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40 Cards in this Set
- Front
- Back
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Metformin |
Block gluconeogenesis Contraindication: renal failure or contrast Common S/E - abdominal upset Worse S/E - Lactic Acidosis Usually 1st line Rx, if pt has renal failure go straight to insulin |
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Sulfonylurea |
glyburide Common S/E - Wt gain Remember renal excretion |
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DPP Inhibitors |
sitagliptin (Treatment in patients ≥65 years did not affect risks of hospitalization for heart failure or hypoglycemia but was associated with reduced risks of all-cause mortality and MACE) |
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Thiazolidinediones |
rosiglitazone
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Alpha glucosidase inhibitors |
Acarbose Miglitol Block intestinal absorption |
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Nateglinide Repaglinide |
Inc insulin |
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Insulin glargine / lantus Detemir NPH Regular Insulin
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Long acting severe hypoglycemia is less with insulin glargine 300 U/mL vs 100 Intermediate Short |
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Exenatide Liraglutide |
Inc insulin Dec glucose lower body weight |
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High glucose >250 + Increase in ketones >5mEq/L and pH <7.3 Low bicarbonate < 18mEq/L Increased serum osmolarity Increased Uric acid |
DKA Common cause - infection, disrupted rx, newly diagnosed Early S/S - polydipsia and polyuria, N,V, abd pain, anorexia |
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DKA management |
1-3 L NS 1st hr + Initial BUN and ABG 1L in 2nd hr 1L next 2hr 1L e 4hrs When gluc <180 - switch to D5 Half NS insulin Add potassium when it reaches normal gluc test + electrolytes e 1-2h till stable then 4-6h |
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Target glycated HBA1c |
HbA1c - 5.5 is prediabetic Diabetic - 6.5 but maybe as high as 7-8% if H/o hypoglycemia |
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DM Checklist |
A1c - 6.5 BP - 130-140/80 LDL/Non HDL (all apoB pro which are bad) Urine microalbumin /cret ratio (FBS - 126 = DM) |
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DM LDL/non HDL goals |
DM+CAD/PAD/TIA/STroke/AAA = LDL <70 non HDL = 30+LDL Only DM = LDL <100, non HDL<130 1st - Atorva 80 rosuva 20 (not 40 bc renal se) 2nd - Ezetimibe (dec LDL, FFA, inc microvs endothelial function) HDL target > 50 |
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Urine microalbumin /creatinine ratio (>30) |
Urine microalbumin is abn if >300 in 24hrs Urine microalbumin /cret ratio is abn if >30 Means kidneys are starting to leak protein Rx ACEI/ARB - don't prevent microalbuminuria, do prevent progression to renal failure DM+ microalb = ACE/ARB DM+ HTN = ACE/ARB if can't use ACE/ARB = CCB |
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Hyperglycemia + confusion |
unDx DM IVF insulin 0.1/unit/kg/hr |
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DM retinopathy |
Laser photocoagulation Ranibizumab if severe |
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DM neuropathy |
Gabapentin Pregabalin |
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Hypoglycemia especially in the morning + Wt gain + High C peptide |
Insulinoma C peptide - inhibited by sugar So if low - malnutrition/gastric bypass if high beta cell not normal |
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Dec in angina pain + DTR delayed + Lethargic + Low T4 + High TSH |
Hypothyroidism most common is hashimoto risk for other autoimmune dis (TSIg) fix comorbidities first ie bypass before Rx Rx thyroxine 100 - 150 mcg replacement FU with free t4 |
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Hyperthyroid |
Only Graves has proptosis not all hyperthyroid causes TSH T4 - RAIU - low uptake = subacute thyroiditis (painful) Rx NSAIDS high diffuse uptake = graves - Rx meto, methimazole - euthyroid - RAI ablation - hypothyroid high nodular uptake = TMNG |
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Thyroid storm / Thyroid Crisis |
critical hyperthyroid Propranolol block symptoms Methimazole 1st choice - agranulocytosis PTU - #4 in liver toxicity Prednisone block peripheral conversion |
