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fam med
| Question | Answer |
|---|---|
| what are the 6 stages of behavior change | precontemplation, contemplation, determination, action, maintenance, relapse |
| 3 MC causes of dyspepsia | GERD, PUD, fxnl dyspepsia (diagnose after upper endoscopy, etc are all nml) |
| alarm symptoms in dyspepsia | age>55 w new onset of sympt, FMH of upper GI cancer, wgt loss, bleeding, worsening dysphagia, odynophagia, anemia, persistent vomitting |
| remember to ask abt NSAID use in dyspepsia | |
| mgmt GERD | PPI, if taking NSAID need to stop (I guess don't need PPI) |
| if dyspepsia but not GERD or NSAID, how manage? | can do empiric PPI or H2 antagonist; **(best) H Pylori test/treat; endoscopy |
| lifestyle changes for GERD& dyspepsia | just avoid trigger foods if only dyspepsia, if GERD: wgt loss, elevating head of bed, avoiding spicy and large meals and meals before bed |
| triple tx for H Pylori | PPI, clarithromycin, amox (flagyl if allergic to PCN) |
| on female w UTI sympt be sure to ask abt | gyne symptoms (discharge, pelvic pain) and even menstrual history; sympt suggestive of pyelo (F/C, N/V, back pain) |
| serious UTI type diseases want to consider/ r/o | renal cell or bladder cancer, pyelo, PID, nephrolithiasis |
| ppl at risk for complicated UTI (ie pyelo) | fxnl or anatomic abnlty of urinary tract incl polycystic kidney dz, nephrolithiasis, neurogenic bladder, preg, DM or immunosupp, recent urinary tract procedure or catheter |
| lifestyle changes for UTI | liquids, urinate s/p sex, drink cranberry juice, wipe front to back s/p BM |
| MC bugs for UTI in female | E Coli, then Staph Sapro |
| tx for uncomplicated UTI in women | 3d Bactrim or Cipro sufficient, if recurrent may used 5-10d and ensure infxn clears |
| what cxns or serious URI don't want to miss | meningitis, brain abscess, orbital cellulitis |
| imaging/w/u for URI/sinusitis | none, could order sinus XR or CT, but not usu helpful, sinus cx could be considered if resistant to tx |
| tx URI/sinusitis | if just viral use nasal saline spray, can give nasal decongestant (pseudoephed, oxymetazoline 3-5d), if sinusitis amox |
| if allergic component URI how tx | loratadine (claritin), fexofenadine (allegra) |
| mild persistent asthma symptoms and use of inhaler | daytime symptoms (using b2) >2x/wk, nighttime 3-4/mo, FEV1 >80% and FEV1/FVC nml (same as intermittent) |
| levels of asthma | intermittent, mild persistent, moderate persistent, severe persistent |
| moderate persistent asthma symptoms and use of inhaler | daytime symptoms (using b2) everyday, nighttime sympt >1x/wk, FEV1 60-80% and FEV1/FVC reduced by 5% |
| severe persistent asthma symptoms and use of inhaler | daytime symptoms (using b2) throughout the day, nighttime sympt every night, FEV1 <60% and FEV1/FVC reduced by >5% |
| well controlled asthma | sympt <2x/wk and nighttime <2x/mo, no interference nml activity, FEV1 >80% of best (can f/u 6mos) |
| not well controlled asthma | sympt >2x/wk and nighttime >2x/mo, some limitation nml activity, FEV1 60-80% of best (add tx and f/u 2-6wks) |
| poor controlled asthma | sympt throughout the day, nighttime sympt almost every night, using b2 mltpl times/day, FEV<60%, for tx consider short term oral steroids and f/u 2wks |
| SE of b2 | tachycardia, tremor, hypoK, paradoxical bronchospasm |
| SE ipratropium | antichol, ie dry mouth, nervous, can have anaphylactic rxn, angioedema |
| SE mast cell stabilizer (cromolyn) | throat irritation/dry throat, bronchospasm, anaphylaxis |
| SE theophylline | N/V, HA, insomnia, irritability. Serious SE: arrhythmias, sz |
| SE leukotriene modifiers | various incl HA, flu like/URI, GI sympt. Serious SE incl angioedema, anaphylaxis |
| mech of action theophylline | prevents breakdown of cAMP and cGMP for sm mscl relax and bronchodilation, also inhibits inflamm mediators |
| key adv/disadv theophylline | cost is advantage; disadv incl SE and need to monitor levels |
| comorbidities/triggers asthma | allergens, GERD, allergic rhinitis, smoke exposure, obesity and OSA |
