CC May 2016 Use of Angiotensin-Converting Enzyme Inhibitors (ACEI) in Diabetics
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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 albuminuria | doesn'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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