FNP exam-Endocrine with 100% correct answers

What is the BMI cut point for screening adults with one or more risk factors for diabetes? 25kg/m2 The ADA recommends annual diabetes screening for patients with BMI >25 and 1 or more risk factors for DM The ADA recommends all patients >45yo be screened for DM every _____years if screening is normal. three What are the risk factors for DM? Age greater than or equal to 45 BMI > 25kg/m2 First degree relative with DM Habitual inactive lifestyle HTN (140/90 or higher) Women with PCOS History of vascular disease Delivery of macrosomic infant (>9lbs) or gestational diabetes AA, Hispanic, Native American, Asian-American, Pacific Inslander Previously identified A1C of > or = to 5.7%, impaired glucose tolerance or IFG The pre-DM A1C levels are >/= 5.7-6.4% What is the AIC level at which T2DM is diagnosed? >/=6.5% (confirmed by repeat testing unless hyperglycemia is unequivical) What FBS levels are considered pre-DM? 100-125mg/dL What FBS is indicative of T2DM? A FBS of >/= 126 on two occasions unless unequivical When is a 2h GTT helpful? pregnancy PCOS Pre-DM 2 h GTT levels 140-199mg/dL A random blood glucose level of ______ is T2DM >200mg/dL What are the suggested A1C goals for patients with T2DM? <7% for most adults with T2DM <8% for older adults with T2DM (due to risk of hypoglycemia) What are the suggested A1C goals for patients with T1DM and most pregnant patients? <6% for T1DM and most pregnant patients How often should a foot exam be performed on diabetics? Every 3 months unless PVD or neuropathy; encourage daily self-checks How often should diabetics have a dilated eye exam? Annually at onset for T2DM; after 5 years of dx if T1DM How often should diabetics have dental exams? Annually How often should fasting serum lipid profile be done on patients with DM? Annually How often should A1C be monitored in patients with DM? Every 3 months if not at goal, then twice annually Metformin is the first-line drug in all patients with T2DM except those with __________ and ____________ disease. Liver and kidney disease What are the two most common side effects of Metformin? diarrhea and flatulence In a patient started on Metformin 1000mg BID, how much should the A1C decrease in three months? 1-2% To what class of drugs does Metformin belong? Biguanides Name the three sulfonylureas? 3Gs- Glimepiride, Glipizide, Glyburide How do sulfonylureas agents work? They kick the pancreas until it squirts out insulin. What are some side effects of sulfonylureas? hypoglycemia, weight gain How much should the A1C decrease with sulfonylureas? 1-2% What is a good plan of treatment for a truck driver who cannot risk hypoglycemia but who is uncontrolled with Metformin alone? Metformin (max dose) plus a DPP-4 (Tradjenta, Onglyza, Januvia, Nesina) In what patients are Actos and Avandia contraindicated? Heart failure Why should sulfonulureas and insulin not be used together? weight gain, insulin alone produces same result with less cost What meds can Metformin be safely combined? Anything! Just don't give to patients with liver or kidney disease.