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NMR > Unit 5+6 > Flashcards

Unit 5+6 Flashcards

1
Q

At what waist circumference is a man thought be at medium risk

A

94-102cm

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2
Q

What waist cirumference is a woman thought to be at medium risk

A

80-88cm

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3
Q

What are adipokines

A

signalling agents found in WAT which influence processes like coagulation, appetite regulation

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4
Q

What is metaboliv syndrome

A

Cluster of conditions that cause an increased risk of DM and Cardiovascular related mortality

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5
Q

What do you need to to be diagnosed with MS

A 
BMI over 30, central obesity 
raised triglycerides
Reduced HDL cholesterol
Raised BP
Raised fasting blood glucose
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6
Q

What do triglycerides need to be over in MS

A

More than 150mg/dL

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7
Q

What does HDL need to be less than in Metabolic syndrome

A

Less than 40mg in males and 50mg in women

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8
Q

What does Raised BP need to be more than in Metabolic syndrome

A

more than 130/85

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9
Q

What does fasting glucose need to be more than in Metabolic syndrome

A

more than 5.6mmol/L

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10
Q

What is the main function of BAT

A

Thermoregulation- produces heat by oxidation of fatty acids

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11
Q

Whats the importance of UCP1 in BAT

A

Acts as a proton channel- diverts pool of protons in the mitochondiral intermembrane space away from ATP synthase- more heat produced less ATP

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12
Q

Where is BAT found on the body

A

Upper back and chest

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13
Q

Where is WAT found in the body

A

Subcutaneous in buttocks, hips, abdo regoins and

visceral fat- around organs

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14
Q

WHich type of WAT are women more likely to get

A

Subcutaneous- around hips, buttocks and abdomen

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15
Q

Why is Visceral fat good to be surrounded by organs

A

Contains macrophages + WAT derived signalling agents e.g. adipokines- sent to liver

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16
Q

What are the 6 types of Adipose derived signalling molecules

A

Adiponectin,,Free-fatty acids, IL6,leptin, Resistin,TNFa

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17
Q

Whats the role of Adiponectin in Diabetes

A

its a antiinflammaory and antiatherosclerosis,
Increases insulin sensitivity
Lower adiponectin fatter people ,

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18
Q

Role of free fatty acids in diabetes

A

Elevated FFA stimulate insulin secretion
Chronic elevation stops insulin production
Visceral FFA are deposited into liver, increasing hepatic gluconeogenesis and production of VLDL

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19
Q

What does the chronic inflammation of FFAs cause

A

Impairs the stimulation of insulin, damages beta cells and so no pancreatic insulin

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20
Q

How are beta cells involved in diabetes

A

Beta cells produce insulin

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21
Q

What happens to the levels of IL6 in diabetes

A

IL6 increases as weight does, its a pro-inflammatory cytokine
IL6 causes lipolysis which produces FFAs and increases leptin

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22
Q

How does leptin work in diabetes

A

Leptin is a satiety hormone, in obesity there is leptin resistance so you can’t tell when you’re full

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23
Q

How does resistin work in diabetes

A

Associated with insulin resistance, visceral produces 15x the amount of resistin than subcutaneous

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24
Q

How does TNFa work in diabetes

A

pro-inflammatory

Increases leptin, lipolysis, lipogenesis in adipocytes and imapirs insulin signalling

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25
Q

In low carb diets what is the max carb you’re allowed

A

20g, then increase to 100g when you’ve reached weight loss

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26
Q

What is ketosis

A

Fatty acids coverted to ketone bodies which are used for energy

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27
Q

How does high protein keep you satiated for longer

A

Decreases the expression for neuropeptide Y

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28
Q

How do low GI foods keep you satiated for longer

A

Digested more slowly

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29
Q

What are the health consequences associated with obesity

A

CVD
decreased life expectancy
T2DM
ARTHRITIS, INFERTILTIY

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30
Q

What are 3 symptoms associated with T1DM

A

Unexplained weight loss, polyuria, polydipsia

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31
Q

What does your HBA1c , random, fasting and 2 hr plasma conc need to be over to be diagnosed with DM

