week 9-13

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Questions and Answers

When initiating treatment with an amylin analogue, what adjustment is typically made to the insulin dose?

Reduced by 50% (correct)

Increased by 50%

Doubled

Kept the same

What is the recommended guideline for patients taking rapid acting insulin?

Avoid exercise during the peak insulin dose (correct)

Take a higher dose of insulin before exercise

Exercise 1 hour before administration

Exercise 2 hours after administration

How do the chemicals in grapefruit affect statin medications?

They increase the metabolism of statin medications

They bind directly to statin medications

They bind to an intestinal enzyme, making the passage of statins easier (correct)

They block the breakdown of statin medications

What is the result of the interaction between grapefruit and statin medications?

Blood medication levels may rise faster and remain at higher levels Signup and view all the answers

Which statins are affected more by grapefruit consumption?

Atorvastatin, simvastatin, and lovastatin Signup and view all the answers

What is the potential consequence of consuming grapefruit with statin medications?

Abnormally high levels of the medication Signup and view all the answers

What is the primary mechanism of action of biguanides?

Decrease hepatic glucose production Signup and view all the answers

Which of the following medications is not used in patients with abnormal creatinine clearance?

Metformin Signup and view all the answers

What is the primary mechanism of action of thiazolidinediones?

Decrease insulin resistance, increasing glucose uptake Signup and view all the answers

What is the primary mechanism of action of alpha-glucosidase inhibitors?

Slow the absorption of starch, disaccharides and polysaccharides Signup and view all the answers

What is the primary mechanism of action of DPP-4 inhibitors?

Inhibit the DPP-4 enzyme that is responsible for degrading the incretins Signup and view all the answers

What is the primary mechanism of action of GLP-1 receptor agonists?

Decrease post-meal glucagon production, delay gastric emptying, and increase satiety Signup and view all the answers

What is the primary mechanism of action of SGLT2 inhibitors?

Inhibit the reabsorption of glucose in the kidneys Signup and view all the answers

What is the primary mechanism of action of amylins?

Decrease post-meal glucagon production, delay gastric emptying, and increase satiety Signup and view all the answers

Which of the following medications carry a significant risk of hypoglycaemia?

Tolbutamide Signup and view all the answers

Which of the following medications is not suitable for T1DM?

Exenatide Signup and view all the answers

What is a recommended precaution when taking a statin?

Avoiding grapefruit products altogether Signup and view all the answers

What is a common side effect of niacin therapy?

Flushing Signup and view all the answers

Why should patients with diabetes mellitus avoid taking niacin?

Niacin increases blood glucose concentrations Signup and view all the answers

What is a severe side effect of lipid-lowering medications, particularly statins and fibric acid derivatives?

Rhabdomyolysis Signup and view all the answers

What should patients experiencing symptoms of rhabdomyolysis do?

Immediately contact their Physician Signup and view all the answers

What is the primary focus of pharmaceutical treatment for PCOS?

Addressing reproductive dysfunction and insulin resistance Signup and view all the answers

What is the purpose of oral contraceptives in PCOS treatment?

To treat menstrual irregularity, hirsutism, and acne Signup and view all the answers

What percentage of patients taking lipid-lowering medications may experience medication intolerance?

Up to 25% Signup and view all the answers

What is the significance of knowing a drug's renal clearance value?

To determine the correct dosage Signup and view all the answers

In chronic renal disease, filtrate formation increases gradually.

False Signup and view all the answers

What is the leading cause of chronic renal disease?

Diabetes mellitus (44% of new cases) Signup and view all the answers

The yellow colour of urine is due to _______________________, a pigment that results when the body destroys haemoglobin.

urochrome Signup and view all the answers

Match the following terms with their definitions:

Creatinine = A substance used to estimate GFR GFR = Glomerular Filtration Rate Urine = Waste product that needs to be filtered by the kidneys Urochrome = A pigment that results when the body destroys haemoglobin Signup and view all the answers

What is the term for the clinical syndrome associated with renal failure?

Uraemia Signup and view all the answers

In renal failure, filtrate formation increases or stops completely.

True Signup and view all the answers

What happens to urea as it moves out of the tubule into the interstitial fluid of the medulla?

It moves by facilitated diffusion Signup and view all the answers

Alcohol increases the release of ADH.

