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Metformin Usmle

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Handwritten video lecture on Pathogenesis, pathophysiology, signs, symptoms and treatment of Diabetes Insipidus for USMLE Step 1 and USMLE Step 2. Diabetes Insidipus is defined as low ADH which can be due to decrease production of ADH (central) or decrease response to ADH (Nephrogenic) PHYSIOLOGY OF ADH SECRETION High osmolality of the plasma activates osmoreceptors which causes production and release of ADH in hypothalamus. ADH is subsequently stored in posterior pituitary until release. ADH acts on the principal cells of the collecting ducts of the kidney. After entering the cell it activates release of aquaporin in the lumen side of the collecting ducts. This causes reabsorption of water due to high osmolality of the medulla. When the water is reabsorbed ADH leads to increase urine osmolality. CENTRAL DIABETES INSIPIDUS Decrease production of ADH by the Hypothalamus or pituitary leads to central diabetes insipidus. Neurosurgery - pituitary surgery Trauma - leads to Central Diabetes Insipidus leading to three stages, polyuria, SIADH phase and permanent diabetes insipidus Tumor, inparticular langerhan cell histiocytosis can cause diabetes insipidus and congenital syndrome such as supraoptic dysplasia. NEPHROGENIC DIABESTES INSIPIDUS May be caused by V2 receptor mutation which is X linked recessive. The most common cause of nephrogenic diabetes insipidus is lithium. Lithium enters the cells via the ENaC and inhibits Aquaporin 2. Hypercalcemia and Hypokalemia can develop diabetes insipidus and is reversal. Drugs which are known to cause nephrogenic diabetes insipidus are foscarnet, cidofovir, amphotericin B. SIGNS and SYMPTOM of DIABETES INSIPIDUS The three primary symptoms of Diabetes Insipidus is polyuria, nocturia, polydipsia. Hypernatremia may develop but not usually because patient will drink enough water. Primarily seen in patients who have diabetes insipidus but no access to water such as infants, and elederly. TREATMENT for Diabetes Insipidus For Central Diabetes insipidus give desmopressin, and other ADH secreting drugs such as chlorpromaide, carbamazepine, clofibrate and NSAIDs. Also a low solute, low protein diet which prevent high urine osmolality. For nephrogenic diabetes insipidus is thiazide diuretics which causes volume depletion trigger an increase in reabsorption of sodium and water in PCT. Amiloride inhibits ENaC so it is primarily used if Nephrogenic Diabetes Insipidus is caused by lithium. Water restriction test is used to diagnose Diabetes insipidus. Water restriction is followed by monitoring the patient urine osmolality and ADH secretion.

Usmle Step 3- Endocrinology

DKA is more common in type 1 or type 2 DM? adipose tissue must have insulin to permit entry of glucose and FFAs; excess fat creates a deficiency of insulin if a pt cannot be well controlled with diabetes on metformin, what do you do? renal insufficiency (increases risk of lactic acidosis), pts using contrast agents for any radiologic or angiographic procedure (can lead to acute renal failure) increases release of insulin from pancreas sitagliptin, linagliptin, alogliptin, and saxagliptin, block metabolism or incretins such as glucagon-like peptide in Type 2 diabetes glucagon-like peptides; increase insulin release and decrease glucoagon secretion from the pancreas rosiglitazone and pioglitazone; increases peripheral insulin sensitivity acarbose, miglitol; block absorption of glucose at the intestinal lining alpha glucoside inhibitors like acarbose and miglitol have what side effects? diarrhea, abd pain bloating, and flatulence bc they block glucose absorption, sugar remains in the bowel available to bacteria and when bacteria eats the glucose they cast off gas and acid works like sulfonylureas (increases release of insulin from the pancreas); very short acting and can cause hypogl Continue reading >>

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Popular Questions

  1. drnrpatel

    A 50-year-old African-American woman returns to the clinic for a follow-up appointment for diabetes treatment. At her last visit, she was screened for diabetes because both of her parents and one of her two sisters have diabetes. After being found to have repeatedly elevated fasting blood glucose levels, the patient was given diabetic education and tried on a course of diet and exercise. While she has no specific complaints today and is pleased that she has lost 4 lb over the last 6 months, her fasting blood glucose is 130 mg/dL and a hemoglobin A1C level is 7.7%. After a lengthy discussion with the patient, it is decided that she should start therapy with metformin as well as continue her dietary controls and exercise regimen. Which of the following is the most common side effect for which she is at risk when starting this therapy?
    A. Anemia, megaloblastic
    B. Gastrointestinal distress
    C. Lactic acidosis
    D. Liver function abnormalities
    E. Weight gain

  2. Chemole

    Quote:

    Originally Posted by rulz
    Latic ACidosis.... Acidosis lactica

  3. ag2011n

    The most common side effect is Gastrointestinal distress, so I go for B.

