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Family Medicine Clerkship- Case files > Metabolic disorders > Flashcards

Metabolic disorders Flashcards

1
Q

What skin condition is associated with insulin resistance?

A

Acanthosis nigricans

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2
Q

A calorie deficit of 500-1,000 cal/day produces what weekly weight loss?

A

Decreasing calories by 500-1,000 a day typically leads to 1-2lbs loss a week

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3
Q

What non-pharmacological interventions are best for weight loss and weight management?

A
  • Weight loss: diet

- Weight management: exercise

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4
Q

Which medication for obesity is NOT an anorexiant?

A

Orlistat => inhibits the absorption of dietary fat

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5
Q

What is the mechanism of action of anorexiant medications?

A

Increase satiation, satiety, or both by increasing norepinephrine release or inhibiting reuptake

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6
Q

At what BMI would a patient be a candidate for bariatric surgery?

A
  • BMI >40 or >35 with comorbid condition
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7
Q

What are the criteria for metabolic syndrome?

A
  • Abdominal obesity [ waist circumference in men >40inch and 35inch in women]
  • Serum triglycerides greater than or equal to 150mg/dL
  • Serum HDL less than 40mg/dL in men and 50 in women
  • Blood pressure >130/85
  • Fasting plasma glucose >110mg/dL
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8
Q

What further testing should be done in patients with high cholesterol?

A
  • blood glucose
  • creatinine
  • liver function tests
  • TSH
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9
Q

After how long might a patient with hyperlipidemia expect to see decreases in cholesterol if they exercise?

A
  • 6 weeks to recheck lipid panel
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10
Q

How often and at what age should a lipid panel be tested?

A
  • Every 5 years starting at age 20
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11
Q

What factors determine the LDL goal of an individual?

A
  • Cigarette smoking
  • hypertension
  • low HDL
  • Age >45 for men; >55 for women
  • Family history of premature coronary heart disease
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12
Q

What is the LDL goal for someone with CHD or a CHD risk equivalent (greater than 20%)?

A
  • 100mg/dL or less
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13
Q

What is the LDL goal for someone with 0-1 identified risks?

A
  • 160 mg/dL or less
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14
Q

What is the LDL goal for someone with 2 or more risk factors and an individual risk of 10-20%?

A
  • 130 mg/DL or less
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15
Q

What are secondary causes of hyperlipidemia?

A
  • diabetes
  • hypothyroidism
  • obstructive liver disease
  • chronic renal failure
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16
Q

What medications can cause an increase in cholesterol?

A
  • progestins
  • anabolic steroids
  • corticosteroids
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17
Q

At what point should drug intervention be considered in the management of hyperlipidemia?

A
  • After 3 visits where therapeutic lifestyle changes have been initiated/discussed
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18
Q

What are the percent cholesterol reduction of statins?

A
  • LDL decrease by 18-55%
  • HDL increase of 5-15%
  • Triglyceride decrease by 7-30%
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19
Q

What are the major side effects of statins?

A
  • myopathy
  • myalgia
  • increased liver enzymes
20
Q

What are contraindications to statins?

A
  • liver disease
  • cytochrome p450 inhibitors
  • cyclosporine
  • macrolindes
  • antifungals
21
Q

What are the bile acid sequestrants and which lipoprotein do they mostly effect?

A
  • Cholestyramine, colestipol, colesevelam

- Most decrease LDL

22
Q

What are the major side effects of bile acid sequestrants?

A
  • GI distress
  • constipation
  • decreased absorption of other meds
23
Q

What is a contraindication to bile acid sequestrant use?

A
  • Triglycerides >400
24
Q

What lipoproteins are the nicotinic acids/niacin primarily known to change?

A
  • LDL 5-25%
  • HDL increase by 15-35%
  • TG decrease 20-50%
25
Q

What are the main side effects of niacin/nicotinic acids?

A
  • flushing
  • hyperglycemia (don’t give in diabetics)
  • hyperuricemia
  • GI distress
  • hepatotoxicity
26
Q

What are the contraindications to nicotinic acids/niacin?

