Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

6030 Primary Care Test 2 Complete ☑️ > Module 3 (b) > Flashcards

Module 3 (b) Flashcards

1
Q

Type 2 Diabetes

-Risk Factors

A
  1. Obesity
    - Primary risk factor — (more common with central distribution — male pattern obesity)
  2. Men are TWICE as likely as women to develop T2DM
  3. High risk Heritage: Native Americans, Black, Hispanic, Asian American & Pacific Islander
  4. Hx of Prediabetes, Gestational DM, or PCOS
  5. Hx of insulin resistance (Acanthosis Nigerians, severe obesity)
  6. Hx of CVD
    - HTN, Dyslipidemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of Type 2 Diabetes

A
  • In a patient with recurrent infections, T2DM should be a differential
  • If a female patient presents with Candida vaginitis multiple times, consider T2DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acanthosis Nigrans

A

Leathery skin in the neck or armpit folds
-Linked to obesity, T2DM, or some Cancers tumors (liver cancer

Treatment is aimed at underlining condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Xanthelasma

A

Yellowish elevated lesions on the skin of the eyelids

  • Soft to touch and flat and yellowish in appearance
  • Appear on upper and lower eyelids and are symmetric
  • Usually NOT painful or itchy And rarely cause visual changes

Can indicate:
-High cholesterol, hypothyroidism, or liver condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Criteria for Testing for Diabetes or Pre-diabetes in Asymptomatic Adults??

A

**Overweight or Obese BMI >= 25kg/m2 or 23Kg/m2 in Asian Americans
Who have one or more of the following Risk factors
1. 1st degree relative with DM
2. High-risk race/ethnicity (AfricanA, latino, Native A, Asian A, Pacific Islander)
3. Hx of CVD
4. Hypertension (>= 140/90 or on a BP medication with controlled BP)
5. HDL <35 mg/dl or triglyceride level >250 mg/dl
6. Women with Polycystic ovary syndrome PCOS
7. Physical inactivity
8. Other conditions that cause insulin resistance
-Ex: Severe obesity, Acanthosis nigrans, xanthelasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

T2DM

-Diagnostic Tests

A
  1. Serum Glucose (random or fasting)
  2. HbA1C

Oral glucose Tolerance test — NOT done in CLINIC setting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T2DM

-Diagnostic Criteria

A
  1. Fasting Glucose >= 126 mg/dl after 8hr fast
  2. Random Plasma Glucose >= 200 with classic symptoms
  3. Oral Glucose Tolerance Test >= 2000 mg/dl
  4. HbA1C >=6.5%

You need a SECOND blood test to confirm diagnosis if BS is high on first test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TIDM vs T2DM

A

Onset: Is Rapid in T1 vs Gradual in T2
Age: T1 is usually younger than T2
Cause: T1 = No insulin vs T2 = ominous octet
Keto acidosis: Common in Type 1 but rare in T2
Treatment: T1 = Insulin, T2 =Diet, lifestyle, oral meds, and/or insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ominous Octet Pathways & Medications to treat them?

-Increased Hepatic Glucose Output Treatment?

A

Metformin (Glitazones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ominous Octet Pathways & Medications to treat them?

-Renal Glucose Excretion Treatment?

A

SGLT2 Inhibitor (Sodium-glucose contransporter 2 inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ominous Octet Pathways & Medications to treat them?

-Decreased Peripheral Glucose Uptake Treatment?

A

Metformin (Glitazones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ominous Octet Pathways & Medications to treat them?

-Glucose Influx Treatment

A
  • alpha Glucosidase inhibitors
  • GLP-1 RA (Glucagon-like Peptide 1 receptor agonist)
  • Pramlintide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ominous Octet Pathways & Medications to treat them?

-Increase Glucose Secretion Treatment

A
  • Incretines

- Pramlintide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ominous Octet Pathways & Medications to treat them?

-Decreased Insulin Secretion Treatment?

A
  • Insulin
  • SFU
  • Glinides
  • GLP-1 RA
  • DPP-4 I (Dipeptidyl peptidase inhibitors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ominous Octet Pathways & Medications to treat them?