  4. -> Continue reading
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SYSTEMIC HYPERTENSION (SHT), TYPE 2 DIABETES (T2DM), HYPERLIPIDEMIA CASE PRESENTATION FOR PHARM.D, M.PHARM PHARMACY PRACTICE

Sketchy Pharm: Metformin, Thiazolidinediones, Pramlintide, Sglt2 Inhibitors Flashcards Preview

It decreases hepatic gluconeogenesis by inhibiting the mitochondrial enzyme glycerophosphate dehydrogenase (think of the girl whom the METaphOR-wielding boy is trying to woo who is biting a mitochondria-shaped candy). Also, it activates AMPK, an enzyme that also works to inhibit gluconeogenesis. (Think of the AMPKandy bag.) Lastly, it increases peripheral insulin sensitivity (like the open Valentine's mailbox on the bench by the metformin metaphor boy). Lactic acidosis from impaired gluconeogenesis (think of the spilled, spoiled milk). This needs to be thought of in patients with renal failure, because metformin is just excreted unmodified by the kidneys (think of the cracked, kidney-shaped tray that the lactic acid is on). Also, GI upset can be caused (like the green-faced girl about to barf at the metformin boy). Rosiglitazone and pioglitazone (think of the girl reading "ROSes are red" on the GLITter-covered card) What is the mechanism of thiazolidinediones? They act on peroxisome proliferator-activated receptor gamma (PPAR-gamma), an intracellular nuclear receptor that increases glucose uptake and decreases glucose production (like the "life of the PPARy" shirt that the thiazol Continue reading >>

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Popular Questions

  1. drnrpatel

    A 50-year-old African-American woman returns to the clinic for a follow-up appointment for diabetes treatment. At her last visit, she was screened for diabetes because both of her parents and one of her two sisters have diabetes. After being found to have repeatedly elevated fasting blood glucose levels, the patient was given diabetic education and tried on a course of diet and exercise. While she has no specific complaints today and is pleased that she has lost 4 lb over the last 6 months, her fasting blood glucose is 130 mg/dL and a hemoglobin A1C level is 7.7%. After a lengthy discussion with the patient, it is decided that she should start therapy with metformin as well as continue her dietary controls and exercise regimen. Which of the following is the most common side effect for which she is at risk when starting this therapy?
    A. Anemia, megaloblastic
    B. Gastrointestinal distress
    C. Lactic acidosis
    D. Liver function abnormalities
    E. Weight gain

  2. Chemole

    Quote:

    Originally Posted by rulz
    Latic ACidosis.... Acidosis lactica

  3. ag2011n

    The most common side effect is Gastrointestinal distress, so I go for B.

  4. -> Continue reading
read more
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http://diabetestruth247.com/ - Diabetes medication heart disease - Does diabetes medication causes heart disease? Diabetic heart disease is treated with lifestyle changes, medicines, and medical procedures. Following the treatment plan your doctor recommends is very important. Compared with people who don't have diabetes, people who have the disease are at higher risk for heart disease, have additional causes of heart disease, may develop heart disease at a younger age, and may have more severe heart disease. Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. Fact: More Than 75% of Diabetics Die Of Heart Disease Nearly half of those who die from heart attacks each year never showed prior symptoms of heart disease. Right now, millions of people over age 40 are suffering from heart disease and do not even know it. Dont be caught off guard. Know your risk now. Weve created a simple, easy-to-complete, online test that will help you understand your heart attack risk factors. When you take the Simple Heart Test it takes just 1 minutes to complete Discover your risk for heart disease and stroke here - http://diabetestruth247.com/

Diabetes Medication Question

SDN members see fewer ads and full resolution images. Join our non-profit community! I have annotated in my FA from Kaplan QBank that sulfonylureas are the first-line Tx in DM-II. I even specifically recall having selected metformin as the answer to one of their quesions for 1st-line Tx in DM-II, but sulfonylureas was the correct answer. They specifically said sulfonylureas are first-line Tx over metformin based on the higher risk of side-effects with the latter. Anyway, p. 333 of FA says for biguanides: "first-line therapy in type 2 DM." Metformin is first line unless they have some contraindication like impaired renal function, in which case you can go to 2nd generation sulfonylureas as first line. But typically a sulfonylurea is an add-on drug when metformin and lifestyle modification aren't sufficient to control the person's diabetes. They are actually now recommending lifestyle modifications + metformin as the initial treatment at diagnosis rather than waiting for lifestyle modifications alone to fail. It's such a benign drug in terms of side effects, delays the progression of DM, and decreases mortality so there's no real reason to wait. Btw, now that I'm going back through Continue reading >>

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Popular Questions

  1. drnrpatel

    A 50-year-old African-American woman returns to the clinic for a follow-up appointment for diabetes treatment. At her last visit, she was screened for diabetes because both of her parents and one of her two sisters have diabetes. After being found to have repeatedly elevated fasting blood glucose levels, the patient was given diabetic education and tried on a course of diet and exercise. While she has no specific complaints today and is pleased that she has lost 4 lb over the last 6 months, her fasting blood glucose is 130 mg/dL and a hemoglobin A1C level is 7.7%. After a lengthy discussion with the patient, it is decided that she should start therapy with metformin as well as continue her dietary controls and exercise regimen. Which of the following is the most common side effect for which she is at risk when starting this therapy?
    A. Anemia, megaloblastic
    B. Gastrointestinal distress
    C. Lactic acidosis
    D. Liver function abnormalities
    E. Weight gain

  2. Chemole

    Quote:

    Originally Posted by rulz
    Latic ACidosis.... Acidosis lactica

  3. ag2011n

    The most common side effect is Gastrointestinal distress, so I go for B.

  4. -> Continue reading
read more

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