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210 Cards in this Set

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cholesterol screen for overweight child at:
9-11 y/o; then at 17-21 y/o
DM screen for overweight child with RF's at:
9y/o and every 2 years thereafter
ABC's of DM
A=a1c and DM meds; B=Blood Pressure; C=Cholesterol
a1c goal with DM:
<7%
BP goal with DM:
<140/90 if NO DM or renal disease; <130/80 if DM
Cholesterol goal with DM:
<100 LDL if DM and CAD; if significant CAD goal is lowered to <70 LDL
HDL Cholesterol goal with DM:
>40 for men; >50 for women
TG goal with DM:
150 or less
DM dx with A1c at:
6.5%
a 6% a1c = what average glucose level?
126mg/dL
a 7% a1c = what average glucose level?
154mg/dL
a 9% a1c = what average daily glucose level?
212mg/dL
a 10% a1c = what average daily glucose level?
240mg/dL
formula for estimating average glucose from a1c
28.7 x (a1c) - 46.7 = estimated average glucose
how often to monitor BG if on oral meds? on insulin?
oral meds: 3-4xw; insulin: 3-4xd
serum G peaks when post-prandial?
60-90minutes post
rapid acting insulin examples:
llispro / Humalog, aspart / Novolog; 2U aspart per / 15g CHO
short-acting insulin examples:
regular / Humulin-R
intermediate-acting insulin example:
NPH / isophane; 12h
long-acting insulin examples:
glargine / Lantus, detemir / Levemir; 12-24h; Lantus has NO peak; these CANNOT be mixed with other types
explain a "70/30" mix:
70 is the long-acting; 30 is the short-acting insulin
the 15 Rule for serum glucose:
if glucose is low, eat 15g CHO, wait 15m, recheck G
G should be above what level just prior to bed:
>110mg/dL
how much will 1-2U of insulin decrease G?
50mg/dL
summing all insulin dosages from the day and divide by five helps estimate what?
the number of grams of CHO to be consumed during the day for a DM pt
oral DM meds: sulfonylureas example:
glyburide / Micronase, glipizide / Glucotrol
MoA of sulfonylureas:
stimulate beta-cells to release insulin
SE's of SU's
hypoglycemia, nausea
Thiazolidenediones (TZD) examples:
pioglitazone / Actos
MoA of TZD:
reduce G produced by Liver, increase insulin sensitivity
SE's of TZD:
fluid retention - may worsen CHF; $$$
MoA of Biguanides:
reduce G produced by Liver, increase insulin sensitivity
example of a biguanide:
metformin
SE's of biguanide (metformin):
GI, diarrhea; not for weak kidney or HF; may decrease B12 level
a1c-lowering effect of lifestyle:
1-2%
a1c-lowering effect of metformin:
1-2%
a1c-lowering effect of SU (glipizide, glyburide)
1-2%
a1c-lowering effect of TZD (pioglitazone):
0.5-1.4%
Amylin in DM:
for both DM I and DM II; injectable only; promotes feeling of fullness, slows PP glucose rise, improved a1c, modest weight loss, decreases amount of insulin required
if known sulfa allergy and DM, be careful with which oral med?
SU's: glyburide / Micronase, glipizide / Glucotrol; these are inexpensive
screen for DM in asx individuals begins when?
at 45y and every 3 years thereafter
family hx of DMI does NOT increase % chance of developing DMII
TRUE
in a pt with DM, when to check for microalbuminuria?
