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MPharm 2 - PH2113 > Unit 5 - Diabetes 3 > Flashcards

Unit 5 - Diabetes 3 Flashcards

1
Q

What is a co-morbidity?

A

Disease or condition that coexists with a primary disease but also stands on its own as a specific disease
- may be physical or mental conditions

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2
Q

What are the possible co-morbidities with diabetes?

A
  • hypertension up to 75% of adults
  • dyslipidaemia
  • cardiovascular disease
  • kidney disease
  • cancer
  • depression
  • non-alcoholic fatty liver disease
  • obstructive sleep apnoea
  • obesity
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3
Q

What are the two types of complications of diabetes?

A
  • macrovascular damage

- microvascular damage

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4
Q

What is the cause of macrovascular damage?

A

Damage to larger blood vessels

  • coronary arteries
  • aorta
  • arteries in the brain and limbs
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5
Q

What is the cause of microvascular damage?

A

Damage to small blood vessels

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6
Q

Give examples of macrovascular complications

A
  • myocardial infarction (MI) and stroke
  • coronary heart disease (CHD)
  • congestive heart failure
  • peripheral vascular disease
  • accelerated atherosclerosis
  • predisposing to peripheral vascular
  • ischaemic heart disease
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7
Q

What percentage of patients with diabetes die from heart disease or stroke?

A

65%

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8
Q

How much higher is the death rate from heart disease or stroke with diabetes compared to those without the disease?

A

2 to 4 times higher

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9
Q

How does diabetes contribute to hypertension?

A

Increasing fluid volume
- diabetes can increase the total amount of fluid in the body
- raises blood pressure
Increasing arterial rigidity
- diabetes can decrease the ability of the blood vessels to stretch
- increasing average blood pressure
Impaired insulin handling
- changes in the way the body produces and deals with insulin
- directly cause increase in blood pressure

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10
Q

At what blood pressure is intervention recommended?

A

> 135/85 mmHg

  • unless the adult with type 1 diabetes has albuminuria or 2 more features of metabolic syndrome
  • should be 130/80 mmHg
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11
Q

What is the first line treatment of hypertension in adults with type 1 diabetes?

A

Renin-angiotensin system blocking drug

  • ACEI
  • ARB
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12
Q

What is dyslipidemia?

A

High levels of lipids in the blood

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13
Q

How does type 2 diabetes cause dyslipidemia?

A
  • decreased high density lipoprotein (HDL)
  • increased triglycerides
  • postprandial lipemia
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14
Q

How does type 1 diabetes cause dyslipidemia?

A
  • hypertriglyceridemia
  • normal or increased levels of high density lipoprotein (HDL)
  • unless glycaemic control is poor or nephropathy is present
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15
Q

What are the priorities of treating dyslipidemia?

A
  1. LDL cholesterol lowering
    - statin 1st line
  2. HDL cholesterol rising
    - lifestyle
  3. triglyceride lowering
    - glycaemic control then fibrates
    - fenofibrates
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16
Q

What is ezetimibe?

A

A drug that lowers plasma cholesterol levels.

  • acts by decreasing cholesterol absorption in the small intestine
  • recommended as 2nd line therapy for those intolerant of statins
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17
Q

How does ezetimibe work?

A

Blocks the absorption of dietary cholesterol and reabsorption of cholesterol entering the small intestine in bile
- especially effective when combined with a statin

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18
Q

What is the function of Omacor?

A

Purified omega-3-fatty acids can lower triglycerides but have little effect on HDL and LDL cholesterol

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19
Q

What values should be obtained in a full fasting blood lipid profile?

A 
Total cholesterol
- target less than 4 mmol/L
Low density lipoprotein (LDL)
- target less than 3 mmol/L
Triglycerides
- target less than 1.7 mmol/L
High density lipoprotein (HDL)
20
Q

What effect does lowering the concentration of LDL and triglycerides and raising the concentration of HDL have?

