Term
| How are the protease inhibitors telaprevir and boceprevir used in Hep C? |
|
Definition
Used as a third add on drug
Increases SVR (sustained virologic response). Keeps it from actively replicating. |
|
|
Term
| What are the 5 classes of ORAL antihypteglcemic agents for T2DM? |
|
Definition
1) Secretagogue
2) Biguanide
3) alpha-Glucosidase inhibitor
4) Glitazone (TZD)
5) DPP-4 inhibitors |
|
|
Term
| What 5 drugs are considered to be the Secretagogues? |
|
Definition
1) Diabeta/glynas/micronase (Glyburide)
2) Glucotrol (Glipizide)
3) Amaryl (Glimepiride)
4) Prandin (Repaglinide)
5) Starlix (Nateglinide) |
|
|
Term
| What drugs are in the Biguanide class? |
|
Definition
|
|
Term
| What drugs are in the alpha-Glucosidase inhibitor group? |
|
Definition
Precose (Acarbose)
Glycet (Miglitol) |
|
|
Term
| What drugs are in the Glitazone/TZD class? |
|
Definition
Actos (Pioglitazone)
Avandia (Rosiglitazone) |
|
|
Term
| What drug in the Glitazone class is only available by the REMS program? |
|
Definition
|
|
Term
| What drugs are in the DPP-4 inhibitor class? |
|
Definition
Januvia (Sitagliptin)
Onglyza (Saxagliptin)
Linagliptin (Tradjenta) |
|
|
Term
| How do the Secretagogues work (MOA)? What does their efficacy depend on? |
|
Definition
Increase basal and postprandial insulin secretion
Relies on functioning Beta-cells |
|
|
Term
| How much do sulfonylureas and repaglinide reduce A1C by? |
|
Definition
|
|
Term
| How much does Nateglinide reduce A1C by? |
|
Definition
|
|
Term
| How are Sulfonylureas dosed? |
|
Definition
|
|
Term
| How is Repaglinide and Nateglinide dosed? |
|
Definition
|
|
Term
| What are the side effects associated with the Secretagogues class? |
|
Definition
| Wt GAIN, skin rxn, allergy, N/V |
|
|
Term
| What is the greatest risk with the Secretagogues? |
|
Definition
|
|
Term
| What are the forms of viral hepatitis? |
|
Definition
|
|
Term
| Most common form of viral hepatitis in US? |
|
Definition
|
|
Term
| What are the most likely forms of hepatits to become chronic? |
|
Definition
|
|
Term
| Hepatitis A and E are similar. They share some risk factors, what are they? |
|
Definition
Poor sanitation
Sexual contact/transmission
Illicit drug use |
|
|
Term
| KNOW TABLE 24-1 risk factors |
|
Definition
|
|
Term
| What form of hepatitis is co-dependant on hep B? |
|
Definition
|
|
Term
| What forms of hepatitis share risk factors? |
|
Definition
|
|
Term
| How is hepatitis transmitted? |
|
Definition
Blood borne pathogens
Sexual transmission
Food/fecal oral |
|
|
Term
| Who is more at risk for hepatitis? |
|
Definition
|
|
Term
| what are ways to Dx hepatitis? |
|
Definition
1) immune response- lab serology. Hep panel blood tests (most import)
2) liver fxn tests (severity)
3) liver biopsy (dx and severity) |
|
|
Term
| Table 24-2 know what's on the chart to be able to interpret it. don't memorize |
|
Definition
|
|
Term
| What forms of hepatits are there vaccines for? |
|
Definition
| Hep A and B. B protects against D as well (must have B to get D) |
|
|
Term
| What forms of hep are there No vaccines for? |
|
Definition
|
|
Term
| Hep A, D and E are typically acute cases. Their treatment therefore are...? |
|
Definition
Supportive care
Immunocompetent and some comrpimised it will pass |
|
|
Term
| Hep B and C have potential to be chronic. |
|
Definition
|
|
Term
|
Definition
| Sanitation, therefore more prevelant in thirdworld conditions |
|
|
Term
| What is preventative tx for hep A? |
|
Definition
Vaccine
Sanitation
IMIG (IM immune globulin) |
|
|
Term
| What's special about immune globulin? |
|
Definition
| Passive immunity- boosts immunity for small time frame. |
|
|
Term
| Who would get IMIG and not vaccine? |
|
Definition
Allergies to vaccines
Immune comprimised
Where it causes harm or can't be effective |
|
|
Term
| When is it Ok to give IMIG in relation to vaccines? |
|
Definition
| No live vaccines w/ IMIG (MMR etc) so you'd have to separate the two by 3 months! |