yearly, if UA (-) for protein
for pt with both DM and HTN, prescribe:
ACEI
example of an alpha-beta-blocker:
"-lol": carvedilol
example of a non-DHP CCB:
diltiazem / Cardizem, verapamil / Calan
monitor ___ with use of a TZD:
ALT
increase risk of lactic acidosis with metformin:
renal insufficiency, dehydration, radiographic contrast dye
secondary causes of hyperglycemia:
niacin, cortico-, thiazides
Lispro peak time:
30 to 90 minutes
regular insulin peak time:
2 to 3 hour peak for R insulin
NPH insulin peak time:
4-10 hour peak for NPH
insulin glargine / Lantus peak time:
NO PEAK, therefore hypoglycemia is unlikely to occur
meglitinide analogues are helpful adjuncts to minimize risk of:
postprandial hyperglycemia
meglitinide analogue examples:
repaglinide / Prandin, nateglinide / Starlix
RF's for heatstroke
obesity, beta-adrenergic antagonists, excessive activity
heatstroke lab finding:
elevated total creatine kinase level
heatstroke intervention:
rehydrate, controlled cooling via tepid sprays and fanning or SELECTIVE application of ice packs; should admit for 24 hours post-stabilization for observation
with use of HMG-CoA reductase inhibitor, monitor what periodically?
AST: aspartate aminotransferase
fibrates affect what, mostly?
HDL increase
niacin affects what, mostly?
HDL increase; post dose flushing is very common
ezetimibe / Zetia (fibrin acid derivatives) affect what?
LDL decrease
with ezetimibe / Zetia use, monitor what?
NO special monitoring needed; generally benign
with lipid-lowering resin (cholestyramine / Questran, colesevelam / WelChol), monitor what periodically?
NO special monitoring needed; generally benign
most effective HMG-CoA RI?
atorvastatin / Lipitor
simvastatin aka
Zocor
rosuvastatin aka
Crestor
fibrate examples:
gemfibrozil / Lopid, fenofibrate / TriCor, ezetimibe / Zetia
causes of secondary hyperlipidemia:
inactivity (low hdl), alcohol (raises TG, HDL, LDL), DM (raises TG, TC, LDL), hypothyroidism (raise TG, TC, LDL), high dose thiazides (raise TC, LDL, TG), chronic renal insufficiency (raise TC, TG)
metabolic syndrome dx:
waist circumference >40" men, >35" women; TG >=150mg/dL; HDL<40mg/dL men, <50mg/dL women; BP>=130/85mmHg; FPG >=100mg/dL
IR and met syndrome are ___ and ___ states.
prothrombic and proatherogenic states
increase IR factors:
obesity, smoking, inactivity
30min bricks walking's effect on IR:
reduces IR 40% lasting for 48h; daily ASA use helps counteract the pro inflammatory and prothrombotic effects of IR
"s" for satiety, "s" for serotonin
TRUE
8000 - 10000 steps / d = ___ miles
4 to 5 miles
NE and dopamine's effects on feeding:
inhibit feeding; consider sypmathomimetics (dexamphetamine, phentermine); sleep disturbances, increase BP common
meds that can promote weight gain:
atypical antipsychotics: resperidone / Risperdal, olanzapine / Zyprexa; antieplieptics: valproate / Depakote, carbamazepine / Tegretol; corticosteroids
gastric bypass candidate should have ___ BMI.
>=40 or >=35 and DM, HTN, apnea, CVD, GERD, DJD, or steatohepatitis WITH behavioral and meds tx failure
average wt. loss from gastric band procedure:
40-60%
average wt. loss from gastric bypass procedure:
70-80%; most lost in first few months
pancreatic CA involving the head of the pancreas includes, clinically:
jaundice; usually NO RUQ tenderness
RF's for pancreatic CA
chronic pancreatitis, tobacco, DM, genetics; 40% have no identifiable risk factors
Dx for pancreatic CA
abdominal CT, normocytic/normochromic anemia, elevated total/direct bilirubin and ALP (NOT elevated amylase -> ONLY in pancreatitis)
RF's for pancreatitis:
gallstones, excessive alcohol, elevated TG's, idiopathic; also opioids, cortico-, thiazides, viral infection, blunt abd trauma