False Signup and view all the answers

What is the effect of ADH on urea recycling?

ADH enhances urea transport out of the medullary collecting duct, increasing urea recycling and strengthening the medullary osmotic gradient. Signup and view all the answers

Loop diuretics, such as furosemide (Lasix), inhibit the formation of the medullary gradient by acting at the ______________________ of the nephron loop.

ascending limb Signup and view all the answers

Match the following diuretics with their mechanisms of action:

Alcohol = Inhibits release of ADH Loop diuretics = Inhibits formation of the medullary gradient Other diuretics = Inhibits sodium reabsorption and obligatory water reabsorption Signup and view all the answers

Most diuretics inhibit potassium-associated symporters.

False Signup and view all the answers

What is the function of the vasa recta?

To form concentrated urine Signup and view all the answers

The glomerulus is the second capillary bed in the nephron.

False Signup and view all the answers

What is the main function of the juxtaglomerular complex (JGC)?

To regulate the rate of filtrate formation and systemic blood pressure Signup and view all the answers

The process of selectively moving substances from the filtrate back into the blood is called ____________________.

tubular reabsorption Signup and view all the answers

What is the main function of glomerular filtration?

To produce a cell- and protein-free filtrate Signup and view all the answers

Tubular secretion is the process of moving substances from the filtrate back into the blood.

False Signup and view all the answers

Match the following processes with their descriptions:

Glomerular filtration = Produces a cell- and protein-free filtrate Tubular reabsorption = Reclaims most of the filtrate Tubular secretion = Moves substances from the blood into the filtrate Signup and view all the answers

How much of the water, salt, and other components is typically reabsorbed in the tubular reabsorption process?

About 99% Signup and view all the answers

What is the function of ANP in the body?

Lower blood sodium content Signup and view all the answers

Tubular secretion is the process of reabsorbing substances from the filtrate back into the blood.

False Signup and view all the answers

What is the primary site of excretion for most substances, except for potassium?

PCT Signup and view all the answers

Tubular secretion is important for disposing of substances that are tightly bound to _______________________.

plasma proteins Signup and view all the answers

What is the outer layer of dense fibrous connective tissue that anchors the kidney and the adrenal gland to surrounding structures?

Renal fascia Signup and view all the answers

The renal pelvis is a region in the kidney that filters waste and excess fluids from the blood.

False Signup and view all the answers

Match the following substances with their roles in tubular secretion:

Urea = Handled by passive processes and secreted into the filtrate Uric acid = Handled by passive processes and secreted into the filtrate Hydrogen ions = Secreted into the filtrate to control blood pH Bicarbonate = Retained and generated to control blood pH Signup and view all the answers

What is the approximate amount of blood delivered to the kidneys each minute under normal resting conditions?

1200mL Signup and view all the answers

Parathyroid Hormone (PTH) primarily acts at the collecting ducts.

False Signup and view all the answers

What is the effect of tubular secretion on blood pH?

Raises blood pH Signup and view all the answers

The interlobar arteries branch into the ______________________ arteries that arch over the bases of the medullary pyramids.

arcuate Signup and view all the answers

Match the following structures with their functions:

Renal fascia = Prevents infections from spreading to the kidney Perirenal fat capsule = Cushions the kidney against blows Fibrous capsule = Anchors the kidney to surrounding structures Calyces = Collects urine and drains it into the renal pelvis Signup and view all the answers

What is the role of tubular secretion in controlling blood potassium levels?

Ridding the body of excess potassium Signup and view all the answers

The smooth muscle in the walls of the calyces, pelvis, and ureter contracts rhythmically to propel urine by peristalsis.

True Signup and view all the answers

What is the region in the kidney where the interlobar arteries branch into small cortical radiate arteries?

Cortex-medulla junction Signup and view all the answers

What is the percentage of total cardiac output delivered to the kidneys each minute under normal resting conditions?

One-fourth Signup and view all the answers

What is a common consequence of progressive deterioration in renal function?

Peripheral oedema, congestive heart failure, and pulmonary congestion Signup and view all the answers

RRT (Renal Replacement Therapy) can correct all signs and symptoms of uraemia.

False Signup and view all the answers

What is the most common form of RRT?