|
|
Term
| What vaccine can you administer with IVIG for post exposure prophylaxis? |
|
Definition
|
|
Term
| How long does it generally take for a vaccine take to take effect? |
|
Definition
|
|
Term
|
Definition
| 5months, if longer you need repeated dose |
|
|
Term
| If travelling to an hep endemic area and will be going within 2wks (vaccine hasn't started working) what can you do to prophylax? |
|
Definition
|
|
Term
| What are the two hep A vaccines? |
|
Definition
|
|
Term
| Who do we vaccinate for hep A? |
|
Definition
International travelers less than 40yo
If greater than 40 or immune comprimiesed add IMIG |
|
|
Term
| What is post exposure prophylaxis for Hep A? |
|
Definition
| Hep A vaccine and IVIG within 14 days of exposure and it's pretty good at preventing infxn |
|
|
Term
| What are the risk factors for Hep B? |
|
Definition
Blood borne pathogens
Sexual contact |
|
|
Term
| when are most children vaccinated for Hep B? |
|
Definition
|
|
Term
| What is the dose timing of Hep B? |
|
Definition
|
|
Term
| What is the immune globulin for hep B? |
|
Definition
|
|
Term
| What are the two Hep B vaccines? |
|
Definition
|
|
Term
| Is hep B preventable from having chronic hep b? |
|
Definition
| Yes, only about 5% develop chronic. Immuno competence has to do with chronic formation |
|
|
Term
| What is preexposure and post exposure prophylaxis for hep b? |
|
Definition
|
|
Term
| Pregnancy (hepB surface antigen +) what treatment should be given? |
|
Definition
|
|
Term
| Pregnant mother is hepB surface antigen negative,how should you treat? |
|
Definition
|
|
Term
| What does HepB surface antigen indicate? |
|
Definition
|
|
Term
| How long does the hepB vaccine last? |
|
Definition
|
|
Term
| In immuno comprimised pt what's important to do when hep b vaccination series is done? |
|
Definition
| check levels to make sure that immunocompetence is acheived with hep B |
|
|
Term
| Who is the hep A and B combination vaccine indicated in? |
|
Definition
| 18yo or older pt. Saves extra needle sticks. Just as effective |
|
|
Term
| What is the Hep A and B combo vaccine called? |
|
Definition
|
|
Term
| Drugs for hepatits b of the same class should what? |
|
Definition
|
|
Term
| What drugs can be used together in chronic hep B? |
|
Definition
| Drugs NOT in the same class |
|
|
Term
| How do you determine treatment of hepatitis B? |
|
Definition
What hetatitis drugs have they been on before?
What his their history?
What is their immune status? |
|
|
Term
| What is something important to remeber about Lamivudine (Epivir-HBV)? |
|
Definition
| It increases resistance to other therapies and therefore shouldn't be used first line |
|
|
Term
| What is something important to remeber about Lamivudine (Epivir-HBV)? |
|
Definition
| It increases resistance to other therapies and therefore shouldn't be used first line |
|
|
Term
| What is the resistance of Adefovir Dipivoxil after 5yrs? |
|
Definition
|
|
Term
| What hetpatitis drugs don't need renal adjustment? |
|
Definition
|
|
Term
| What drug wouldn't you use with tenofovir? |
|
Definition
|
|
Term
| Which is preffered? tonofovir or adenofvir |
|
Definition
|
|
Term
| What drug can you use if tenofvir stops working? |
|
Definition
|
|
Term
|
Definition
| Hepatitis B Immune globulin |
|
|
Term
| What dosing should a genotype 1 hepC patient have of what drug? |
|
Definition
| Weight based dosing of ribovirin |
|
|
Term
| What type of dosing of riboviron does genotypes 2 and 3 of HepC need? |
|
Definition
|
|
Term
| Are there any vaccines for hepC? |
|
Definition
|
|
Term
| what is prophylaxis for Hep C? |
|
Definition
| Life style modification, avoid high risk behaviors |
|
|
Term
| What is the gold standard for treatment of chronic Hep C? |
|
Definition
| Pegylated Interfereon (Pegasys and Pegatron) |
|
|
Term
| What is another good treatment for Hep C? |
|
Definition
|
|
Term
| What is the best treatment for Hep C? |
|
Definition
