What is the appropriate screening for nephropathy in diabetes?
Annual testing for microalbuminuria starting at diagnosis for Type II, 5yrs after diagnosis for Type IAnnual Scr
What is the appropriate screening for neuropathy in diabetes?
10 guage monofilament test in 4 spotsAnnual diabetic foot exam
What is the appropriate screening for retinopathy in diabetes?
Annual ophthalmic exam until stable, then q 2-3yrs
What is the tx for nephropathy?
ACEIARBNon-dihydropyridine CCBs (Diltiazem, Verapamil), BBL, or diuretic+ Protein restriction (0.8-1.0g/kg or less)+ Replace red meat with chickenDialysis
What is the tx for neuropathy in diabetes?
TCACarbamazepineValproatePregabalinDuloxetine
What is the tx for autonomic neuropathy in diabetes?
MetoclopramideErythromycinPDE-5 inhibitors (ED)Intraurethral prostaglandins (ED)Vacuum devices (ED)Avoid diets high in fiberMultiple small meals throughout the daymoderate exercise
What is the tx for retinopathy in diabetes?
None that work besides glycemic and BP control
What are the SE of ACEI?
CoughAngioedemaHyperkalemiaRenal toxicity
What are the SE of ARBs?
Cough (much less than ACEI)Angioedema (much less than ACEI)HyperkalemiaRenal toxicity
What are the SE of TCAs?
Anticholinergic SE (anti-SLUD - salivation, lacrimation, urination, defecation)SedationWt gainAlpha blockadeQT prolongationTorsades de pointes
What are the SE of Carbamazepine?
Aplastic anemiaDizzinessAuto-induction3A4 induction
What are the SE of Valproate?
Wt gainTremorAlopeciaIncreased LFTsIncreased ammoniaLoss of libidoPancreatitis
What are the SE of Pregabaliln?
DizzinessSedationBlurred visionWt gainDiscontinuation syndromeRenal issues (adjust for dysfunction)
What are the SE of Duloxetine?
NauseaConstipationDiarrheaDry mouthFatigueHADiscontinuation syndrome$$$$$$$
What are the SE of Metoclopromide?
Facial spasmsDepressionEPSE including irreversible tardive dyskinesia
What are the SE of Erythromycin?
Skin rashCrampingNAbdominal painSudden cardiac arrest (QT prolongation)
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?
vasodilationdecreased HRnegative inotrope(decreased CO overall)
How do TCAs help protect against neuropathy?
slow the nerve conduction = decreased pain
How does pregabalin protect against neuropathy?
unknownbinds with high affinity to the alpha2-delta site in CNS tissuesdecrease in Ca dependent release of several neurotransmitters is seen in vitro
How does Duloxetine protect against neuropathy?
potent inhibitor of neuronal 5-HT and NE reuptake and a weak DA reuptake inhibitor
What is the MOA of Metoclopramide in gastroparesis?
5-HT4 agonist5-HT3 antagonistD2 antagonistCholinergic facilitator
Wht is the MOA of Erythromycin in gastroparesis?
Motilin receptor agonist