-CNS Dysfunction treatment

A

-Cycloset (Dopamine Receptor Agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diabetes Care

-Personalized care!

A 
DM treatment is not one size fits all! 
Consider:
-Efficacy
-Side effects
-Side benefits (Weight loss addition) 
-Cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Non-Insulin Therapies in T2DM

-(Biguanides) Metformin

A
  1. Recommended initial therapy for T2DM **
  2. ONLY for pt’s with eGFR >= 45;
  3. DO NOT initiate Metformin for eGFR between 30 - 44 ml
  4. Consider extended release if GI side effects occur
  5. Inform Pt about METALLIC taste
  6. Risk of B12 deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Insulin Therapy

-Rapid Acting Insulin

A
  1. Lispro
  2. Aspart
  3. Glulisine

Given before, during or after meal. Med is provider and patient preference.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Insulin Therapy

-Long-Acting Insulin

A
  1. Glargine
  2. Detemir
  3. Degludec
20
Q

T2DM

-Combination Therapy

A
  1. Metformin is used with another medication with atherosclerotic CVD is present. CAD, MI, renal dz, or hypoglycemia is a risk factor.
21
Q

T2DM

-HbA1C Goals

A
  1. New onset, no complication, no CVD = A1c goal of <7%
  2. Significant CVD = 7-8%
  3. Many Co-morbidities, low life expectancy = 8-9%
22
Q

Approach for Individualize HbA1C targets

-usually non-modifiable

A
  1. Less Stringent approach if pt has risk of hypoglycemia or drug adverse effects
  2. More stringent approach if pt is newly diagnosed diabetic
  3. Less stringent approach if pt has short life expectancy
  4. Less stringent with important co-morbidities
  5. Less stringent with established vascular complications

Pt preference and resources and support system are potentially modifiable factors

23
Q

Anti-hyperglycemic Therapy in Adults w/ T2DM

-Monotherapy

A

For A1c < 9%
1. Lifestyle management + Metformin

ALWAYS initiate LIFESTYLE management (Diet, exercise, smoking cessation, weight control)
-Always discuss smoking cessation with smokers

-Monitor Pt’s in 3 months due to A1c measuring effectiveness over 3 months.
—If at goal, follow up A1c in 3-6 months
—If not at goal, CONSIDER medication taking behavior**; consider dual therapy

24
Q

Anti-hyperglycemic Therapy in Adults w/ T2DM

-Dual Therapy

A

A1c >= 9%

  1. Lifestyle management + Metformin + Additional agent (depending on problem)
    - If patient has atherosclerotic CVD, add a medication that lowers risk of CVD adverse events

Assess A1c at target after 3 months
—If at goal, follow up A1c in 3-6 months
—If not at goal, CONSIDER medication taking behavior**; consider triple therapy

25
Q

Anti-Hyperglycemic Therapy in Adults with T2DM

-Triple Therapy

A

HbA1C >= 10%, BG >= 300 mg/dl, or patient is markedly symptomatic

-Lifestyle management + Metformin + 2 additional agents

-Monitor Pt’s in 3 months due to A1c measuring effectiveness over 3 months.
—If at goal, follow up A1c in 3-6 months
—If not at goal, CONSIDER medication taking behavior**; consider combination injectable therapy

26
Q

Medications with Proved CVD & CKD Benefit

A
  1. SGLT2 Inhibitors
    - Medication names end in “Flozin”
  2. GLP-1 Analogs
    - Medication names end in “Lutide”
27
Q

Medications Proven Heart Failure Benefit

A
  1. SGLT2 Inhibitors

- Medication name ends in “Flozin”

28
Q

If Cost is a Major Issue??

-Ex of Affordable Meds?

A
  1. Biguanide - Metformin
  2. Sulfonylurea (SU)
  3. Thiazolidineodiones (TZD)
  4. Insulin
29
Q

T2DM Medications

-Weight Loss Meds?