Dx for pancreatitis:
abdominal CT - abdominal US good for gall bladder or pancreatic CA
Sx for acute pancreatitis:
pain and volume constriction
tx for acute pancreatitis:
tx underlying gallbladder disease, hypertriglyceridemia, or discontinuation of alcohol, corticosteroids, or thiazides
amylase in pancreatitis:
2-12h after sx onset; >1000U/L it is about 80% chance of cholelithiasis dx
lipase in pancreatitis:
4-8h after sx onset, peaks at 24h; measuring serum lipase with amylase increases dx specificity
most likely found in Graves disease:
decreased TSH
Graves disease characteristics:
m/c thyrotoxicosis, HYPERthyroidism, 8:1 female:male, 20-40y onset age, correlation with autoimmune disorders; thyroid enlargement, exophthalmos, nervousness, tachycardia, heat intolerance, scan reveals "hot" gland
Hashimoto's thyroiditis characteristics:
m/c inflammatory disease of the thyroid, HYPOthyroidism leading cause; genetic, linked with autoimmunity, women 30-50y, enlarged thyroid, firm gland with fine nodules, neck pain; thyroid Ab's found in almost all cases
hyperthyroid sx:
energy, nervousness, exopthalmos, wt. loss, smooth / silky skin, fine hair / thinning, hyper-defecation, amenorrhea, hyperreflexia
hypothyroid sx:
low energy, fatigue, post-thyroiditis in 90% of cases, wt. gain, coarse / dry skin, constipation, menorrhagia, hyporeflexia / "hung up" patellar DTR
thin, brittle nails: hypo- or hyperthyroid?
hyperthyroid
proximal muscle weakness:
hyperthyroid
TSH levels, nml:
0.3 - 3 mIU/L for TSH is nml range
new max dose of Zocor (simvastatin)
40mg / d; myalgia!
sodium recommendation for adults:
<2,300 mg/d
AHA sodium recommendation for pt >51y/o, AA, HTN, DM, or CKD:
<1,500 mg/d
1 tsp salt =
2,300 mg/d
1 serving of CHO is ___ gm.
15 g = 1 serving CHO
Alcohol's effect on serum glucose:
alcohol lowers glucose because it decreases the amount of glucose released by the Liver and calories in alcohol are NOT converted to glucose
ADA's recommendation for daily protein:
15%-20% of daily calories for protein
ADA's recommendation for daily fat:
20-35% of daily calories for fats
cholesterol screen for overweight child at:
9-11 y/o; then at 17-21 y/o
DM screen for overweight child with RF's at:
9y/o and every 2 years thereafter
ABC's of DM
A=a1c and DM meds; B=Blood Pressure; C=Cholesterol
a1c goal with DM:
<7%
BP goal with DM:
<140/90 if NO DM or renal disease; <130/80 if DM
Cholesterol goal with DM:
<100 LDL if DM and CAD; if significant CAD goal is lowered to <70 LDL
HDL Cholesterol goal with DM:
>40 for men; >50 for women
TG goal with DM:
150 or less
DM dx with A1c at:
6.5%
a 6% a1c = what average glucose level?
126mg/dL
a 7% a1c = what average glucose level?
154mg/dL
a 9% a1c = what average daily glucose level?
212mg/dL
a 10% a1c = what average daily glucose level?
240mg/dL
formula for estimating average glucose from a1c
28.7 x (a1c) - 46.7 = estimated average glucose
how often to monitor BG if on oral meds? on insulin?
oral meds: 3-4xw; insulin: 3-4xd
serum G peaks when post-prandial?
60-90minutes post
rapid acting insulin examples:
llispro / Humalog, aspart / Novolog; 2U aspart per / 15g CHO
short-acting insulin examples:
regular / Humulin-R
intermediate-acting insulin example:
NPH / isophane; 12h
long-acting insulin examples:
glargine / Lantus, detemir / Levemir; 12-24h; Lantus has NO peak; these CANNOT be mixed with other types
explain a "70/30" mix:
70 is the long-acting; 30 is the short-acting insulin
the 15 Rule for serum glucose:
if glucose is low, eat 15g CHO, wait 15m, recheck G
G should be above what level just prior to bed:
>110mg/dL
how much will 1-2U of insulin decrease G?
