notes 465- DM, thyroid, anemia Flashcards
diagnosis of DM
FPG 7 or more, A1C 6.5 or more, 2hPPG or any random glucose over 11.1
when might urine ketone testing be used
pregnancy, acute illness or stress, preprandial over 14, DKA sxpresent
eligibility for TPA in stroke
presents within 3 hours of sx onset. CI- rapidly improving, hemmorhage, seizure with stroke, recent stroke or head injury in last 3 months, recent GI bleed, low platelets, BP over 185, recent anticoag (2 days)
if not eligible for TPA in a stroke, what do you give
if hemorrhage ruled out, give antiplatelet (aspirin). BUT, if assumed cardioembolic (Afib, mechanical valve, severe CHF) might get anticoag instead
what are patients who just had a stroke at high risk of
DVT- must provide proph (LMWH, UFH)-can be used 48 hours after hemorrhagic
first line drugs to treat BP in someone after acute phase of stroke
thiazide and ace
do you treat high BP in acute phase of stroke (first 72 hours)
not usually- only if extreme like greater than 220. We want high pressure and blood flow
dipyradimole/ASA’s only indication is in
2’ stroke prevention (aggrenox)
when is radioactive iodine used? CI?
hyeprthyroid. CI in pregnancy and exopthalmus (can worsen)
2 drugs that can induce hypothyroidism
amiodarone and lithium
when to expect sx improvement with levothyroxine
2-3 weeks max at 6
definition of anemia (M/F)
M= less than 130, F= less than 120
heme vs non heme iron
heme-animals, better absorbed and more consistent, less affected by diet. non heme= plants, most supplements, needs acid to absorb
what increases absorption of iron
vitamin C (oranges, peppers)
enteric coated iron
decrease absorption, especially in patients with decreased gastric acidity
acronym for iron strengths
fish swim great (fumarate, sulfate, gluconate- 33,20,11, blue-red-green). Polysaccharide iron 100%
iron in kids
can be toxic. dose 3-6mg/kg/day divided TID
which parenteral iron needs test dose due to risk of anaphylaxis
dextran
how long do you continue therapy after anemia resolved
3-6 months to allow for store repletion. Hb increases about 10g/L per week, and is usually corrected in six
cockcroft gault equation
[(140-age)xABW}/[0.814xSCrmmmol/L] x0.85 if female
what does BNP indicate
fluid overload or increased stretch of heart muscle (heart failure)
which SU can be used up until dialysis? which must be stopped at 50?
gliclizide. Glyburide must be stopped
at what renal fx is metformin CI
less than 30- lactic acidosis
when are thiazides no longer effective for diuresis
less than 30ml/min
treatment of hyperkalemia
kayexelate (CI in obstructive bowel disease), if severe combo of calcium gluconate, glucose, insulin, sodium bicarb, sabutamol, kayex and possibly dialysis
which antibiotics need to be adjusted for renal dysfx? which on CI if Crcl less than 60?
adjust: vanco, AG, septra, FQ, pens, cephs. Nitrofurantoin CI less than 60
cardiac meds to adjust in renal dysfx
sotalol, nadolol, digoxin, fibrates
analgesics to adjust in renal dysfx? which to avoid?
adjust codeine and morphine, avoid meperidine
psychotropics to adjust in renal dysfx
lithium, gaba, tarzodone, topiramate
misc drugs to adjust inr enal dysfx
colchicine,H2RAs, metoclopromide, glicli, glybur, sitaglipt, metformin
who should not get ASA (age)
kids 0-11- reye’s syndrome
diarrhea in kids 3-11
ORT (if dehydrated), attapulgite and then refer if not better
good treatment for travellor
s diarrhea- ABX
azith or FQ
there are 2 types of liver injury- what liver tests indicate each
1) cholestatic (ALP and GGT) 2) hepatocellular (AST, ALT)
hep a vs hep b treatment
hep a- no role for pharm only supportive. B use interferon or nucleoside analogues (udine, ovir) (nucleos have better response rate, increased success, safer, less SE, PO vs SQ-but resistance may be an issue and longer tx)
which hepatitis’ have vaccines
only a and b NOT c or e. b protects against d
treatment for hep c
PI (evir) in combo with PEG and ribavirin. Sofosbuvir is best as not CI in advanced liver dsx and doesn’t have to be with PEG!
how often do you screen for DM
q3y in those 40 and older or at high risk for type 2, don’t screen in type one because can’t prevent
diabetes diagnosis
FPG 7 or more, 2 hour post or random 11.1 or more, A1c 6.5 or more
when does a diabetic patient get and statin and ace or arb
macrovascular complications/dsx, microvascular dsx, age 55 or older
when does a diabetic patient get ASA
2’ prevention only (macrovascular dsx included)
when does a diabetic patient get a statin only for vascular protection
age 40-55, age over 30 and diabetes for more than 15 years, required based on lipid guidelines
what are the target doses for perindopril, ramipril and telmisartan in diabetes based on trials
perind 8mg, ramipril 10mg, telmisartan 80mg.
exercise recomendations for diabetes
150minutes per week with 2-3x resistance training
SMBG- on insulin once per day
check at least once per day but at variable times
SMBG- on insulin multiple times per day
at least 3x/day at different times (ensure pre and psot prandial)
prediabetes definitions
a1c 6.0-6.4, impaired fasting glucose (6.1-6.9), impaired glucose tolerance (7.8-11)
metabolic syndrome
constellation of disorders; need 3 or more; abdominal obesity, HTN (even treated), increased TG, decreased HDL, FPG over 5.6 (or treated for DM)
can detemir or glargine insulin be mixed with other insulins
no not recommended
which insulins are recomended with CS11 (continuous SQ insulin) in diabetes
aspart or lispro
which diabetes med is safe at all levels of renal rx
repaglinide
which two diabetes meds are CI at Crcl less than 30
metformin and exenatide
symptomatic hyperglycemia and metabolic decompensation at diagnosis of type 2 diabetes requires
treatment with metformin (or other, but usually this) and insulin
neurogenic vs neuroglyopenic sx of hypoglycemia
neurogenic- autonomic fx. neuroglycopenic all have to do with brain/head (weak, drowsy, confused, HA, dizzy)
equal to 15g of glucose
6 lifesavers, 1 tbsp (15ml) honey, 3/4 cup juice or regular soft drink, 3 tsp (1 tbsp-ie 15ml) of table sugar dissolved in water
in patients taking acarbose, what must they be treated with in hypoglycemia
glucose NOT sucrose as this inhibits sucrose digestion
GLP1 vs DPP4 inh
GLP more nausea but lower A1c more
how are the glps1s given
lira- once daily, exenatide either once weekly or BID with meals, dulaglutide is once weekly. all SQ
what is a good ratio of basal to bolus
40% basal, 60% bolus (20% with each meal)
folic acid in pregnancy with DM
5mg daily x3 months prior to conception and for first 3 months, then 0.4-1mg until min 6 months post partum or done breast feeding
pregnancy with diabetes can accelerate
retinopathy-get eyes checked
order for drawing up insulin
clear (rapid) before cloudy (long)
meds that decrease a1c less than 1%
DAS (das sucks- thanks Caitlin)- DPP4, Acarbose, Secretagogues (SU and meglitinides) plus TZDs. Also possibly sglt2 as they are 0.7-1
