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Clin Med II - Test II
Clin Med II - Test II
20
Medical
Graduate
09/17/2012

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Term
Insulin
Definition
-Primary for DMI, but can be used for DMII with insulinopenia
SHORT ACTING:
-Regular: Onset 1hr, lasts 5-7hrs
-Insulin Lispro/Aspart/Glusiline: Onset 20min, Lasts 4hrs

LONG ACTING:
-NPH: onset delayed 2-4hrs, Peaks @ 8-10hrs
-Insulin Glargine; 24hrs, no peaks
-Insulin Detemir: 17hrs
Term
Sulfonylurea Receptor Drugs: Sulfonylureas
Definition
-Tolbutamine, Tolazamide, Aletohexamide
-Stimulates Insulin release from B-cell
-Not for type I (absolute failure of B-cells)
-Can cause hypoglycemia
Term
Sulfonylurea Receptor Drugs: D-Phenylalanine Derivitives
Definition
-Nateglinide
Term
Sulfonylurea Receptor Drugs: Meglitinide Analogs
Definition
-Rapaglinide
-Chemically identical to Glyburide, without sulfonic acid moeity
-Less risk of hypoglycemia
Term
Metformin
Definition
-1st line therapy for DMII - Start @ time of Dx
-Decreases glucoenogenesis in liver, increases glucose uptake in muscle

SE:
-Lactic acidosis; ARF c contrast dyes
Term
Thiazolindinediones
Definition
-Rosiglitazone, Pioglitazone
-Increased insulin sensitivity
-Decreased fatty acid/glucose output/adipokines/HbA1C 1-2%
Term
Alpha-Glucosidase Inhibitors
Definition
-Acarbose, Miglitol
-Completely inhibit Alpha-Glucosidase Enzymes in gut
-Delays carbohydrate absorption

SE:
-GI problems
Term
Incretins: GLP-1 Receptor Agonists
Definition
-Exenatide
SE: pancreatitis risk

-Liraglutide:
-SE: Thyroid cancer risk
Term
Incretins: DPP-4 Antagonists
Definition
-Sitagliptin, Saxagliptin
-Blocks DPP-4 to allow endogenous GLP-1 to fxn longer
-Decreases Hb1AC 0.5-1.4%
Term
Islet Amyloid Polypeptide
Definition
-Pramlintide
-Delays gastric emptying, suppresses glucagon, decreased appetite
-Type I or II
-Decreased HbA1C 0.4% with 1.7kg wt decrease
Term
Chronic Diabetes Mgmt: Cardiovascular
Definition
-Tx DM pts as if they have already had an AMI
-Aggressive BP mgmt: <130/80
-ACE-i 1st line tx, then CCB, BB, vasodilators
-Decrease LDL <70
-Statins 1st line
-Increase HDL >40
-Decrease Triglycerides <150
-ASA 81-325mg for AMI risk reduction
Term
Chronic Diabetes Mgmt: Diabetic Retinopathy
Definition
-Glucose mgmt
-Yearly ocular exam
Sx:
-Photocoagulation; Vitrectomy

Med:
-Anti-angeogenic drugs
Term
Chronic Diabetes Mgmt: Diabetic Nephropathy
Definition
-ACE-i drug of choice
-Dietary protein restriction
-Strict protein restriction
-Strict glycemic control
-Early Tx of UTI
-Avoid contrast dyes
Term
Chronic Diabetes Mgmt: Diabetic Neuropathy
Definition
-Annual podiatry exam
-Complete neurosensory exam
Peripheral:
-Lyrica, Neurontin, Amytriptilene, Carbamazapine
Autonimc:
-Gastroperesis: small meals, erythromycin
-Neurogenic bladder: Bethanecol, self-cath
-Impotence: Sildanefil, various prosthesis
Term
Hydroxymethylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors
Definition
-Statins
Lipid effects:
-Decreases LDL/Triglycerides
-Increases HDL

SE:
-Mild: muscle aches, GI problems
-Severe: Renal failure, rhabdomyolysis
Term
Nicotinic Acid
Definition
-Decreases mortality
Lipid effects:
-Decreases VLDL
-Increases HDL

SE:
-Flushing, pruritis
Term
Bile Acid-Binding Resins
Definition
-Cholestyramine, Colesevelam, Colestipol
Lipid Effects:
-Decreases LDL
-Increases Triglycerides

SE:
-GI symptoms
-Decreases fat soluble Vitamin Absorption
Term
Fibric Acid Derivatives
Definition
-Gemfibrozil, Fenofibrate
-PPAR-alpha
Lipid Effect:
-Decreases triglycerides
-Increases HDL

SE:
-Cholelithiasis
-Myositis
Term
Ezetimibe
Definition
Lipid Effects:
-Decreases LDL
-->Long term data still out
Term
Omega-3 Fatty Acid
Definition
Lipid Effect:
-Decreases hepatic VLDL production

-EPA and DHA more effective than alpha-linolenic acid

SE:
-Fishy aftertaste
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