Haemodialysis Signup and view all the answers

Haemodialysis is a process of ultrafiltration (fluid removal) and clearance of _____________ from the blood.

toxic solutes Signup and view all the answers

Match the following vascular access methods with their descriptions:

Fistula = Joining an artery to a vein Graft = An artificial tube placed in the arm or leg Central venous catheter = A type of catheter used for vascular access Signup and view all the answers

Fistula is the most common access method that has the highest risk of complications.

False Signup and view all the answers

What is the primary mechanism of action of haemodialysis?

Ultrafiltration (fluid removal) and clearance of toxic solutes from the blood Signup and view all the answers

What is the primary cause of metabolic abnormalities in patients with renal failure?

Parathyroid hormone excess Signup and view all the answers

Haemodialysis is the least used therapy for renal failure.

False Signup and view all the answers

What is the preferred method of renal replacement therapy?

Transplantation Signup and view all the answers

Dietary adjustments for _______________________ intake play an important role in the initial management of renal failure.

protein, sodium and fluid Signup and view all the answers

Match the following therapies with their indications:

Angiotensin-converting enzyme inhibitor / Angiotensin receptor blocker (ACEI/ARB) = Control of blood pressure Weight loss = Management of diabetes Dietary adjustments = Initial management of renal failure Signup and view all the answers

What is the primary mechanism of action of therapies used in the management of renal failure?

All of the above Signup and view all the answers

Peritoneal dialysis is a commonly used therapy for renal failure.

False Signup and view all the answers

What is the term for the clinical syndrome associated with renal failure?

Uraemia Signup and view all the answers

What is a suitable exercise test for patients with ESRD?

All of the above Signup and view all the answers

Exercise training can favourably alter kidney function in human studies.

False Signup and view all the answers

What is the benefit of exercise training in CKD patients not yet treated with dialysis?

improves overall fitness and seems to be of some benefit on resting blood pressure and visceral fat Signup and view all the answers

Exercise heart rate responses are normalised after _______________________.

transplant Signup and view all the answers

Why should caution be taken when using heart rate to determine training intensity in patients with stage 5 disease?

Due to medication and uraemia influencing heart rate response Signup and view all the answers

Exercise training in CKD patients can harm kidney function.

False Signup and view all the answers

What is a consideration when prescribing exercise for patients being treated with dialysis?

multiple barriers to exercise may exist Signup and view all the answers

The exercise prescription for patients with CKD should include _______________________, resistance, and flexibility exercises.

aerobic Signup and view all the answers

Match the following exercise tests with their characteristics:

Short Physical Performance Battery = Used in elderly people 6 Minute Walk Test = Used in CKD patients Sit-to-Stand Test = Used in ESRD patients Gait speed testing = Used in haemodialysis patients Signup and view all the answers

What is a benefit of successful renal transplant?

Increase in exercise capacity Signup and view all the answers

Exercise training improves the functional scores on self-reported scales in peritoneal dialysis patients.

False Signup and view all the answers

What is the recommended amount of moderate to vigorous physical activity per week for patients with CKD?

at least 150 minutes Signup and view all the answers

Exercise training is associated with a reduction in depression scores in patients with CKD.

True Signup and view all the answers

What is the benefit of exercising during dialysis treatment for patients with ESRD?

reduces the likelihood of cramping and hypotension during dialysis Signup and view all the answers

Patients with CKD who are not on dialysis can benefit from exercise training programs using standard exercise prescriptions for the general population, so long as they are screened properly and start at a ______________ intensity.

low to moderate Signup and view all the answers

Match the following benefits of exercise training with their effects on patients with CKD:

improvements in cardiorespiratory fitness = up to 20% reductions in markers of inflammation = improvements in muscle strength improvements in health-related quality of life = reductions in depression scores changes in plasma lipids = variable Signup and view all the answers

Exercise should be deferred if the patient is experiencing shortness of breath related to excess fluid status.

True Signup and view all the answers

What is the recommended timing for exercise in patients with ESRD?

during dialysis Signup and view all the answers

What is the benefit of exercising on non-dialysis days for patients with ESRD?

larger adaptations usually occur Signup and view all the answers

What is the main cause of death in CKD patients?

Cardiovascular disease Signup and view all the answers

Patients with ESRD often know how much activity is too much activity.

False Signup and view all the answers

What is the importance of gradual progression in exercise for haemodialysis patients?