A
  • chronic liver disease
  • gout
  • diabetes
  • hyperuricemia
  • peptic ulcer disease
27
Q

What are the fibric acids/fibrates and what component of cholesterol do they have the greatest effect on?

A
  • Femfibrozil, fenofibrate, clofibrate

- decrease TG by 20-50%

28
Q

What side effects are associated with fibric acids/fibrates?

A
  • dyspepsia
  • gallstones
  • myopathy
  • unexplained non CHD deaths
29
Q

What are the contraindications to fibrates?

A
  • Severe renal disease

- severe hepatic disease

30
Q

What lipoprotein does Ezetimibe have the greatest effect on?

A
  • Exetimibe ( cholesterol absorption blocker) reduces LDL by 13-25%
31
Q

What are the major side effects of Ezetimibe?

A
  • abdominal pain

- diarrhea

32
Q

What are the contraindications to ezetimibe?

A
  • hepatic insufficiency or disease
33
Q

How often should liver enzymes be monitored in patients on statins?

A
  • 6-12 weeks after initiation or dosage change

- 6-12 months thereafter

34
Q

What diagnostic studies and follow up studies should be done for newly diagnosed diabetic patients?

A
  • Blood glucose measurement
  • Electrolytes
  • BUN
  • Creatinine
  • Fasting lipids
  • Urine microalbumin:creatinine ratio
  • HgA1C
35
Q

Apart from increased thirst/urination what is another presenting sign of diabetes?

A
  • Difficult to treat or recurrent fungal infections

- Other immune deficient states should also be considered

36
Q

How is diabetic ketoacidosis different from nonketotic hyperosmolar syndrome?

A
  • Diabetic ketoacidosis: Seen in type 1 diabetics; syndrome characterized by hyperglycemia, high levels of serum acetone and an anion gap metabolic acidosis. Due to a propensity to metabolize fats into ketones
  • Nonketotic hyperosmolar syndrome: blood sugar levels become highly elevated and the patient has a large fluid deficit. In severe cases coma or death can occur
37
Q

What demographic of women should be screened for gestational diabetes?

A

ALL WOMEN

38
Q

What are the diagnostic criteria for diabetes?

A

1) Random glucose >200 along with polydipsia, polyuria, polyphagia, frequent infections, weight loss
2) Fasting glucose more than 125 on more than 2 occasions
3) 2 Hour plasma glucose 200 or more after a 75g glucose load

39
Q

What is the mechanism of action of metformin?

A
  • Metformin is the first line treatment for DM2: decreases glucose output during gluconeogenesis and improves insulin sensitivity in the liver and muscle with no hypoglycemia
40
Q

What is the most dangerous side effect of metformin?

A
  • Lactic acidosis especially with renal insufficiency (contraindicated in patients with creatinine >1.5, hepatic insufficiency, or congestive heart failure)
  • Other side effects include nausea and diarrhea
41
Q

What is the mechanism of action of the sulfonylureas?

A
  • Stimulate beta cells in the pancreas to secrete insulin

- some risk of hypoglycemia

42
Q

What are the best validated second line drugs in the treatment of DM2?

A
  • Sulfonylureas (Glibenclamide, Glimepiride, Glipizide, Tolbutamide)
  • Insulin
43
Q

What is the mechanism of action of thiazolidinediones?

A
  • Glitazones improve insulin sensitivity in muscle and adipose tissue, they also decrease hepatic gluconeogenesis and increase peripheral glucose utilization
  • Glitazones also decrease triglycerides and increase HDL
  • Metabolized in the liver and can be used by patients with renal impairment
44
Q

What are common causes of hypoglycemia?

A
  • fasting, exogenous insulin, autoimmunity, sulfonylurea abuse, hormonal deficiency (hypoadrenalism, hypopituitary, glucagon deficiency)
45
Q

What is the most effective way to treat hypoglycemia in an UNCONSCIOUS patient outside the hospital setting?

A
  • Glucagon
46
Q

How is hypoglycemia treated in an inpatient setting?

A
  • IV dextrose

Family Medicine Clerkship- Case files (13 decks)

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