiphene: fertility drug?? anti estrogen effects at hypo/pituitary, pro estrogen effects as uterus and breast
tamoxifen (breast CA): anti?estrogen at hypo/pit, pro estrogen at uterus, bone serum lipids
raloxiefene? anti osteoporosis: works on bone serum lipids
how do bisphoshonates work??
alendronate, risedronate, ibandoronate, zoledronic acid
long term inhibitors of bone resorption, binds to hydorxyapatite, inhibits osteoclast aciton, long skeletal retention and duration of action
how does calcitonin work?
fast acting inhibitor of bone resportion?? subcutaneous or intransala admin, rapid onset and offest, binds to specific receptors on osteoclasts to reduce activity
which drugs inhibit RANK ligand?
osteoprotegerin (promotes increase in BMD)?? its an endogenous peptide produced by osteoblasts and acts as a decoy receptor for RANKL, prevents binding of RANK
denosumab: monoclonal Ab against rANKL, prevents activaiton of RANK
PTH 1?34 (teriparatide)?? anabolic agent promoting new bone formation, binds to receptors on osteoblasts, inc osteoblast number and new bone formation
what does a T score tell you?
how do you interpret it?
for every 1 SD the score increases, the risk of fracture doubles
T score of 3= risk 8x normal
greater than 2.5 is osteoporosis
between 1 and 2.5 is osteopenia
what are incretins?
stimulate insulin release from beta cell?? like warning signs that the blood glucose will be rising
what is the requirement for screening for diabetes in adults?
all adults who are overweight (BMI>25) and have 1+ additional risk factor
all adults over age 45
if results normal, should be repeated at least every 3 yrs
what are the requirements for screening asymptomatic children?
overweight (BMI>85th%ile), plus 2 risk factors
screening should begin at age 10 or at onset of puberty, repeat every 3 yrs
diagnostic criteria for diabetes
A1c>6.5%
fasting plasma glucose>126 mg/dl?? no food for 8 hr
2 h plasma glucose>200 during
patient with classic symptoms of hyperglycemia with a random plasma glucose of >200 mg
numbers for pre?diabetes?
impaired fasting glucose (100?125)
impaired glucose tolerance (140?149 after 75 g glucose load
at risk A1c: 5.7?6.4%
intervention for pre diabetic states
5.7??5.9% or IFG or IGT: lifestyle intervention, follow up at 1 yr
>6% or IFG/IGT +other features?? lifestyle interventions and/or metformin, f/u 6 mo
diabetes: lifestyle intervention + metformin, follow up in 3 mo
what was the dietary fat goal for the diabetes prevention program?
amount of exercise?
<25% of calories from fat, calorie intake 1200?1800 kcal/day
150 min/week of exercise
how should you adjust your diet for exercise?
1 hr moderate exercise
BG<100: add 15 gCHO
100?180: add 10?15 g CHO
180?300? no food
2 hr 100?180: add 30?45
180?300: add 15 g CHO
what do sulfonylureas do?
what about meglitinides?
how much do they decresae A1C?
this class increases insulin secretion
sulfonylureas: glyburide, glipizide, glimepride
meglitinides: repaglinide, nateglinide (work quicker than sulfonyureas)
activate the K channels to close so you depolarize the cell, open Ca channels, allow for insulin release
MOA: stimulate basal and postprandial insulin secretion, they require functioning beta cells
can dec HbA1c: 1?2%
can cause weight gain, allergy, hypoglycemia
enhance physiological route of insulin delivery, initial response reate, no lag time prior to response, work in days to weeks