50mg/dL
summing all insulin dosages from the day and divide by five helps estimate what?
the number of grams of CHO to be consumed during the day for a DM pt
oral DM meds: sulfonylureas example:
glyburide / Micronase, glipizide / Glucotrol
MoA of sulfonylureas:
stimulate beta-cells to release insulin
SE's of SU's
hypoglycemia, nausea
Thiazolidenediones (TZD) examples:
pioglitazone / Actos
MoA of TZD:
reduce G produced by Liver, increase insulin sensitivity
SE's of TZD:
fluid retention - may worsen CHF; $$$
MoA of Biguanides:
reduce G produced by Liver, increase insulin sensitivity
example of a biguanide:
metformin
SE's of biguanide (metformin):
GI, diarrhea; not for weak kidney or HF; may decrease B12 level
a1c-lowering effect of lifestyle:
1-2%
a1c-lowering effect of metformin:
1-2%
a1c-lowering effect of SU (glipizide, glyburide)
1-2%
a1c-lowering effect of TZD (pioglitazone):
0.5-1.4%
Amylin in DM:
for both DM I and DM II; injectable only; promotes feeling of fullness, slows PP glucose rise, improved a1c, modest weight loss, decreases amount of insulin required
if known sulfa allergy and DM, be careful with which oral med?
SU's: glyburide / Micronase, glipizide / Glucotrol; these are inexpensive
screen for DM in asx individuals begins when?
at 45y and every 3 years thereafter
family hx of DMI does NOT increase % chance of developing DMII
TRUE
in a pt with DM, when to check for microalbuminuria?
yearly, if UA (-) for protein
for pt with both DM and HTN, prescribe:
ACEI
example of an alpha-beta-blocker:
"-lol": carvedilol
example of a non-DHP CCB:
diltiazem / Cardizem, verapamil / Calan
monitor ___ with use of a TZD:
ALT
increase risk of lactic acidosis with metformin:
renal insufficiency, dehydration, radiographic contrast dye
medication secondary causes of hyperglycemia:
niacin, cortico-, thiazides
Lispro peak time:
30 to 90 minutes
regular insulin peak time:
2 to 3 hour peak for R insulin
NPH insulin peak time:
4-10 hour peak for NPH
insulin glargine / Lantus peak time:
NO PEAK, therefore hypoglycemia is unlikely to occur
meglitinide analogues are helpful adjuncts to minimize risk of:
postprandial hyperglycemia
meglitinide analogue examples:
repaglinide / Prandin, nateglinide / Starlix
RF's for heatstroke
obesity, beta-adrenergic antagonists, excessive activity
heatstroke lab finding:
elevated total creatine kinase level
heatstroke intervention:
rehydrate, controlled cooling via tepid sprays and fanning or SELECTIVE application of ice packs; should admit for 24 hours post-stabilization for observation
with use of HMG-CoA reductase inhibitor, monitor what periodically?
AST: aspartate aminotransferase
fibrates affect what, mostly?
HDL increase
niacin affects what, mostly?
HDL increase; post dose flushing is very common
ezetimibe / Zetia (fibrin acid derivatives) affect what?
LDL decrease
with ezetimibe / Zetia use, monitor what?
NO special monitoring needed; generally benign
with lipid-lowering resin (cholestyramine / Questran, colesevelam / WelChol), monitor what periodically?
NO special monitoring needed; generally benign
most effective HMG-CoA RI?
atorvastatin / Lipitor
simvastatin aka
Zocor
rosuvastatin aka
Crestor
fibrate examples:
gemfibrozil / Lopid, fenofibrate / TriCor, ezetimibe / Zetia
causes of secondary hyperlipidemia:
inactivity (low hdl), alcohol (raises TG, HDL, LDL), DM (raises TG, TC, LDL), hypothyroidism (raise TG, TC, LDL), high dose thiazides (raise TC, LDL, TG), chronic renal insufficiency (raise TC, TG)
metabolic syndrome dx:
waist circumference >40" men, >35" women; TG >=150mg/dL; HDL<40mg/dL men, <50mg/dL women; BP>=130/85mmHg; FPG >=100mg/dL
IR and met syndrome are ___ and ___ states.