A

HBA1c: over 48mmol/mol
Random- less than 11.1mmol/mol
Fasting: less than 7

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32
Q

Name the rapid acting insulin

A

Aspart, glulisine, lispro
Onset is 15 mins
Peaks- 1-2hrs
Duration 4-6hrs

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33
Q

Short acting insulin

A

ActRapid
30-60mins
Peak- 2-4 hrs
Duration- 6-8

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34
Q

Name a long acting insulin analogue

A

Detemir
Glargine
Degludec- Tresiba

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35
Q

Name some intermediate acting analogue

A

Aspart (Novomix30) and Lispro

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36
Q

How often should blood glucose be monitored in T1DM in adults and children

A

Adults- QDS

Children- 5 capillary blood tests a day

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37
Q

When are you allowed to be on CSII

A

When HBA1c is 69mmol/mol despite on Multiple injections

Older than 12: Tried MDI but still get hypoglycemia

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38
Q

Where should you inject insulin

A

Fatty tissue, stomach, side of thigh or buttocks

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39
Q

Why should you leave a gap every time you inject insulin

A

Hard lumps called lipose are formed which stop insulin being absorbed

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40
Q

How should you inject insulin

A

prime pen so inlin leaking

Insert at 90 degree angle, count to 10

41
Q

Which is the longest duration of action of insulin

A

Glargine- 20-24hrs

Detemir- 12-24 hrs

42
Q

To manage T2DM how long do they have to try dietary and lifesyle advice

A

3 months before medication

43
Q

What is the MOA of metformin

A

Increases peripheral uptake of glucose

Reduces hepatic gluconeogenesis

44
Q

Side effects of metformin

A

GI disturbances, weight loss, lactic acidosis, reduces b12 absorption

45
Q

What are the symptoms of hypoglycaemia

A

Sweating, dizziness, nausea and confusion

46
Q

MOA of sulphonylureas

A

Increase insulin secretion

47
Q

Side effects of sulphonylureas with examples of them

A

Gliclazide, Glimepride, Glipizide, Gilbenclamide

Hypoglycemia, weight gain, hypersensitivity

48
Q

Examples of Meglinitides and which class of drug are they similar to

A

Regpaglinitide

Similar to Sulphonylurea as they increase isnulin but have shorter duration and rapid onset

49
Q

Side effects of Meglinitides

A

Hypoglycemia, weight gain, hypersensivity, visual disturbances, abdo pain and diarrhea

50
Q

MOA of Acarbose

A

Inhibitor alpha glucosidase, and decreases metabolism of carbs and sugars

51
Q

Mechanism of Pioglitazone

A

PPARy agonist
Weight gain
Dont use in heart failure patients

52
Q

Mechanism of DDP4 inhibitors

A

Gliptins

Increase incretins which stimualte insulin secretion

53
Q

Examples of icnretin mimetics

A

Exanatide, Liraglutide

54
Q

SGLT2I MOA

A

Inhibit reuptake of glucose and water so excreted in pee

55
Q

Whats the intial treatment of DM

A

Add metformin

56
Q

What if metformin is contraindicated in stage 1

A

Use Pioglitazone (PPYAR agonist)
Sulphonylurea or
DPP4I- liptins

57
Q

What is first intensification

A

Dual therapy
Metformin +sulphonylurea
Metformin +pioglitazone
Metformin +DDPP4I

58
Q

What is second intensification

A

Triple therapy
Metformin, DPP4I + sulphonylurea
Metformin, Pioglitazone +sulphonylurea
Start insulin therpay

59
Q

When would you use a incretin mimetic (Glucagon-1-peptide)

A

in triple therpay with metformin, sulphonylurea when metformin and 2 other oral drugs don’t work

60
Q

When can you use an incretin mimetic, under what conditions

A

BMI over 35+ a problem associated with obesity

BMI under 35+ can’t use insulin therapy, weight loss will benefit

61
Q

When would you definitely give a Statin in TYPE 1 diabetes

A

Older than 40
Diabetes more than 10yrs
Have established nephropathy
Have other CVD risk factors

62
Q

When would you give statin in T2DM

A

Give atorvastatin 20 to ppl who have a 10% or greater 10 yr risk of developing CVD

