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OTC > notes 465- DM, thyroid, anemia > Flashcards

notes 465- DM, thyroid, anemia Flashcards

1
Q

diagnosis of DM

A

FPG 7 or more, A1C 6.5 or more, 2hPPG or any random glucose over 11.1

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2
Q

when might urine ketone testing be used

A

pregnancy, acute illness or stress, preprandial over 14, DKA sxpresent

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3
Q

eligibility for TPA in stroke

A

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)

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4
Q

if not eligible for TPA in a stroke, what do you give

A

if hemorrhage ruled out, give antiplatelet (aspirin). BUT, if assumed cardioembolic (Afib, mechanical valve, severe CHF) might get anticoag instead

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5
Q

what are patients who just had a stroke at high risk of

A

DVT- must provide proph (LMWH, UFH)-can be used 48 hours after hemorrhagic

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6
Q

first line drugs to treat BP in someone after acute phase of stroke

A

thiazide and ace

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7
Q

do you treat high BP in acute phase of stroke (first 72 hours)

A

not usually- only if extreme like greater than 220. We want high pressure and blood flow

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8
Q

dipyradimole/ASA’s only indication is in

A

2’ stroke prevention (aggrenox)

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9
Q

when is radioactive iodine used? CI?

A

hyeprthyroid. CI in pregnancy and exopthalmus (can worsen)

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10
Q

2 drugs that can induce hypothyroidism

A

amiodarone and lithium

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11
Q

when to expect sx improvement with levothyroxine

A

2-3 weeks max at 6

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12
Q

definition of anemia (M/F)

A

M= less than 130, F= less than 120

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13
Q

heme vs non heme iron

A

heme-animals, better absorbed and more consistent, less affected by diet. non heme= plants, most supplements, needs acid to absorb

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14
Q

what increases absorption of iron

A

vitamin C (oranges, peppers)

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15
Q

enteric coated iron

A

decrease absorption, especially in patients with decreased gastric acidity

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16
Q

acronym for iron strengths

A

fish swim great (fumarate, sulfate, gluconate- 33,20,11, blue-red-green). Polysaccharide iron 100%

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17
Q

iron in kids

A

can be toxic. dose 3-6mg/kg/day divided TID

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18
Q

which parenteral iron needs test dose due to risk of anaphylaxis

A

dextran

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19
Q

how long do you continue therapy after anemia resolved

A

3-6 months to allow for store repletion. Hb increases about 10g/L per week, and is usually corrected in six

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20
Q

cockcroft gault equation

A

[(140-age)xABW}/[0.814xSCrmmmol/L] x0.85 if female

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21
Q

what does BNP indicate

A

fluid overload or increased stretch of heart muscle (heart failure)

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22
Q

which SU can be used up until dialysis? which must be stopped at 50?

A

gliclizide. Glyburide must be stopped

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23
Q

at what renal fx is metformin CI

A

less than 30- lactic acidosis

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24
Q

when are thiazides no longer effective for diuresis

A

less than 30ml/min

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25
Q

treatment of hyperkalemia

A

kayexelate (CI in obstructive bowel disease), if severe combo of calcium gluconate, glucose, insulin, sodium bicarb, sabutamol, kayex and possibly dialysis

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26
Q

which antibiotics need to be adjusted for renal dysfx? which on CI if Crcl less than 60?

A

adjust: vanco, AG, septra, FQ, pens, cephs. Nitrofurantoin CI less than 60

27
Q

cardiac meds to adjust in renal dysfx

A

sotalol, nadolol, digoxin, fibrates

28
Q

analgesics to adjust in renal dysfx? which to avoid?

