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CC May 2016 Use of Angiotensin-Converting Enzyme Inhibitors (ACEI) in Diabetics

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echoecho's version from 2016-07-26 04:22

Section

Question Answer
ACEI play a role in prevention and management of complications of diabetes, especially diabetic ________?nephropathy
Regarding the JNC-8, does it recommend a specific drug class for the first-line treatment of HTN in diabetic patients compared to previous years?no
What are the treatment recommendations for HTN in diabetic patients?1) thiazides 2) CCBs for AA 3) thiazides 4) ACEI 5) ARBs or CCBs for nonAA patients
Treatment of BP > _____/_____ in diabetic patients > 18 years of age (the same threshold as non-diabetics < 60 years of age)?140; 90
*** The ADA recommends either a _____ or an _____ as part of the BP regimen in all diabetic patients with HTN?ACEI; ARB
JNC-8 recommends first-line use of what 2 medication classes in all patients with CKD?ACEI; ARB
Why is dual inhibition of the renin-angiotensin system with the combination of an ACEI and ARB NOT recommended?because the combination increases the risk of adverse drug effects such as hypotension and hyperkalemia; while proteinuria was decreased, renal impairment actually increased in studies
What is usually the earliest manifestation of diabetic nephropathy?albuminuria
Older literature used the terms microalbuminuria and macroalbuminuria. What is the current terms used respectively?microalbuminuria = moderate albuminuria AND macroalbuminuria = severe albuminuria
How is the degree of albuminuria expressed?Either as 1) total albumin excretion over 24 hours OR as the albumin/creatinine ratio (ACR) in a random urine sample
What ratio is sufficiently accurate to make a dx of kidney disease (so a 24 hour urine albumin measure is not necessary)?ACR (albumin/creatinine ratio) in a random urine sample
The ADA defines "albuminuria" as an ACR > _____ mg of albumin per gram of creatinine?30
An ACR level > _______ mg/g is considered severe albuminuria?300
*** Because moderate levels of albuminuria may resolve spontaneously, treatment should NOT be initiated unless a minimum of ____ out of ____ tests are POSITIVE within a 6 month period?2; 3
*** Patients with confirmed albuminuria should receive what classification of HTN drugs, REGARDLESS of BP level?ACEI or ARB
*** The ADA recommendations indicate that clinicians should "consider" what classification of BP medications in diabetic patients with known cardiovascular disease and/or cardiac risk?ACEI
Have some randomized trials shown a reduction in cardiovascular events with the use of ACEI?yes
Trials of ACEI were LESS likely to show benefit when ______lowering therapy was more consistently utilized?lipid
A Cochrane review found that use of ACEI in diabetic patients without albuminuria did what?reduced progression to albuminuria (this effect was similar in pts w/ and those w/o baseline HTN)
ACEI reduced all-cause ______?mortality
Current ADA recommendations ______ (does vs. doesn't) endorse the use of ACEI or ARBs in normotensive patients w/o albuminuriadoesn't
Do direct comparisons between ACEI and ARBs establish the clear superiority of one class over the other?no
There more studies supporting the efficacy of ACEI, why?because ACEIs were introduced earlier and tested in higher-risk populatoins
Metformin is contraindicated in men with a creat level > ____ and women with a creatinine level > ____?1.5; 1.4
Regulatory agencies in Canada an dEurope allow for more ______ use of Metformin in patients with mild kidney disease?liberal
Is the presence of albuminuria a contraindication to Metformin use?no
*** SUMMARY = Blockade of what system remains an important part of HTN control and prevention of DM nephropathy in diabetic patients?renin-angiotensin-aldosterone system
*** SUMMARY = What 2 HTN medication classes (but not both), should be standard treatment in diabetic patients wtih confirmed albuminuria?ACEI; ARBs
*** SUMMARY = The definition of levels of albuminuria are based on what ratio that can be performed on a random voided urine specimen?albumin/creatinine ratio
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