| components to developing therapeutic relationship | develop atmosphere of trust, connect on non-medical topic, learn abt family contextual things related to dz, offer to partner w pt, show empathy, etc |
| tx for mild persistent? Moderate? Severe? | short acting b2 + low dose steroid. For moderate add long acting b2. for severe add medium dose steroid--if that doesn't control add oral steroid |
| cut offs for lipids | tChol <200, >240 is high. TG <150, >200 high. HDL 40-60 (where 60 or higher is good!). LDL >160 high |
| LDL when start tx and goals: pt with BOTH DM and CAD | start lifestyle and Rx at 70, goal <70 |
| LDL when start tx and goals: pt with DM OR CAD OR 10yr risk >20% | start lifestyle at 100 and Rx at 100 or 130, goal <100 |
| LDL when start tx and goals: pt with 2 RF, 10yr risk 10-20% | start lifestyle at 130 and Rx at 100 or 130, goal <130 |
| LDL when start tx and goals: pt with 2 RF, 10yr risk <10% | start lifestyle at 130 and Rx at 160, goal <130 |
| LDL when start tx and goals: pt with <2 RF | start lifestyle at 160 and Rx at 160 or 190, goal <160 |
| RF used to calculate LDL | smoking, HTN, FMH of premature CAD |
| LDL cutoff and goal for HTN, smoker w/o FMH premature CAD | would need to calculate 10yr risk, but if >20%: start lifestyle at 130 and Rx at 100 or 130, goal <130 |
| SE sulfonylureas | hypoglycemia, wgt gain, rare: hepatitis, heme abnlties |
| name types of hypolgycemics used DM2 (8, incl 4 MC) | **sulfonylureas (glyburide, glipizide), **biguanides (metformin), **thiazolidinediones (rosiglitazone, pioglitazone),**alpha glucosidase inhibitors (acarbose), meglinitinides, amylin analogs, incretin analogs, DPPV-IV inhibitors |
| key SE/cautions of metformin | GILMAR=GI, lactic acidosis, metallic taste, renal (can't use if Cr 1.5 male, 1.4 female), wgt loss |
| which hypoglycemics can cause hepatitis/hepatotoxicity | sulfonylureas, alpha glucosidase, thiazolidinediones |
| SE meglitinides | hypolgycemia, anaphylactoid, heme |
| which oral hypoglycemics have risk of hypoglycemia (4) | sulfonylureas, meglitinides, amylin analogs and incretin mimetics |
| SE thiazolidinediones (rosglitazone, pioglitazone) | fluid retention, hepatotoxicity, CHF |
| SE alpha glucosidase inhibitors | diarrhea, flatulence, bloating, rare: hypersensitivity, hepatitis |
| SE amylin analogs | N/V, anorexia, HA, interferes w absorption oral meds, avoid in gastropoeresis, **severe hypoglycemia in DM1 |
| SE incretin mimetics | N/V, diarrhea, avoid in gastropoeresis or severe RF, **severe hypoglycemia in DM2 on sulfonylureas |
| which oral hypoglycemics have GI SE (4) | **biguanides (metformin), **alpha glucosidase inhibitors (acarbose), amylin analogs, incretin analogs |
| SE DPPIV inhibitors | runny nose, sore throat, HA, rare: hypersensitivity/anaphylactoid, S-J |
| MOA sulfonylureas (glyburide, glipizide) | stimulate insulin sxn |
| adv/disadv sulfonylureas (glyburide, glipizide) | cost, safety, low SE |
| MOA biguanide (metformin) | incrs insulin sensitivity, decrs liver production of glu |
| adv/disadv metformin | use in overwgt to decs wgt |
| MOA meglitinides | pancreas incrsd sxn of insulin (Same as sulfonylureas but shorter acting) |
| adv/disadv meglitinides | shorter acting than sulfonylureas (meal adjusted dosing), more effective than sulfonylureas and less likely hypoglycemia |
| MOA thiazolidinediones | enhances insulin sensitivity in mscl |
| adv/disadv thiazolidinediones | lowers insulin requirements (bc improves insulin sensitivity) |
| MOA alpha glucosidase inhibitors | inhibits intestinal alpha glucosidase |
| adv/disadv alpha glucosidase inhib | improves post-prandial hypergly, generally poorly tolerated |
| MOA amylin analogs, how given | subQ before meal for ppl on insulin. Slows gastric emptying and decrses appetite |
| adv/disadv amylin analgos | can only use in DM1 or 2 on insulin, improves postprandial hypergly, helps wgt loss, can't give gastropoeresis |
| MOA incretin mimetics | subQ before meal for DM2. Slows gastric emptying and decrses appetite, stimulates glu dependent insulin secretion |