| Combination of Pegalated Interferon AND riboviron |
|
|
Term
| What is the difference in pegylated and non pegylated? |
|
Definition
| Poly ethylene glycol attached to molecule to extend the half life |
|
|
Term
| What are the protease inhibtors used for Hep C? |
|
Definition
| Telaprevir and boceprevir |
|
|
Term
| What does protease inhibtors decrease the chance of in hep C? |
|
Definition
| Decreases likelyhood of transmission AND developemnet of chiroisis |
|
|
Term
|
Definition
|
|
Term
| What does protease inhibitors increase the likely hood? |
|
Definition
| Achieving SBR (sustained biologic response) |
|
|
Term
| What do you monitor for pegylated interferon and riboviron? What are counseling points? |
|
Definition
|
|
Term
| What is best prophylaxis for Hep E? |
|
Definition
| Avoid risk factors (sanitation) |
|
|
Term
| What is treatment for Hep E infection? |
|
Definition
|
|
Term
| What is prophylaxis for Hep D? |
|
Definition
|
|
Term
|
Definition
| what ever the patient says it is. It is subjective |
|
|
Term
|
Definition
| very- 2nd leading cause of time off work next to common cold is back or joint pain |
|
|
Term
| Everyone is always one step away from needing an opiate |
|
Definition
|
|
Term
| What are three types of pain |
|
Definition
Visceral (organ)
Somatic (connective tissue ie, skin bone etc) |
|
|
Term
|
Definition
pain that is caused by stimulation of peripheral nerve fibers tha
Nociceptive pain may also be divided into "visceral," "deep somatic" and "superficial somatic" pain |
|
|
Term
| How is organ pain normally described? |
|
Definition
| duller, not able to pinpoint |
|
|
Term
| how is somatic pain described? |
|
Definition
|
|
Term
| What are characteristics of neuropathic pain? |
|
Definition
Numbness/tingling
Pins and needles feel
parasethesis |
|
|
Term
| What is neuropathic pain? |
|
Definition
| Actually tissue damage to the nerve itself |
|
|
Term
| Can nerve damage be reveresed? |
|
Definition
|
|
Term
|
Definition
| Disruption in nerve pathway |
|
|
Term
| Remember neuropathyways with pain can "rewire" and not be reversed. |
|
Definition
|
|
Term
| What are characteristics of acute pain? |
|
Definition
| Sweating, wincing, grimacing, inc BP/HR |
|
|
Term
| What are the characteristics of chronic pain? |
|
Definition
Disability
Long term (3-4mo) |
|
|
Term
| What are the two classifications/types of pain? |
|
Definition
|
|
Term
| Know table 69-1 for O'neil |
|
Definition
|
|
Term
| How do you assess pt for pain? |
|
Definition
1) When did it begin? How long have you had it?
2) what makes it better?
3) what makes it worse?
4) where is the pain?
5) how does it compare with the other pain you have experienced?
6) Does intensity change with time? |
|
|
Term
| Should you expect to achieve zero pain? |
|
Definition
|
|
Term
| Establish what reasonable therapy is |
|
Definition
|
|
Term
| As people feel better they do more, what does this mean for pain? |
|
Definition
| Pain score may be the same, but AODL may be better. This is GOOD. |
|
|
Term
| When might someone be a drug seeker or selling drugs? |
|
Definition
| Same pain score and no change in ADLs |
|
|
Term
| What do we use to determine the line of agents? |
|
Definition
|
|
Term
| Is dependance and tolerance to medication usual in Acute pain? |
|
Definition
|
|
Term
| Is dependance and tolerance to medication common in chronic pain? |
|
Definition
|
|
Term
| How likely is it that there is a psychological component to chronic pain? |
|
Definition
Often a Major problem
Not usually present in acute pain |
|
|
Term
| Is depression common with chronic pain? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What do we use for mild pain treatment? |
|
Definition
APAP, NSAID (non-opiods) +/- adjuvent
Level 1 |
|
|
Term
| What do you use to treat moderate pain? |
|
Definition
Low potency Opiod and tramadol w/ APAP or NSAID +/- adjuvent +/- non-opiod
Level 2 |
|
|
Term
| What do you use for severe pain? |
|
Definition
High potency Opiods +/- adjuvent +/- non-opiod
Level 3 |
|
|
Term
| What is the max daily dose of APAP? |
|
Definition
|
|
Term
| What is the max daily dose of Ibuprofen? |
|
Definition
|
|
Term
| How does APAP work? (MOA) |
|
Definition
| Decreases prostaglandins in CNS |
|
|
Term
| What is the significance of CNS prostaglandin action of APAP? |
|
Definition
| No anti-inflamatory response (peripherally) |
|
|
Term
| leading cause of liver failure? |
|
Definition
|
|
Term
| ?What are the contraindications for tylenol thereapy |
|
Definition
Alcohol, chirosis, heptatitis, liver disease
Biggest problem is APAP combo drug addition |
|
|
Term
|
Definition
| Cycloxygenase inhibition AT THE SITE OF INFLAMMATION. Prostiglandin effect too (fever) |
|
|
Term
| If one class of NSAID doesn't work with optimized dose, before you move to tramadol or another opioid what should you do? |
|
Definition
|
|
Term
| What is the most common salicylate? |
|
Definition
|
|
Term
| What is the major notable effect of ASA? |
|
Definition
| Irreversible platelet inhibitor |
|
|
Term
| Know to DC ASA 5-10d before surgery because of platelet turnover needed to eliminate drug. |
|
Definition
|
|
Term
| What is the ASA NSAID interaction that we need to be concerned about ? |
|
Definition
|
|
Term
| What is a contraindication for NSAID? |
|
Definition
| GI bleed (req hospitalization) and RENAL FAILURE |
|
|
Term
| Which should you take first? ASA or NSAID? |
|
Definition
| Take ASA to get your platelet effect first |
|
|
Term
| If pt needs to be on ASA for MI or Stroke do we still use NSAID? |
|
Definition
|
|
Term
| What does inhibition of prostacycline cause? |
|
Definition
|
|
Term
| What inhibits prostacycline? |
|
Definition
|
|
Term
| 30-50ml/min what should be assessed w/ NSAID? |
|
Definition
|
|
Term
| What are some drug interactions to watch with NSAIDs? |
|
Definition
Anticoagulents
SSRI (inc GI bleeds)(both drugs chronicly) |
|
|
Term
| What's max daily dose of ASA? |
|
Definition
|
|
Term
| What is a uniquely common side effect of ASA? |
|
Definition
Tinnitus
Also can cause asthma problems
Allergies |
|
|
Term
|
Definition
Ibuprofen
Etoldolac
Mobic
Naproxen |
|
|
Term
| What is normal dosing of Ibuprofen |
|
Definition
800mg q5-8hr
Reverisble platelet inhibition is notable |
|
|
Term
| What is the drug of choice for cancer bone pain, tooth pain, fracture pain. |
|
Definition
|
|
Term
| What doseage form is Phenoprofen and ketoprofen now available? Hows that significant? |
|
Definition
| There are some transdermal patches, good for GI disoder Pts |
|
|
Term
| What is upset stomach a problem of with NSAID usually from? Local or systemic effet? |
|
Definition
| Local, so patches bypass that side effect. |
|
|
Term
| What NSAID is the only one available as IV? |
|
Definition
|
|
Term
| What is significant about COX2? |
|
Definition
| Doesn't cause bleed issues, it's more selective |
|
|
Term
| What is the problem about COX2? |
|
Definition
push the dose up and it loses its selectivity
(>about 100-200mg BID) |
|
|
Term
| How often do we normally dose drugs? |
|
Definition
|
|
Term
| Does acetaminophen have anti-inflammatory properties? |
|
Definition
|
|
Term
| what is the best tolerated drug with the least number of side effects for pain? |
|
Definition
|
|
Term
| What are routes for APAP? |
|
Definition
|
|
Term
| What's the max dose for Tramadol? |
|
Definition
|
|
Term
|
Definition
| synthetic codeine analogue, indicated for mild to moderate pain |
|
|
Term
| What is indicative of tramadol toxicity? |
|
Definition
|
|
Term
| What drug interactions of tramadol are important? |
|
Definition
| SSRI- seritonin syndrome, not likely but it is possible so be aware |
|
|
Term
| How long does adding apap or nsaid to an opioid add to duration of action? |
|
Definition
|
|
Term
| What do you do to optimize analgesic effects of opioids? |
|
Definition
|
|
Term
| How long does tramadol work? |
|
Definition
| Not very long, very short acting. Dosed q4-6hr |
|
|
Term
| Which NSAID is unsed for a longer duration? |
|
Definition
|
|
Term
| Which NSAID has higher side effect that other NSAID (esp GI) |
|
Definition
|
|
Term
| What is Meloxicams features? |
|
Definition
Long dosing (15-20h)
more COX-2 selective |
|
|
Term
| What is good about Etoldolac? |
|
Definition
| slightly more COX2 selective |
|
|
Term
| How long does naproxen last? |
|
Definition
|
|
Term
| What receptor promots euphoric effects and GI transit? |
|
Definition
|
|
Term
| What receptor causes sedation and dec resp and GI transit? |
|
Definition
|
|
Term
| What do delta receptors effect? |
|
Definition
| modulation of NT other than analgesia |
|
|
Term
| what are two big counseling points about opioids? |
|
Definition
| drowsyness and constipation |
|
|
Term
| What drug is converted to morphine and is CYP2D6 dependant? |
|
Definition
|
|
Term
| Which is more potent hydrocodone or codein? |
|
Definition
|
|
Term
| What are your low potency opioids? |
|
Definition
| tramadol, hydrocodone, codiene |
|
|
Term
| What must be administered with opioids for long term patients? |
|
Definition
| Stimulant and stool softener |
|
|
Term
| How much APAP do you need to get effective addative effects with opioids? |
|
Definition
|
|
Term
| What are the higher potency opioids? |
|
Definition
Oxycodone
Morphine
Hydromorphone |
|
|
Term
| Is respiratory depression more likely with IV SQ or Oral dose form? |
|
Definition
|
|
Term
| What is an OK respiratory rate? |
|
Definition
|
|
Term
| What side effects can opioids have? (especially in geriatrics) |
|
Definition
ACUTE PSYCHOSIS 50 AND UP
Mood changes(drepssion)
Sedation
Euphoria |
|
|
Term
| how do you treat acute psychosis in geriatrics that's drug induced? |
|
Definition
|
|
Term
| What's a problem about opioids? |
|
Definition
We develop tolerance to: sedative doses, euphoric effects
Some (not complete) tolerance to: Respiratory depression (longer you're on opioid better you do)
No tolerance to: Anxiolytic effects or CONSTIPATING EFFECTS and <5% For analgesia become tolerant |
|
|
Term
| What is the most common opioid in hospitals? |
|
Definition
|
|
Term
| What is closely related to pain? |
|
Definition
|
|
Term
| How do pain and anxiety work together? |
|
Definition
|
|
Term
| What is a good way to increase pain outcomes as far as the pain/anxiety cycle goes? |
|
Definition
| treat anxiety and get proper sleep |
|
|
Term
| What is the only opioid in the antagonist class? |
|
Definition
|
|
Term
| What are the agonist/antagonist opioid derivatives? |
|
Definition
Pentazocin (Talwin)
Butoxphanol (Stadol)
Nalbuphine (Nubian)
Buprenorphine (Buprenex) |
|
|
Term
| What is the agonist/antagonist general duration of action? |
|
Definition
|
|
Term
| How much buprenorphine is equivalent to 10mg of morphine? |
|
Definition
|
|
Term
| How many mg of Nubian/Nalbuphine are equivalent to 10mg of Morphine? |
|
Definition
|
|
Term
| How many Mg of butorphanol/stadol are equivalent to 10mg of morphine? |
|
Definition
| 2mg IM or 1spray Intranasal |
|
|
Term
| What percentage of the more potent drug do you use when converting? |
|
Definition
|
|
Term
| When underdosing from stronger to weaker opioid dose to best equivalence what do you do? |
|
Definition
| Dose around the clock and have a schedualed med for breakthrough pain |
|
|
Term
| What drugs are in the Phenylpiperidine class? |
|
Definition
meperidine (Demerol)
fentanyl |
|
|
Term
| What two classes might you be able to use in a true phenathrine allergy? |
|
Definition
Phenylpiperidines (meperidine-like agonists)
Diphenylheptanes (methadone like agonists) |
|
|
Term
| What drugs are in the Diphenylheptanes class? |
|
Definition
|
|
Term
| What drugs are in the phenanthrene class? |
|
Definition
| morphine, hydromorphone, oxymorphone, levorphanol, codeine, hydrocodone, oxycodone |
|
|
Term
| What opioid effects preload and afterload? |
|
Definition
|
|
Term
| How is morphine available? |
|
Definition
|
|
Term
| What do we not see as much of with hydrocodone and oxycodone? |
|
Definition
| not as much hypotension etc and puritis/histamine release |
|
|
Term
| What are the two cleanest opioids products we have? |
|
Definition
|
|
Term
| What is the max dose of straight opioids? |
|
Definition
|
|
Term
| What's the three big problems with Meperidine (Demerol) |
|
Definition
| metabolite- normeperadine accumulates. Bad for renal insuficiency and causes seizures |
|
|
Term
| On a mg/mg basis how much more potent is fentanyl than morphine? |
|
Definition
|
|
Term
| What is the halflife of fentanyl IV roughly? |
|
Definition
|
|
Term
| what is good about the short halflife of fentanyl IV? |
|
Definition
| makes for good pain control adjustment in acute setting. |
|
|
Term
| How often does a fentanyl patch get changed initially? |
|
Definition
|
|
Term
| Describe the halflife of methadone |
|
Definition
| long and active metabolites are even longer! It has miss matched pharmacokinetics/dynamics |
|
|
Term
| How should you dose methadone for pain when initiating? |
|
Definition
| 15-20mg upto 4 days then back it off or they'll OD |
|
|
Term
| pentozacin/talwin cause what in geriatrics? |
|
Definition
|
|
Term
| What class is pentozacin/talwin in? |
|
Definition
|
|
Term
| What do you need to be careful about switching from opioid to agonist-antagonist |
|
Definition
| high risk of withdrawl because it stimulates pain receptors and binds without causing analgesic effect. Causes a ceiling effect. |
|
|
Term
| If you push the dose to high on the agonist-antagonist? |
|
Definition
| You have no increased analgesia, maybe decreased analgesia and worse side effects |
|
|
Term
| what is part of the criteria of starting suboxone? |
|
Definition
must already be going through the first stages of withdrawal
This way it doesn't throw them into withdrawl should be dosed in the clinic |
|
|
Term
| What's significant about buprenorphine? |
|
Definition
Dosed SQ
Lasts 4-6hrs
Very potent drug |
|
|
Term
| Why do you mix buprenoprhine and naloxone for suboxone? |
|
Definition
| Prevent people from shooting it. Shoot narcan and you get immediate withdrawal |
|
|
Term
| what drug has a higher affinity for receptor sites than other opioids? |
|
Definition
|
|
Term
| What class is narcan/naloxone? |
|
Definition
| 100% pure opioid blocker, it's a reversal agent, it's for emergency only |
|
|
Term
| How long is the halflife of narcan? |
|
Definition
| very short, less than 1hr or 2 therefore be mindful, someone might be OK and then crash again when it wears off. |
|
|
Term
| what about the halflife of narcan affects its dosing? |
|
Definition
| short halflife, usually needs multiple doses |
|
|
Term
| How should you treat acute pain? |
|
Definition
| Aggressively, prevent/break the pain/anxiety cycle, you'll need less drug for less time. |
|
|
Term
| How many mg/day of methadone in an opiate niave person should throw a red flag? |
|
Definition
|
|
Term
|
Definition
| T1DM- REQUIRES exogenous insulin, destrxn of pancreatic bcells (no insulin secretion) DKA first manifestation! |
|
|
Term
| What is the screening/dx criteria for diabetes? |
|
Definition
| Impaired Glucose Tolerance test Dx prediabetes |
|
|
Term
| How many people are UNAWARE they have diabetes? |
|
Definition
|
|
Term
| how many people have diabetes? how many are Dx? |
|
Definition
|
|
Term
| What are macrovascular complications of diabetes? |
|
Definition
| stroke, heart disease, HTN, peripheral vascular disease, foot problems |
|
|
Term
| What are microvascular complications of diabetes? |
|
Definition
| Eye disease (retinophathy/cataracts), renal disease, neuropathy, foot problems |
|
|
Term
| How many people in the US have prediabetes? |
|
Definition
|
|
Term
| What percentage of diabetics have T2DM? What about T1Dm? |
|
Definition
|
|
Term
| What causes insulin deficiency in T1DM? |
|
Definition
| autoimmune beta cell destruxn |
|
|
Term
| What are risk factors for DM? |
|
Definition
Family Hx, lack of activity, over weight, African american, native american, hispanic, asian american or pacific islander
HTN and dyslipidemia |
|
|
Term
| What is the criteria for gestational DM |
|
Definition
| women delivering baby weighing >9lb |
|
|
Term
| why do we treat gestational DM? |
|
Definition
infant hypoglycemia
hyperbilirubinemia
complications w/ large baby |
|
|
Term
| What hormone decreases blood glucose? |
|
Definition
|
|
Term
| What hormone raises blood glucose? |
|
Definition
|
|
Term
| What is the level for imparied fasting glucose? |
|
Definition
|
|
Term
| what is the range for overt DM fasting glucose? |
|
Definition
|
|
Term
| What is imparied glocose tolerance for 2hr PP? |
|
Definition
|
|
Term
| What is the level for overt DM for post prandial? |
|
Definition
|
|
Term
| what is ADA target HbA1C? |
|
Definition
|
|
Term
| What ist he AACE guidelines for A1C? |
|
Definition
|
|
Term
| What is the ADA preprandial blood sugar goal? |
|
Definition
|
|
Term
| What is the peak post prandial goal for ADA? |
|
Definition
|
|
Term
| What is the preprandial goal for AACE? |
|
Definition
|
|
Term
| what is the peak post prandial for AACE? |
|
Definition
|
|
Term
| what is the peak post prandial for AACE? |
|
Definition
|
|
Term
| What is the BP goal for both ADA and AACE? |
|
Definition
|
|
Term
| What is the LDL goal for ADA and AACE in diabetes? |
|
Definition
|
|
Term
| What is the HDL goal for ADA and AACE in diabetes for men and women |
|
Definition
|
|
Term
| What is the TG goal for ADA and AACE? |
|
Definition
|
|
Term
| What should diabetic pts always be assesed for? |
|
Definition
| elegibility to use ASA for cardiac |
|
|
Term
| What two drugs have compelling indications with diabetes? |
|
Definition
|
|
Term
| What are the monitoring parameters of DM? |
|
Definition
Dilated eye exam
Foot exam
Microalbumin/SrCr
Influenza vaccine
Depression questionair |
|
|
Term
| What 4 things might affect blood sugar? |
|
Definition
Food
Exercise
Stress
Time of day |
|
|
Term
| Is there such a thing as a diabetic diet? |
|
Definition
|
|
Term
| What should a diabetic meal plan include? |
|
Definition
low fat
high fiber
low-moderate in calories |
|
|
Term
| Describe the "plate method" |
|
Definition
| Small portion of milk and fruit on the side and plate is divided in half. Half is vegtables and the other half is comprised of meat and starches (1/4 of each) |
|
|
Term
| What had the greatest effect on reaising blood sugar? carbs, fats, proteins |
|
Definition
|
|
Term
| how many carbs are in a serving for diabetics counting carbs? |
|
Definition
|
|
Term
| How many servings of carbs are reecommended per meal for diabetics? |
|
Definition
| 2-3 servings (20-45g carb) |
|
|
Term
| What are the four steps to self-monitoring blood glucose? |
|
Definition
1) identifiy abnormality (hypoglycemia, fasting, postprandial)
2) determine timing and frequency of occurrence
3) investigate causes
4) take action |
|
|
Term
| What are some reasons patients don't test blood sugar? |
|
Definition
| lack of instructions, cost, discomfort |
|
|
Term
| What does a HgA1C of >8 indicate? |
|
Definition
| Fasting blood glucose problem |
|
|
Term
| What does a HgA1C of <8 indicate? |
|
Definition
| problem with postprandial blood glucose |
|
|
Term
| What are four factors that can affect the blood glucose? |
|
Definition
Food
Exercise
Stess
Time of day |
|
|
Term
| If pt is unable to control blood sugar with diet and exercise (t2dm) what should be done next? |
|
Definition
|
|
Term
| What do we do for diabetes when diet and exercise fail and we don't want to put patient on insulin yet? |
|
Definition
| Lifestyle + Metformin + potentially sulfonylurea |
|
|
Term
| What do we do for pt who has failed diet and exercise therapy and we want to avoid sulfonylurea? |
|
Definition
| Lifestyle + Metfomin + Basal insulin |
|
|
Term