Gradual progression is crucial to avoid setbacks and to accommodate their extremely low fitness levels. Signup and view all the answers

In haemodialysis patients, _______________ testing for strength is not recommended because of secondary hyperparathyroidism-related bone and joint problems.

1RM Signup and view all the answers

Match the following special considerations with the type of patient:

Haemodialysis patients = Patients with extremely low fitness levels Transplant patients = Patients are initially weak and may experience orthopaedic and musculoskeletal discomfort CKD patients = Patients are likely to be diabetic, hypertensive, and overweight or obese Signup and view all the answers

Patients with CKD not yet receiving dialysis are likely to be physically active.

False Signup and view all the answers

Why should exercise heart rate prescriptions be avoided in haemodialysis patients?

Heart rate prescriptions are typically invalid in haemodialysis patients, and RPE (Rated Perceived Exertion) is recommended instead. Signup and view all the answers

What should be avoided when exercising haemodialysis patients?

Using the fistula arm for exercise during dialysis Signup and view all the answers

In transplant patients, exercise heart rate responses are _______________ after transplant.

normalised Signup and view all the answers

Prednisone may accelerate adaptations to resistance training in transplant patients.

False Signup and view all the answers

What is the characteristic of Generalised Anxiety Disorder (GAD)?

Excessive worry about actual circumstances, events or conflicts Signup and view all the answers

GAD typically begins in adulthood.

False Signup and view all the answers

What is the percentage of the Australian population affected by Generalised Anxiety Disorder?

3 - 8% Signup and view all the answers

The most important risk factor for GAD development is _______________________.

Family history Signup and view all the answers

Match the following anxiety disorders with their characteristics:

Generalised Anxiety Disorder = Excessive worry about actual circumstances Social Anxiety Disorder = Fear of social or performance situations Separation Anxiety Disorder = Fear of separation from attachment figure Panic Disorder = Sudden intense fear or discomfort Signup and view all the answers

What is the characteristic of Anorexia Nervosa?

Restriction of energy intake relative to requirements Signup and view all the answers

Binge-Eating Disorder is characterised by eating a very large amount of food in a discrete time window.

True Signup and view all the answers

What is the name of the disorder characterised by eating a very large amount of food in a discrete time window?

Binge-Eating Disorder Signup and view all the answers

What is a characteristic of psychotic disorders?

Abnormal thinking and perceptions Signup and view all the answers

A psychologist can prescribe medication.

False Signup and view all the answers

What is another term for a mental illness characterized by periods of mania followed by periods of depression?

Bipolar Disorder Signup and view all the answers

Schizophrenia is a mental illness characterized by an abnormal interpretation of ____________________.

reality Signup and view all the answers

What is an example of a trauma- and stressor-related disorder?

Post-Traumatic Stress Disorder (PTSD) Signup and view all the answers

Mood disorders are a group of mental illnesses characterized by feelings of excessive worry and fear.

False Signup and view all the answers

Match the following mental illnesses with their descriptions:

Schizoaffective Disorder = The concurrent presence of schizophrenia and a mood disorder Bipolar Disorder = A mental illness characterized by periods of mania followed by periods of depression PTSD = A trauma- and stressor-related disorder Anxiety Disorder = A group of mental illnesses characterized by feelings of excessive worry and fear Signup and view all the answers

What are the two types of symptoms of Schizophrenia?

Positive and Negative Signup and view all the answers

What is a characteristic of manic episodes?

Abnormally and persistently elevated, expansive or irritable mood Signup and view all the answers

Trauma- and stressor-related disorders are associated with intense feelings of ______________________.

fear, horror, anger, sadness, and hopelessness Signup and view all the answers

A lack of interest in the world is a positive symptom of Schizophrenia.

False Signup and view all the answers

Feeding and Eating Disorders are a group of mental illnesses characterized by abnormal thinking and perceptions.

False Signup and view all the answers

What is the main goal of treatment for Schizophrenia?

To ease the symptoms and reduce the risk of relapse. Signup and view all the answers

Antipsychotic medications, particularly _______________________, increase the risk of diabetes, hypertension, and hyperlipidemia.

second-generation Signup and view all the answers

What is the primary mechanism of MDD?

All of the above Signup and view all the answers

PTSD is typically caused by an exposure to a natural disaster.