A

Slows the progression of atherosclerosis

21
Q

What is non-alcoholic fatty liver disease?

A

Build up of fat in the liver

22
Q

What percentage of diabetic patients have non-alcoholic fatty liver disease?

A

70%

23
Q

What lifestyle interventions may improve non-alcoholic fatty liver disease?

A
  • weight loss
  • regular exercise
  • smoking cessation
  • healthy diet
24
Q

What does tight control of blood pressure lead to?

A

Reduced number of cardiac events and stroke

25
Q

What is the target diastolic blood pressure to avoid cardiovascular disease as a complication of diabetes?

A

80 mmHg

26
Q

Which hypotensive agents should be used with caution to control blood pressure in patients with diabetes?

A

Thiazides

Beta-blockers

27
Q

How can lipid profiles be improved to manage cardiovascular disease as a complication of diabetes?

A
  • reduce LDL cholesterol
  • increase HDL cholesterol
  • reduce triglycerides
28
Q

What lifestyle changes can be made in diabetic patients to avoid cardiovascular disease?

A

Smoking cessation

Weight loss

29
Q

What is the function of anti-thrombotic therapy?

A

Reduces platelet aggregation and inhibit thrombus formation in the arterial circulations

30
Q

Which drug should NOT be offered to adults with type 1 diabetes for the primary prevention of cardiovascular disease?

A

Aspirin

31
Q

Gives examples of microvascular damage as a complication of diabetes?

A 
Damage to eyes
- diabetic retinopathy
Damage to the kidneys
- diabetic nephropathy
Damage to nerves
- diabetic neuropathy
32
Q

What is the leading cause of preventable sight loss in the UK?

A

Diabetes

33
Q

How does diabetes cause damage to the eye?

A

Blood vessels in the retina of the eye can become

  • blocked
  • leaky
  • grow haphazardly
34
Q

How can eye problems be prevented in diabetic patients?

A 
Get your eyes screened
Look out for changes to your eyesight
- seeing floaters
- whispy clouds
- floating in and out your vision
- dimmer vision
- struggling to see in the dark
- blurred vission
Cataracts and glaucoma more common in diabetics
Patients should have annual eye test
- retinal screeing
Retinopathy screening is different from a general eye examination
- should be arranged upon diagnosis and annually thereafter
35
Q

What are the early symptoms of diabetic nephropathy?

A

No symptoms

36
Q

How is diabetic nephropathy diagnosed?

A

Detect protein in urine through urine test

- albumin

37
Q

What are the symptoms of diabetic nephropathy?

A
  • albuminuria
  • hypertension
  • declining renal function
38
Q

What are the symptoms of diabetic nephropathy if kidney damage is severe?

A
  • weight loss
  • poor appetite
  • swollen ankles
  • feeling tired
  • feeling sick
39
Q

How can diabetic nephropathy be reversed?

A

Early detection and treatment

40
Q

How can diabetic nephropathy be treated?

A

Control of blood glucose
Control of blood pressure
- ACEI or angiotensin receptor blockers (ARBs)
- ACEI used to minimise decline in renal function even if BP normal
- ACEI not only lower BP but also help protect kidneys from further damage and decrease the amount of protein in urine

41
Q

What harms the nerves’ ability to transmit signals and damages the blood vessels that carry oxygen and nutrients to the nerves?

A

Hyperglycaemia

42
Q

What are the three types of neuropathy?

A
  • sensory
  • autonomic
  • motor
43
Q

What is affected by sensory neuropathy?

A
  • touch
  • temperature
  • pain
  • feet
  • legs
44
Q

What is the treatment for sensory neuropathy?

A
  • duloxetine

- amitriptyline

45
Q

Which body parts are affected by autonomic neuropathy?

A
  • organs

- glands

46
Q

What is the treatment of gastroparesis?

A
  • metoclopramide

- domperidone

47
Q

What is the treatment for diabetic diarrhoea?

A

Codeine phosphate

MPharm 2 - PH2113 (50 decks)

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