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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
|