A

adjust codeine and morphine, avoid meperidine

29
Q

psychotropics to adjust in renal dysfx

A

lithium, gaba, tarzodone, topiramate

30
Q

misc drugs to adjust inr enal dysfx

A

colchicine,H2RAs, metoclopromide, glicli, glybur, sitaglipt, metformin

31
Q

who should not get ASA (age)

A

kids 0-11- reye’s syndrome

32
Q

diarrhea in kids 3-11

A

ORT (if dehydrated), attapulgite and then refer if not better

33
Q

good treatment for travellor

s diarrhea- ABX

A

azith or FQ

34
Q

there are 2 types of liver injury- what liver tests indicate each

A

1) cholestatic (ALP and GGT) 2) hepatocellular (AST, ALT)

35
Q

hep a vs hep b treatment

A

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)

36
Q

which hepatitis’ have vaccines

A

only a and b NOT c or e. b protects against d

37
Q

treatment for hep c

A

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!

38
Q

how often do you screen for DM

A

q3y in those 40 and older or at high risk for type 2, don’t screen in type one because can’t prevent

39
Q

diabetes diagnosis

A

FPG 7 or more, 2 hour post or random 11.1 or more, A1c 6.5 or more

40
Q

when does a diabetic patient get and statin and ace or arb

A

macrovascular complications/dsx, microvascular dsx, age 55 or older

41
Q

when does a diabetic patient get ASA

A

2’ prevention only (macrovascular dsx included)

42
Q

when does a diabetic patient get a statin only for vascular protection

A

age 40-55, age over 30 and diabetes for more than 15 years, required based on lipid guidelines

43
Q

what are the target doses for perindopril, ramipril and telmisartan in diabetes based on trials

A

perind 8mg, ramipril 10mg, telmisartan 80mg.

44
Q

exercise recomendations for diabetes

A

150minutes per week with 2-3x resistance training

45
Q

SMBG- on insulin once per day

A

check at least once per day but at variable times

46
Q

SMBG- on insulin multiple times per day

A

at least 3x/day at different times (ensure pre and psot prandial)

47
Q

prediabetes definitions

A

a1c 6.0-6.4, impaired fasting glucose (6.1-6.9), impaired glucose tolerance (7.8-11)

48
Q

metabolic syndrome

A

constellation of disorders; need 3 or more; abdominal obesity, HTN (even treated), increased TG, decreased HDL, FPG over 5.6 (or treated for DM)

49
Q

can detemir or glargine insulin be mixed with other insulins

A

no not recommended

50
Q

which insulins are recomended with CS11 (continuous SQ insulin) in diabetes

A

aspart or lispro

51
Q

which diabetes med is safe at all levels of renal rx

A

repaglinide

52
Q

which two diabetes meds are CI at Crcl less than 30

A

metformin and exenatide

53
Q

symptomatic hyperglycemia and metabolic decompensation at diagnosis of type 2 diabetes requires

A

treatment with metformin (or other, but usually this) and insulin

54
Q

neurogenic vs neuroglyopenic sx of hypoglycemia

A

neurogenic- autonomic fx. neuroglycopenic all have to do with brain/head (weak, drowsy, confused, HA, dizzy)

55
Q

equal to 15g of glucose

A

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

56
Q

in patients taking acarbose, what must they be treated with in hypoglycemia

A

glucose NOT sucrose as this inhibits sucrose digestion

57
Q

GLP1 vs DPP4 inh

A

GLP more nausea but lower A1c more

58
Q

how are the glps1s given

A

lira- once daily, exenatide either once weekly or BID with meals, dulaglutide is once weekly. all SQ

59
Q

what is a good ratio of basal to bolus

A

40% basal, 60% bolus (20% with each meal)

60
Q

folic acid in pregnancy with DM

A

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

61
Q

pregnancy with diabetes can accelerate

A

retinopathy-get eyes checked

62
Q

order for drawing up insulin

A

clear (rapid) before cloudy (long)

63
Q

meds that decrease a1c less than 1%

A

DAS (das sucks- thanks Caitlin)- DPP4, Acarbose, Secretagogues (SU and meglitinides) plus TZDs. Also possibly sglt2 as they are 0.7-1

OTC (21 decks)

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