A
  1. GLP-1 Analogs

2. SGLT-2 Inhibitors

30
Q

T2DM Medications

-Weight Maintenance

A
  1. Metformin

2. DPP4 Inhibitors

31
Q

T2DM Medications

-Weight Gain

A
  1. Insulin
  2. Sulfonylureas
  3. Thiazolidinediones
  4. Meglitinides
32
Q

T2DM Medications

-High Risk for Hypoglycemia

A
  1. Insulin
  2. Sulfonylureas
  3. Meglitinides
33
Q

T2DM Medications

-Low Risk for Hypoglycemia

A
  1. Metformin
  2. GLP-1 Analogs
  3. SGLT-2 Inhibitors
  4. DPP4 Inhibitors
  5. Thiazolidineodiones
34
Q

What Medication has high efficacy and reduces the risk of worsening Diabetic Nephropathy?

A
  1. Liraglutide (GLP1-RA)
35
Q

Non-Pharmacologic Management

-Exercise

A
  1. Aerobic (moderate): 30 min/day, 5-6 days/week (>/= 150 minutes)
    - Resistance Training: 2-3 days/week
36
Q

Nonpharmacologic Management

-Psychosocial Care?

A
  1. Symptoms of diabetes distress, depression, anxiety and eating disorders.

All diabetic patients should be screened for DEPRESSION
-PHQ2 and PHQ-9

Healthy weight loss is always recommended

37
Q

T2DM in Older Adults

-Stats

A
  1. 1 in 4 adults (25%) over 65 years old
  2. Aging is major risk factor (insulin production decreases w/ age w/ increase insulin resistance)
  3. More subtle new onset s/s
  4. HbA1C target of 7.5% - 8% (American Geriatric Society Guidelines)
38
Q

Risk Factors for Hypoglycemia in Older Adults?

A
  1. Use of Insulin and other medications that can also cause hypoglycemia
  2. Irregular meals
  3. Unpredictable exercise patterns
  4. Decreased renal function
  5. Polypharmacy
  6. Hospitalization
  7. Co-existing co-morbidities
39
Q

DM in Older Adults

-Glycemic control and reduced Medication are achieved by?

A
  1. Healthy eating
  2. Physical activity (W/ Strong consideration for safety, hypoglycemia risk)
  3. Weight reduction
40
Q

DM in Older Adults

-Treatment Goal

A
  1. Avoid Hypoglycemia ***

2. Achieve best glycemic control

41
Q

DM in Older Adults

-Health Promotion

A
  1. Yearly dilated eye exam
  2. Evaluation of feet at least Annually
    - FOOT INSPECTION should occur in EVERY visit in patients with Diabetes
    - Proper footwear and assess w/out socks and between toes
  3. Yearly influenza vaccine
  4. Pneumococcal vaccine
  5. Depression Screening
42
Q

Pharmacological Therapy in T2DM

-Older Adult Consideration

A
  1. Declining renal and hepatic function
  2. Increased risk for polypharmacy
  3. Increased risk for hypoglycemia
  4. Limited clinical trials in older adults
  5. Patient’s functional and cognitive status
  6. CV risks and comorbidities
43
Q

Pharmacological Therapy in T2DM in Older Adults

-1st line oral treatment?

A
  1. Metformin is the 1st line agent for oral therapy

- LOWER RISK for hypoglycemia

44
Q

Pharmacological Therapy in T2DM in Older Adults

-Medications to Use with Caution??

A
  1. Insulin and insulin secretagogues
    - Use with caution; glycemic goals should be less strict
  2. Sulfonylureas (SU)
    - Use w/ caution; associated with hypoglycemia
  3. Thiazolidinediones (TZD’s)
    - Use w/ caution in elderly
    - CONTRAINDICATED in pre-existing HF, edema, hepatic failure**
45
Q

Pharmacological Therapy in T2DM in Older Adults

-Medications to Avoid?

A
  1. Glyburide should be AVOIDED

- Associated with hypoglycemia in older adults

46
Q

Pharmacological Therapy in T2DM in Older Adults

-Thiazolidinediones (TZD) Contraindicated in Pt w/?

A
  1. TZD’s are contraindicated in patients with preexisting:

- Heart Failure, Edema, & Hepatic failure

6030 Primary Care Test 2 Complete ☑️ (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions