Cps Ii Exam 1- Diabetes Type Ii And Copd

Front 1

4 disease state risk factors for DM2

Back 1

• Hypertension ( 140/90 mmHg in adults)
• HDL cholesterol 35 mg/dl (0.90 mmol/l) and/or a triglyceride level 250 mg/dl (2.82 mmol/l)
• Polycystic ovary syndrome
• History of vascular disease

Front 2

4 patient factors that put pt at risk for DM2

Back 2

Age 45 years
Overweight (BMI >= 25 kg/m2*)
Race (non-whites)
habitual physical inactivity

Front 3

3 items in pt hx that would be risk factors for DM2

Back 3

family hx of diabetes (parents/siblings)
previously ID'd with IFG or IGT
hx of GDM or delivery of baby weighing > 9 lbs

Front 4

how to diagnose diabetes (4 criteria- how many to be diagnostic?)

Back 4

A1c>= 6.5%
OR
fasting glucose >= 126

OR
sx of diabetes (polyuria, polydipsia, unexplained weight loss) + random plasma glucose >= 200 mg/dL

OR 2 hour post challenge glc conc of >=200 during 75g oral glucose tolerance test (no one does this)

Front 5

glucose goals (A1c, fasting, postprandial) for diabetes

Back 5

A1c<7
fasting glc 70-130
postprandial < 180

Front 6

lipid goals (TG, TC, LDL, HDL) for diabetes

Back 6

TG < 150
TC < 200
LDL < 100
HDL > 50 for women and 40 for men

Front 7

5-7 rule for statins

Back 7

doubling dose of statins after initial dose will decrease TC by additional 5 % and LDL by 7%

Front 8

non pharm shit for lipids -1
diet-4

Back 8

Weight loss with exercise
diet- medical nutrition therapy, control fat in diet to <7%; beneficial to adopt a DASH diet, manage carbs/protein intake etc.

Front 9

ASA in diabetic patients- when to give as secondary? primary? (in general)

Back 9

Secondary prevention if DM + hx of CVD (Post ACS—combine with clopidogrel x 1 year)
Primary prevention in pts at ↑ CV risk

Front 10

primary prevention with ASA in diabetic pt (for macrovascular disease)- when to give (2)

Back 10

10 year risk > 10%

Most men >50 and women >60 years old who have at least one additional risk factor (family hx of CVD, HTN, smoking, dyslipidemia or albuminuria)

Front 11

• For patients with CVD and documented aspirin allergy, what is an alternative

Back 11

clopidogrel (75 mg/day) should be used

Front 12

ASA is not recommended in diabetes primary prevention for...

Back 12

10 year risk < 5% (men <50 yo, women < 60 yo) with no additional risk factors

Front 13

frequency of visits for your patient with diabetes

Back 13

Initial: Have them come back in one week. Then, with the exception of symptoms and abnormal at home glucose readings, I would gradually extend the interval until they are only coming in for their biannual A1C

Front 14

Suggest a plan for frequency of visits for your patient with diabetes

Develop an appropriate monitoring plan for the patient with diabetes with emphasis on HgbA1C, lipids, and urinalysis and eye exam

Back 14

HbA1c won't change quickly- so measure every 3 months, or biannually if stable
Cholesterol- annually

albuminuria- annually


eye exam- annually

Front 15

shit you check at every visit for diabetic complications (3)

Back 15

foot exam- every visit
smoking cessation- every visit
BP- every visit

Front 16

dosing of glipizide- initial and max

Back 16

Glipizide: initial dose 5 mg QD. Max dose is technically 40mg (>15 mg QD needs to be divided) but null benefit seen after 20mg

Front 17

glyburide dosing initial and max

Back 17

start at 2.5-5 mg qd, titrate up by 2.5 mg per week as needed.
Max of 20mg, but diminishing benefit after 10mg. Could try 10mg BID.

Front 18

metformin dosing initial and max for IR and ER

Back 18

500 mg QD-->titrate up over next few weeks until 2000 mg /day for IR (real max is 2550 but if you do this , prob can't do BID)

2400 for ER (max)

Front 19

metformin contraindications (3)

Back 19

clearly contraindicated by renal impairment (Scr 1.4 in females, 1.5 in males) or
low cardiac output (or high risk of CHF)
radiocontrast dye

Front 20

3 main AEs with thiazolidinediones

Back 20

weight gain
edema (dose dependent)
hepatocellular injury (rare)

Front 21

6 precautions to take with thiazolidinediones

Back 21

• Potentially hepatotoxic. Not recommended for use in patients with LFTs >2.5x normal
• In premenopausal, anovulatory women with insulin resistance, ovulation may resume during treatment and the patient may be at risk of pregnancy.
• Due to possible increases in plasma volume, these drugs are not recommended in patients with NYHA class III or IV cardiac status unless the benefits clearly outweigh the risks.

caution in pt with edema
fracture risk increased

cause bladder dmg

Front 22

changes to labs from thiazolidinediones (2)

Back 22

Hemoglobin and the WBC may decrease during the first 4 to 8 weeks of therapy (remain relatively constant thereafter)

Front 23

monitoring for pioglitazone (4 things routine and 1 thing at baseline)

Back 23

Hemoglobin A1c, serum glucose at 3 month visits

signs and symptoms of heart failure

liver enzymes (ALT, AST, alkaline phosphatase, and total bilirubin) prior to initiation in all patients (with or without liver disease)- continue routine periodic monitoring (twice yearly when stable on dose) during treatment only in patients with liver disease or suspected liver disease

Routine ophthalmic exams are recommended; patients reporting visual deterioration should have a prompt referral to an ophthalmologist and consideration should be given to discontinuing pioglitazone.

Signs/symptoms of bladder cancer (dysuria, macroscopic hematuria, dysuria, urinary urgency).

Front 24

algorithm for diabetes- step 1
if that doesn't work what 2 options?

alternatives (2)

last line-->2 options: oral therapy and injectable therapy

Back 24

lifestyle + metformin

then if that doesn't work, either add basal insulin or sulfonylurea

alternative options are pioglitazone or GLP agonist (exenatide, liraglutide-->weight loss)

if that doesn't work (the orals) try basal insulin +metformin, OR pio + sulfa + metformin

if still no good, intensive insulin + metformin

Front 25

diabetes monotherapy- what to give if..

overweight/obese?

CI to metformin?

skinny?

mild, post prandial glycemia?

thiazolidinediones as monotherapy?

Back 25

Overweight or Obese: Metformin

Contraindication or intolerance to Metformin: Sulfonylurea

Lean: Sulfonylurea or Glinide

Mild, post-prandial glycemia: α-Glucosidase inhibitor or Glinide

Thiazolidinedione controversial as monotherapy

Front 26

three most likely bacterial organisms responsible for acute exacerbations of COPD (3) and an alternative explanation

Back 26

H.influenzae
S. pneumoniae
M. catarrhalis


can also be viral

Front 27

if simple chronic bronchitis (lower risk), what do you use to treat bacterial exacerbations (4)

Back 27

Ampicillin, amoxicillin, doxycycline, TMP/SMX

Front 28

if complicated chronic bronchitis (higher risk) what do you use to treat bacterial exacerbations (3)

Back 28

Amoxicillin/Clavulanate
Extended spectrum quinolones
(Levo-, torva-, spar-, grepafloxacin)

Extended spectrum macrolides

purpose is to cover broader range of species

Front 29

simple chronic bronchitis definition (age, exacerbations, FEV1)

Back 29

<65, <4 exacerbations/yr, FEV1 >50%

Front 30

complicated chronic bronchitis definition (age, exacerbations, fev1, and 4 disease states)

Back 30

>65, >4 exacerbations/yr, FEV1 <50%
CHF, DM, CKD, Liver disease

Front 31

duration of abx therapy for COPD

Back 31

Prescribe for 7-14 days
If patient does not respond after 3-5 days it might be something else or they aren't taking abx right

Front 32

Identify the patient with COPD who is an appropriate candidate for corticosteroid therapy (inhaled) (2 properties- FEV and something else)

Back 32

for inhaled:
symptomatic COPD patient documented spirometric response to glucocorticosteroids
OR those with an FEV1 < 50% predicted and repeated exacerbations requiring treatment with antibiotics and/or oral glucocorticosteroids

Front 33

purpose of trying inhaled corticosteroids

how long to give at first?

Back 33

additional control of disease in steroid responders
Give trial of 6 wks to 3 months to assess response

Front 34

% of COPD patients that respond to corticosteroids

does it alter disease progression?

Back 34

10-20% of COPD pts are steroid responders; not proven to alter disease progression

Front 35

prednisone dose for acute exacerbation

Back 35

30-60 mg (usually 40 mg) for 10-14 days

Front 36

albuterol inhaler dose/freq for COPD
used when

Back 36

90 μg per inhalation; 1 to 2 inhalations every 4 to 6 hr, as needed

Front 37

tiatroprium dosing for COPD (dose and frequency)
used for what?

Back 37

Long-term, once-daily 1 capsule (18 mcg) maintenance treatment of bronchospasm asssociated with COPD

Front 38

albuterol nebulizer dose

Back 38

2.5 mg every 4 to 6 hr, as needed

Front 39

albuterol - mono or combo?

Back 39

can be scheduled as mono- or combo- therapy (with ipratroprium??)

Front 40

Develop a medication treatment plan for a patient as they move through the stages of COPD from At Risk to Severe- at risk, mild?

Back 40

at risk- just prevent by keeping away allergens and vaccinating (flu/pneumo)

moderate- short acting bronchodilator as needed

Front 41

retarded algorithm for COPD 5 steps I DONT FUCKING UNDERSTNAD THIS ALGORITHM

Back 41

wtf...albuterol for short term?

ipra/tiotroprium- max that out

add LABA

O2/pulmonary rehab

still exacerbations- can add theophylline or 2 weeks po prednisone

does it respond to steroids? if so can try MDIs

Front 42

moderate COPD treatment (3)

Back 42

- Short-acting bronchodilator when needed

- Regular treatment with one or more long-acting bronchodilators

- Rehabilitation

Front 43

severe COPD treatment (4)

Back 43

- Short-acting bronchodilator when needed

- Regular treatment with one or more long-acting bronchodilators

- Rehabilitation

- Inhaled glucocorticoids if significant symptoms, lung function response, or if repeated exacerbations