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What is the appropriate screening for nephropathy in diabetes?
- Annual testing for microalbuminuria starting at diagnosis for Type II, 5yrs after diagnosis for Type I
- Annual Scr
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What is the appropriate screening for neuropathy in diabetes?
- 10 guage monofilament test in 4 spots
- Annual diabetic foot exam
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What is the appropriate screening for retinopathy in diabetes?
Annual ophthalmic exam until stable, then q 2-3yrs
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What is the tx for nephropathy?
- ACEI
- ARB
- Non-dihydropyridine CCBs (Diltiazem, Verapamil), BBL, or diuretic
- + Protein restriction (0.8-1.0g/kg or less)
- + Replace red meat with chicken
- Dialysis
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What is the tx for neuropathy in diabetes?
- TCA
- Carbamazepine
- Valproate
- Pregabalin
- Duloxetine
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What is the tx for autonomic neuropathy in diabetes?
- Metoclopramide
- Erythromycin
- PDE-5 inhibitors (ED)
- Intraurethral prostaglandins (ED)
- Vacuum devices (ED)
- Avoid diets high in fiber
- Multiple small meals throughout the day
- moderate exercise
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What is the tx for retinopathy in diabetes?
None that work besides glycemic and BP control
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What are the SE of ACEI?
- Cough
- Angioedema
- Hyperkalemia
- Renal toxicity
-
What are the SE of ARBs?
- Cough (much less than ACEI)
- Angioedema (much less than ACEI)
- Hyperkalemia
- Renal toxicity
-
What are the SE of TCAs?
- Anticholinergic SE (anti-SLUD - salivation, lacrimation, urination, defecation)
- Sedation
- Wt gain
- Alpha blockade
- QT prolongation
- Torsades de pointes
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What are the SE of Carbamazepine?
- Aplastic anemia
- Dizziness
- Auto-induction
- 3A4 induction
-
What are the SE of Valproate?
- Wt gain
- Tremor
- Alopecia
- Increased LFTs
- Increased ammonia
- Loss of libido
- Pancreatitis
-
What are the SE of Pregabaliln?
- Dizziness
- Sedation
- Blurred vision
- Wt gain
- Discontinuation syndrome
- Renal issues (adjust for dysfunction)
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What are the SE of Duloxetine?
- Nausea
- Constipation
- Diarrhea
- Dry mouth
- Fatigue
- HA
- Discontinuation syndrome
- $$$$$$$
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What are the SE of Metoclopromide?
- Facial spasms
- Depression
- EPSE including irreversible tardive dyskinesia
-
What are the SE of Erythromycin?
- Skin rash
- Cramping
- N
- Abdominal pain
- Sudden cardiac arrest (QT prolongation)
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How do ACEI protect against nephropathy?
dilation of efferent arteriole = decreased pressure in glomerulus = decreased protein in urine = decreased progression of kidney disease
-
How do CCBs protect against neuropathy?
- vasodilation
- decreased HR
- negative inotrope
- (decreased CO overall)
-
How do TCAs help protect against neuropathy?
slow the nerve conduction = decreased pain
-
How does pregabalin protect against neuropathy?
- unknown
- binds with high affinity to the alpha2-delta site in CNS tissues
- decrease in Ca dependent release of several neurotransmitters is seen in vitro
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How does Duloxetine protect against neuropathy?
potent inhibitor of neuronal 5-HT and NE reuptake and a weak DA reuptake inhibitor
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What is the MOA of Metoclopramide in gastroparesis?
- 5-HT4 agonist
- 5-HT3 antagonist
- D2 antagonist
- Cholinergic facilitator
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Wht is the MOA of Erythromycin in gastroparesis?
Motilin receptor agonist
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