| adv/disadv incretin mimetics | improves postprandial hypergly, helps wgt loss |
| MOA DPPIV inhibitors | incrsd insulin sxn |
| agents for HLD (5) | bile acid sequest, niacin, statins, fibric acid, ezetimibe |
| SE bile acid sequest (cholestyramine, colestipol) | GI |
| SE niacin | flushing, GI, hyperuric; hepatotoxic, PUD, severe hypergly |
| SE statins | incrsd LFTs, myositis, rhabdo |
| SE fibric acid derivatives (gemfibrozil, fenofibrate) | GI, incrsd LFTs, gallstones, myositis |
| SE ezetimibe | upper respir sympt, HA, myalgia, rare hypersensitivity |
| MOA bile acid sequest | interrupts bile absorb so more cholesterol turned into bile acids in liver |
| adv/disadv bile acid sequest | usu add to statin bc SE |
| MOA niacin | decrses TG synthesis in liver and increases lipases clearing vLDL |
| adv/disadv niacin | good for incrsd TG and LDL, but SE limit use |
| MOA statin | HMG CoA reductase leading to decrsd cholesterol synthesis in liver |
| adv/disadv statin | effective and limited SE |
| MOA fibric acid | binds PPAR |
| adv/disadv fibric acid | use for high TG |
| MOA ezetimibe | inhibits cholesterol absorption in small intestine |
| goals for DM for glu (fasting/postprandial), HbA1c, BP, LDL, TG | fasting glu 130, postprandial 180, BP 130/75, LDL 100, TG 150, HbA1c 7 |
| cut offs for impaired glu tolerance | fasting 110-125 or 2hr postprandial 140-200 |
| cut offs for dx of DM, incl HbA1c | fasting >125 or 2hr postprandial >200, or random >200 w symptoms. Need 2 readings. Or HbA1c >6.5 x2. |
| ranges for HTN, preHTN | preHTN 120-139/80-89; HTN I: 140-159/90-99; HTN II 160/100 |
| 8 meds for HTN | diuretics, bb, ccb, ACEI, ARB, alpha1 antagonists, alpha2 agonists, direct vasodilators |
| SE BB | FARSHILD: fatigue, asthma, reynauds/impaired peripheral circulation, sex dysfxn, halluc, insomnia, lipid…bradycardia, mask hypoglycemia |
| SE diuretics | depends on specific, but hypoK, hypoMg, hyperuric, shortterm incrs cholesterol and glu |
| SE CCBs | HA, flushing, peripheral edema, gingival hyperplasia, constipation, bardycardia/arrhythmias, CHF (ie verapamil ChOPPd Liver: constip, heart block, prolactin, potassium) |
| SE ACEI | CAPTOPRIL: cough, angioedema, potassium, taste, preg, rash, liver toxicity |
| SE ARB | angioedema (less than ACEI), hyperK |
| SE alpha1 blockers | orthostatic hypotension |
| SE a2 agonist | antichol, ie sedataion, dry mouth, bradycardia, rebound HTN |
| SE vasodilators | HA, flushing, reflex tachycardia, lupus like |
| ex of direct vasodilators | hydralazine, NG, nitroprusside, isosorbide nitrate |
| ex of central alpha 2 agonists | methyldopa, clonidine |
| MOA alpha1 blocker | blocks post syn alpha1, leads to less NE release |
| adv/disadv direct vasodilators | difficult to control HTN, rapid control via IV, also pregnancy (hydralazine) |
| adv/disadv diuretics for HTN | CHF |
| adv/disadv bb for HTN | post MI, angina, SVT, CHF, diastolic dysfxn, migraine |
| adv/disadv ccb for HTN | angina, SVT, reynauds, diastolic dysfxn, migraine |
| adv/disadv ACEI for HTN | DM w albuminuria, CHF, postMI w systolic dysfxn, prevention progression CRF |
| adv/disadv alpha1 blockers for HTN | BPH, HLD |
| adv/disadv alpha2 agonist for HTN | clonidine can be used for rapid control HTN |
| what's BATHE model for psych visits | Background (what's happening), affect (emotl state), trbl (what trbles you most), handling, empathy |
| in prevention and screening what are the 6 major areas | CV, cancer, ID, injury/trauma, metabolic, emotl |
| screening DM starts, freq | 45yo q3yrs or overwgt other RF |
| screening HLD starts, freq | 35men, 45 women, q5 |
| DEXA starts | 65yo, 60 if high risk |
| mammography starts, freq | 50-75 q2 |
| colonoscopy starts, freq | 50yo q10, or 10yrs before earliest/40yo high risk |
| ASA given to | 45-79men and 55-79yo women for DM and hi risk CVD |
| pap smear starts, freq | 21-30 q2; 30-65 q3 |
| pelvic starts, freq | 20-40 q3; annual >40 |
Created by:
ehstephns
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