63
Q

How do you find out CVD risk

A

use QRISK3 tool

64
Q

When don’t you use aspirin/clopidogrel in diabetes

A

Don’t use it if they have T2 diabetes without CVD

65
Q

What is the main cause of blindness in CVD

A

Diabetic nephropathy

66
Q

How are the cells of the retina damaged

A

High blood glucose damages the blood vessels that supply the retina

67
Q

What are the risk factors for retinopathy

A

Poor diabetic control, hypertension, renal disease and hyperlipidaemia

68
Q

How should you manage diabetic nephropathy

A

Control BP and blood glucose , smoking cessation

69
Q

What should be the BP for people with DM with nephropathy

A

Less than 130/80

70
Q

What are the symptoms of peripheral neuropathy

A

Allodynia,leg cramps, numbness, pain, tingling

71
Q

What drugs should be sued in peripheral neuorpathy

A

Amitriptyline,duloexetine, gabapentin or pregablin

72
Q

What drug is used in acute rescue therapy

A

Tramadol

73
Q

Which cream do you give for localized neuropathic pain

A

Capsaicin cream

74
Q

What level of HBA1c should you avoid getting pregnant

A

above 86mmol/ml

75
Q

Which long acting insulin should be used during pregnancy

A

Isophane insulin (NPH)

76
Q

Which drugs should be discontinued in pregnancy with DM

A

Statins, ARBs, ACEIs

77
Q

What range does hypoglycaemia start

A

Less than 4mmol/mol

78
Q

What is thyrotoxicosis

A

syndrome where you’ve been exposed to elevated levels of thyroid hormones for a long time

79
Q

Thyrotoxicosis is most likely to produce which disease

A

Graves disease

80
Q

WHo is hyperthyroidism most common in

A

Women

81
Q

What is graves disease

A

Abnormal IgE which occupies TSH receptor- so mimicks TSH causing cell division and stimulating thyroid hormone secretion

82
Q

What are TRABs

A

Stimulatory Igs which inhibit TSH receptor

83
Q

What levels are elevated in Nodular disease

A

Only T3

84
Q

Which type of thyroidism has a gradual onset

A

Hypothyroidism

85
Q

Which thyroidism do you get weight gain

A

Hypothyroidism

86
Q

Which drugs alleviate symptoms of palpitations, tremor, anxiety in severe thyrotoxicosis

A

Non-selective beta blockers

87
Q

MOA of carbimazole

A

Prodrugs, converted to methiazole, prevents thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, reduceing T3 and t4

88
Q

How long is the treatment for graves disease

A

6-12 months

89
Q

Name the anti-thyroid drugs

A

Thiamazole, carbimazole, propylthiouracil, thionamide

90
Q

Which type of thyroidism does Hashimotos cause

A

Hypothyroidism

91
Q

What is the most common side effect of anti-throid drugs

A

Rash and Arthropathy(inflammation of the joint)

92
Q

Which 3 symptoms require urgent FBCs as a side effect of the Anti-thyroid drugs

A

Mouth ulcers, sore throat and pyrexia

93
Q

Carbimazole
dose
Half life
biological effect

A

40-60mg
4-6 hrs for half life
Biological effect lasts up to 40 hrs

94
Q

How often do you check t4 conc with carbimazole

A

Every 6 weeks until they’re normalized

95
Q

Which anti thyroid drug ispreferred in 1st trimester of pregnancy

A

Propylthiouracil over carbimazole

96
Q

What drugs are reccomended for postutal hypotension

A

Fluodrocortisone 100-400mcg OD + can combine with flurbiprofen and ephedrine HCL

97
Q

What drug can be used in gustatory sweating

A

Antimuscarinic Propantheline bromide

98
Q

What are the symptoms of Thyroid crisis

A

Tachycardia, muscle weakness, hyperthermia, sweating and vomiting, anxious and psychotic

99
Q

Drug management for thyroid crisis

A

Propylthiouracil oral +lugols iodine
IV glucocorticoids- inhibit deiodinase
IV BB-propanolol is preffered bc it inhibtis deiodinase

NMR (3 decks)

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