notes 465- DM, thyroid, anemia

Question 1

diagnosis of DM

Answer 1

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

Question 2

when might urine ketone testing be used

Answer 2

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

Question 3

eligibility for TPA in stroke

Answer 3

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)

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

thiazide and ace

Question 7

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

Answer 7

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

Question 8

dipyradimole/ASA’s only indication is in

Answer 8

2’ stroke prevention (aggrenox)

Question 9

when is radioactive iodine used? CI?

Answer 9

hyeprthyroid. CI in pregnancy and exopthalmus (can worsen)

Question 10

2 drugs that can induce hypothyroidism

Answer 10

amiodarone and lithium

Question 11

when to expect sx improvement with levothyroxine

Answer 11

2-3 weeks max at 6

Question 12

definition of anemia (M/F)

Answer 12

M= less than 130, F= less than 120

Question 13

heme vs non heme iron

Answer 13

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

Question 14

what increases absorption of iron

Answer 14

vitamin C (oranges, peppers)

Question 15

enteric coated iron

Answer 15

decrease absorption, especially in patients with decreased gastric acidity

Question 16

acronym for iron strengths

Answer 16

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

Question 17

iron in kids

Answer 17

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

Question 18

which parenteral iron needs test dose due to risk of anaphylaxis

Answer 18

dextran

Question 19

how long do you continue therapy after anemia resolved

Answer 19

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

Question 20

cockcroft gault equation

Answer 20

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

Question 21

what does BNP indicate

Answer 21

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

Question 22

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

Answer 22

gliclizide. Glyburide must be stopped

Question 23

at what renal fx is metformin CI

Answer 23

less than 30- lactic acidosis

Question 24

when are thiazides no longer effective for diuresis

Answer 24

less than 30ml/min

Question 25

treatment of hyperkalemia

Answer 25

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

Question 26

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

Answer 26

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

Question 27

cardiac meds to adjust in renal dysfx

Answer 27

sotalol, nadolol, digoxin, fibrates

Question 28

analgesics to adjust in renal dysfx? which to avoid?

Answer 28

adjust codeine and morphine, avoid meperidine

Question 29

psychotropics to adjust in renal dysfx

Answer 29

lithium, gaba, tarzodone, topiramate

Question 30

misc drugs to adjust inr enal dysfx

Answer 30

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

Question 31

who should not get ASA (age)

Answer 31

kids 0-11- reye's syndrome

Question 32

diarrhea in kids 3-11

Answer 32

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

Question 33

good treatment for travellor | s diarrhea- ABX

Answer 33

azith or FQ

Question 34

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

Answer 34

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

Question 35

hep a vs hep b treatment

Answer 35

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)

Question 36

which hepatitis' have vaccines

Answer 36

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

Question 37

treatment for hep c

Answer 37

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!

Question 38

how often do you screen for DM

Answer 38

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

Question 39

diabetes diagnosis

Answer 39

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

Question 40

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

Answer 40

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

Question 41

when does a diabetic patient get ASA

Answer 41

2' prevention only (macrovascular dsx included)

Question 42

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

Answer 42

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

Question 43

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

Answer 43

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

Question 44

exercise recomendations for diabetes

Answer 44

150minutes per week with 2-3x resistance training

Question 45

SMBG- on insulin once per day

Answer 45

check at least once per day but at variable times

Question 46

SMBG- on insulin multiple times per day

Answer 46

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

Question 47

prediabetes definitions

Answer 47

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

Question 48

metabolic syndrome

Answer 48

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

Question 49

can detemir or glargine insulin be mixed with other insulins

Answer 49

no not recommended

Question 50

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

Answer 50

aspart or lispro

Question 51

which diabetes med is safe at all levels of renal rx

Answer 51

repaglinide

Question 52

which two diabetes meds are CI at Crcl less than 30

Answer 52

metformin and exenatide

Question 53

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

Answer 53

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

Question 54

neurogenic vs neuroglyopenic sx of hypoglycemia

Answer 54

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

Question 55

equal to 15g of glucose

Answer 55

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

Question 56

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

Answer 56

glucose NOT sucrose as this inhibits sucrose digestion

Question 57

GLP1 vs DPP4 inh

Answer 57

GLP more nausea but lower A1c more

Question 58

how are the glps1s given

Answer 58

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

Question 59

what is a good ratio of basal to bolus

Answer 59

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

Question 60

folic acid in pregnancy with DM

Answer 60

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

Question 61

pregnancy with diabetes can accelerate

Answer 61

retinopathy-get eyes checked

Question 62

order for drawing up insulin

Answer 62

clear (rapid) before cloudy (long)

Question 63

meds that decrease a1c less than 1%

Answer 63

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