| What might we use in Pt that wants to/needs to loose weight and is diabetic but has failed diet and exercise alone? |
|
Definition
| Lifestyle + Metformin + GLP-1 agonists |
|
|
Term
| What is another option for diabetics not wanting to inject themselves and no wanting to use sulonylureas? |
|
Definition
| Lifestyle + Metformin + Pioglitazone |
|
|
Term
| What do you do when initial drug therapy chosen fails to control blood sugar? |
|
Definition
| Add on or go with Lifestyle + metformin + intensive insulin |
|
|
Term
| Can you add a sulonylurea to a pioglitazone per se? |
|
Definition
|
|
Term
| Which of the following isn't approved for add on treatment in diabetes with lifestyle change and metformin per the ADA? |
|
Definition
|
|
Term
| What drugs can be added to metformin and lifestyle change as step 2 therapy? |
|
Definition
Sulfonylurea
Basal insulin
Pioglitazone |
|
|
Term
| What insulin shouldn't ever be combined with another insulin? |
|
Definition
|
|
Term
| What is the T1DM max dose of Simalin? |
|
Definition
|
|
Term
| What is the T2DM starting dose of Simalin? |
|
Definition
|
|
Term
| How much does the starting dose of Victoza lower A1C? |
|
Definition
|
|
Term
| What is the role of Colesevelam in diabtes? |
|
Definition
Lower A1C some
Good for pt who can't tolerate statin |
|
|
Term
| What is special about trajenta? |
|
Definition
| doesn't need renal dosing |
|
|
Term
| What is a problem with trajenta? |
|
Definition
|
|
Term
| How long does it take TZDs to work? |
|
Definition
|
|
Term
| What sulfonylurea doesn't Dr Kimble like? |
|
Definition
|
|
Term
| When carb counting how many grams of carbs should a women have? Man? |
|
Definition
|
|
Term
| which antidiabetic drug decreases LDL and increases HDL? |
|
Definition
|
|
Term
| What oral antidiabetic agent class is known to cause bone fracture and ovulation stimulation? |
|
Definition
|
|
Term
| What glucose does Acarbose and Miglitol primarily effect? |
|
Definition
|
|
Term
| How should alpha-glucosidase inhibitors be administered? |
|
Definition
| with the first bite of food |
|
|
Term
| Generic name of Tragenta? |
|
Definition
|
|
Term
| What glucose dose DPP 4 inhibitors affect? |
|
Definition
Both post prandial and fasting. Most effect is on post prandial
NOT FOR T1DM OR DKA |
|
|
Term
| What drugs should not be used in DKA |
|
Definition
|
|
Term
| What antidiabetic drug class has no major side effects? |
|
Definition
|
|
Term
| What is a contraindication for symlin (pramlintide) |
|
Definition
gastroparesis
HgA1C >9
Pt unwilling to sel-monitor blood glucose |
|
|
Term
| JS uses 20u of detemir and 15u of Apidra with breakfast and dinner. Total daily insulin? 500gm carb/daily dose = ? (rule of 500) |
|
Definition
50
500/50 = 10 therefore 1u of insulin is for 10g of carb |
|
|
Term
| what is the most common complication with diabetes? |
|
Definition
|
|
Term
| What are the Sx of hypoglycemia? |
|
Definition
| shaking, sweating, fast heart beat |
|
|
Term
| what is a common cause of hypoglycemi that clinicians are responsible for? |
|
Definition
| not adjusting drug dosing for renal or hepatic imparairment |
|
|
Term
| For hypoglycemia what can you use? |
|
Definition
Orange juice
Carb
Glucose tabs
Skim milk |
|
|
Term
| When on alpha-glucosidase inhibitos what do you use for hypo glycemia? |
|
Definition
3-6 glucose tabs
8oz skim milk |
|
|
Term
| How much carb, OJ, glucose tabs, skim milk should you use for hypoglycemia? |
|
Definition
15g carb
4oz OJ
3-6 glucose tabs
8oz skim milk |
|
|
Term
| How do you treat hypoglycemia with glucogon kit? |
|
Definition
| administer 1mg IM/SQ, repeat in 20min if needed. Roll onto side to prevent aspiration |
|
|
Term
| Does DKA occure more commonly in T1 or T2DM |
|
Definition
|
|
Term
| What is an odd sign of DKA? |
|
Definition
|
|
Term
|
Definition
| fluids and regular insulin |
|
|
Term
| No lipid lysis and no ketone formation in HHS |
|
Definition
|
|
Term
| What is BP goal for diabetes? |
|
Definition
|
|
