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Tx DM Part II
Pharm-II
| Question | Answer |
|---|---|
| Causes of hypoglycemia | excessive insulin, ↑work or exercise, delay omission of a meal, illness w/ vomiting, fever or diarrhea |
| S/S hypoglycemia | fatigue, excessive hunger, tachy, diaphoresis, paresthesia, mentation deficits |
| Tx of hypoglycemia of a conscious patient | oral glucose15-20 gm (chew), food (OJ), meal or snack, liquid best (MR in 15 mins) |
| Tx of hypoglycemia of an unconscious pt | glucagon 1mg sq, im, iv (response 5-20min MR x 1 or 2 prn) OR IV dextrose |
| Sick day tx for DM type 2 | usually ok, may need to ↓ sugar intake d/t continuous elevated BG levels |
| Sick day tx for DMT1 | continues nl insulin regimen, use supplemental rapid-acting insulin based on BG results |
| When do we give additional insulin w/ DM1 sick pts | if ketonuria develops, sugar solns to maintain BG may be used |
| Reasons for weird BG in sick DM1 pts | caloric intake ↓, insulin sensitivity ↓, so pts MUST monitor frequently |
| What would ↓ mortality in ICU DM pts w/ AMI | tight glucose control |
| What medication should we hold with a hospitalized pt | metformin |
| Goal of BP with DM | <130-80 |
| Note DB goals for HTN | below |
| Preferred HTN agents | ACE and ARBs (others include BBs, Diuretics, CCBs) |
| When do we use satins to lower LDL in DM pts | >40 w/o CVD but >1 other but 1 or more RF for it |
| CVD lipid goal | <100 Optional to be <70 |
| Why would we use niacin in DM tx for high lipids | to help ↑ BG |
| Primary prevention with aspiritn | 75-162mg/day for ppl 10 yr RF >10%, or men >50, women>60 w/ 1 major risk factor |
| Major risk factors for CVD | FHx M 55 F 65, smoking, HTN, albuminuria, dyslipidemia |
| Secondary prevention w/ aspirin | Hx of CVD |
| ASA allergy prevention medication | clopidogrel 75mg |
| When do we combine these | up to 1 yr post ACS |
| When is ASA NOT recommended | adults w/ low CV risk (10 yr risk <5%) or men <50, F<60 wo RF’s |
| What do we need to tell EVERY pt | STOP SMOKING |
| Microalbuminuria | spilling small proteins into urine 30-200mcg/mg creatinine, |
| What is a well established marker for CVD risk | microalbuminuria |
| When do we start an ACEi or ARB | if microalbuminuria is present even if normotensive |
| How do we estimate CrCl | croft-gault equation (140-age)xLBM/72 x SCr LBM: 50+(2.3 x (60-ht) or 45.5 +(2.3 x (60-ht) |
| How often should we do finger stick glucose, and A1C | 1-6xday, and every 3-6m, 3 if not at goal |
| Goal for microalbuminuria | <30, > than is predictive of nephropathy |
| F/U for lipids | yearly, or every 2 if stable |
| Lipid goals | LDL <100, HDL >40 M >50F, TG < 150 |
| Foot exam frequentcy | every visit |
| CV autonomic neuropathy | yearly , and p ted, |
| Vaccinations for DM pts | Flu every fall, pneumovax (1 >2, or >64 and 1st vaccine was >5 years ago, also Chronic syndromes: nephrotic, CRD, immunocomprimised, Hep B per CDC |
| Current percentage of adults of have A1C < 7 | 57.1% |
| How many have achieved all A1C, BP, and TC goals | 12.2% |
| 3 labs indicative of prediabetes | FPG 100-125, OGGT: 140-199, A1C: 5.7-6.4 |
| What should wt loss be to prevent DM | 7% total body wt, PA 150m/week, |
| When do we consider metformin | BMI >35, Age <60, Women w/ prior GDM |
Created by:
becker15
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