prothrombic and proatherogenic states
increase IR factors:
obesity, smoking, inactivity
30min brisk walking's effect on IR:
reduces IR 40% lasting for 48h; daily ASA use helps counteract the pro inflammatory and prothrombotic effects of IR
"s" for satiety, "s" for serotonin
TRUE
8000 - 10000 steps / d = ___ miles
4 to 5 miles
NE and dopamine's effects on feeding:
inhibit feeding; consider sypmathomimetics (dexamphetamine, phentermine); sleep disturbances, increase BP common
meds that can promote weight gain:
atypical antipsychotics: resperidone / Risperdal, olanzapine / Zyprexa; antieplieptics: valproate / Depakote, carbamazepine / Tegretol; corticosteroids
gastric bypass candidate should have ___ BMI.
>=40 or >=35 and DM, HTN, apnea, CVD, GERD, DJD, or steatohepatitis WITH behavioral and meds tx failure
average wt. loss from gastric band procedure:
40-60%
average wt. loss from gastric bypass procedure:
70-80%; most lost in first few months
pancreatic CA involving the head of the pancreas includes, clinically:
jaundice; usually NO RUQ tenderness
RF's for pancreatic CA
chronic pancreatitis, tobacco, DM, genetics; 40% have no identifiable risk factors
Dx for pancreatic CA
abdominal CT, normocytic/normochromic anemia, elevated total/direct bilirubin and ALP (NOT elevated amylase -> ONLY in pancreatitis)
RF's for pancreatitis:
gallstones, excessive alcohol, elevated TG's, idiopathic; also opioids, cortico-, thiazides, viral infection, blunt abd trauma
Dx for pancreatitis:
abdominal CT - abdominal US good for gall bladder or pancreatic CA
Sx for acute pancreatitis:
pain and volume constriction
tx for acute pancreatitis:
tx underlying gallbladder disease, hypertriglyceridemia, or discontinuation of alcohol, corticosteroids, or thiazides
amylase in pancreatitis:
2-12h after sx onset; >1000U/L it is about 80% chance of cholelithiasis dx
lipase in pancreatitis:
4-8h after sx onset, peaks at 24h; measuring serum lipase with amylase increases dx specificity
most likely found in Graves disease:
decreased TSH
Graves disease characteristics:
m/c thyrotoxicosis, HYPERthyroidism, 8:1 female:male, 20-40y onset age, correlation with autoimmune disorders; thyroid enlargement, exophthalmos, nervousness, tachycardia, heat intolerance, scan reveals "hot" gland
Hashimoto's thyroiditis characteristics:
m/c inflammatory disease of the thyroid, HYPOthyroidism leading cause; genetic, linked with autoimmunity, women 30-50y, enlarged thyroid, firm gland with fine nodules, neck pain; thyroid Ab's found in almost all cases
hyperthyroid sx:
energy, nervousness, exopthalmos, wt. loss, smooth / silky skin, fine hair / thinning, hyper-defecation, amenorrhea, hyperreflexia
hypothyroid sx:
low energy, fatigue, post-thyroiditis in 90% of cases, wt. gain, coarse / dry skin, constipation, menorrhagia, hyporeflexia / "hung up" patellar DTR
thin, brittle nails: hypo- or hyperthyroid?
hyperthyroid
proximal muscle weakness:
hyperthyroid
TSH levels, nml:
0.3 - 3 mIU/L for TSH is nml range
new max dose of Zocor (simvastatin)
40mg / d; myalgia!
sodium recommendation for adults:
<2,300 mg/d
AHA sodium recommendation for pt >51y/o, AA, HTN, DM, or CKD:
<1,500 mg/d
1 tsp salt =
2,300 mg/d
1 serving of CHO is ___ gm.
15 g = 1 serving CHO
Alcohol's effect on serum glucose:
alcohol lowers glucose because it decreases the amount of glucose released by the Liver and calories in alcohol are NOT converted to glucose
ADA's recommendation for daily protein:
15%-20% of daily calories for protein
ADA's recommendation for daily fat:
20-35% of daily calories for fats