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ICU multiorgan fail pts + High T3 T4 + TSH normal |
Euthyroid sick syndrome catabolic effect TSH equilibration takes 4 wks |
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Multinodular Goiter |
TSH - normal - FNA - Benigh - Observe and FU TSH - abn = Toxic = No CA chance so no FNA needed |
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Post Thyroidectomy pt + ER + Low Na + Very high CK |
myxedema coma - critical hypothyroidism Rx IV hydrocortisone/pred (not dexa) high T4 (1 mcg = 2 mcg PO doses) |
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Elderly + Afib + Wt Loss + high TSH, no other symptoms |
Apathetic hyperthyroidism Elderly don't exhibit traditional tremors and anxiety Rx Beta # Methimazole If AFib doesn't resolve then ablate DO Anticoagulate AFib for 6 mths |
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Hypercalcemia |
inc parathyroid (only dis with high PTH) CA ie MM sq lung ca (PTrP) Sarcoid Familial hypocalciuria (no s/s) Immobility |
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Acute Hypercalcemia |
Short QT Saline Pamidronate Furosemide Calcitonin |
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Cushing syndromes |
pituitary adenoma = cushing's dis small cell ca adrenal adenoma (low acth) low dose abn - urinary free cortisol - high dose suppress pituitary not CA or Adrenal (postoperative serum cortisol levels ≤140 nmol/L were predictive of non-recurrence) |
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Hyperaldosteronism |
Hypertension + low renin + low potassium Spironolactone |
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Pheochromocytoma headache +flushing + palpitation after bathroom + high bp + orthostasis present |
rule of 10% bilateral, malignant, children, extra adrenal, recur Metanephrine Dx Urine free catecholamines, MIBG Scan Phenoxybenzamine Once bp controlled then Propranolol |
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Prolactinoma |
Causes - metoclopramide, phenothiazine, Tca Rx cabergoline |
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Acromegaly |
IGF Give glucose - no gh suppression is abnormal 1st line - Transsphenoidal removal 2nd line - Octreotide > cabergoline FU - Insulin like growth factor |
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H/o hypothyroidism + wt loss + low na + inc peripheral eosinophils + inc pigmentation |
Addisons (adrenal insufficiency) Dx - cosyntropin stimulation (also HIV test bc it causes adrenal insufficiency) Rx - hydro+fludrocortisone (remember to increase cortisone if they get hospitalised for an infection or surgery) |
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diastolic HTN + fatigue + hypoK + met alkalosis + inc aldos + dec renin |
Conn's Syndrome Do imaging then surgery consult |
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Hyponatremia |
normal serum sodium level is 135-145 mEq/L defined as a serum sodium level <135 mEq/L hypervolemic, hypotonic, hyponatremia is clinically detectable edema or ascites that signifies an increase in total body water Urine osmolality helps to differentiate between conditions associated with impaired free water excretion and primary polydipsia To avoid ODS in patients with chronic hyponatremia - Minimum correction 4-8 mmol/L per day normal risk for ODS: maximum correction of 10-12 mmol/L in any 24-hour period high risk for ODS: maximum correction of 8 mmol/L in any 24-hour period |
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Normovolemic (euvolemic) asymptomatic hyponatremic patients rx Hypervolemic hyponatremia rx |
Rx free water restriction (<1 L/d) Rx salt and fluid restriction plus loop diuretics and correction of the underlying condition |
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Aged garlic effect on DM pts at high CVD risk Vit D effect on neuropathy |
No effect Decrease in symptom score only |
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SGLT2 inhibitors (Dapagliflozin) |
Decreases HbA1c and SBP in patients on combined hypertensive therapy |
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If pt on max dose of metformin and sulfonylurea Next step? |
Consider exenatide plus pioglitazone for better glucose control than insulin |
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Dulaglutide added to insulin effects |
better weight control, HbA1c control, and fasting serum glucose control |