False Signup and view all the answers

Match the following symptoms with the correct mental disorder:

Hallucinations = Schizophrenia Loss of interest or pleasure = MDD Re-living the event = PTSD Signup and view all the answers

Exercise has been shown to reduce symptoms in people with _______________________.

MDD Signup and view all the answers

What is the bi-directional relationship between physical health behaviours and psychological well-being?

There is a relationship where physical health behaviours can impact psychological well-being and vice versa. Signup and view all the answers

What is the primary mechanism of action of SSRIs in the management of PTSD?

Increasing the levels of serotonin in the brain Signup and view all the answers

Mental illness is diagnosed according to the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

True Signup and view all the answers

What is the term used to describe a person who lives with, or is in the process of recovering from, a mental illness or mental health problem?

Mental Health Consumer Signup and view all the answers

What is the aetiology of mental illness believed to be related to?

A combination of biological, psychological, and environmental factors Signup and view all the answers

Mental health problems do not meet the diagnostic criteria for a mental illness and are often experienced temporarily as a reaction to ______________ stress.

life Signup and view all the answers

Match the following health professionals with their roles:

Psychologist = A registered allied health professional who specialises in human behaviour Psychiatrist = A medical doctor who has completed specialised training in psychiatry Signup and view all the answers

Recovery-oriented approach focuses on the achievement of an optimal state of personal, social and emotional wellbeing.

True Signup and view all the answers

What percentage of the total government health expenditure was spent on mental health services in 2020-21?

7.3% Signup and view all the answers

What is the most effective type of exercise for reducing symptoms in those with diagnosed anxiety disorders?

Aerobic exercise Signup and view all the answers

There is a clear optimal dose of exercise for reducing MDD risk.

False Signup and view all the answers

What are some strategies that can be used to optimize exercise adherence in patients with MDD?

Motivational interviewing techniques, action planning concepts, transtheoretical model of behaviour change, modest goal setting strategies Signup and view all the answers

Exercise has been shown to be as effective as ______________ for the treatment of MDD.

an SSRI Signup and view all the answers

What is a potential reason why many people with anxiety are reluctant to undertake exercise?

Anxiety sensitivity Signup and view all the answers

There is evidence that exercise can reduce depression through both biological and psychological mechanisms.

True Signup and view all the answers

What is the term for the process of selectively moving substances from the filtrate back into the blood?

Reabsorption Signup and view all the answers

Match the following mechanisms with their effects on MDD symptoms:

Aerobic exercise = Reduces MDD symptoms Resistance training = Improves MDD symptoms Dietary modification = Acts additively or synergistically with exercise to improve MDD symptoms Smoking cessation = Acts additively or synergistically with exercise to improve MDD symptoms Signup and view all the answers

There is a dose-response relationship between exercise volume and reduction in ______________ risk.

MDD Signup and view all the answers

What is the impact of Schizophrenia on life expectancy compared to the general population?

Reduced by 15-25 years Signup and view all the answers

Exercise has been shown to have a negative impact on psychiatric symptoms in people with Schizophrenia.

False Signup and view all the answers

What is the primary mechanism of action of exercise in Schizophrenia treatment?

Aerobic fitness and reduction of cardiometabolic risk factors Signup and view all the answers

In people with Schizophrenia, exercise appears to have a _______ impact on the positive, negative, cognitive, and mood symptoms associated with the condition.

favourable Signup and view all the answers

What is the correlation between maximum aerobic capacity and global functioning in people with Schizophrenia?

Positive correlation Signup and view all the answers

Individuals with Schizophrenia typically have high levels of aerobic fitness.

False Signup and view all the answers

What is the significance of social support in exercise programs for people with Schizophrenia?

Plays a significant role in the initiation and maintenance of an exercise program Signup and view all the answers

Match the following benefits of exercise in Schizophrenia treatment:

Improved aerobic fitness = Reduced cardiometabolic risk factors Reduced psychiatric symptoms = Improved mood symptoms Improved global functioning = Reduced anxiety and stress Signup and view all the answers

Exercise programs for people with Schizophrenia should only be conducted in individual settings.

False Signup and view all the answers

In people with Schizophrenia, higher intensity _______ has been shown to have better outcomes, but with increased dropout rates.

aerobic exercise Signup and view all the answers

What is a common misconception about people with mental illness?

All of the above Signup and view all the answers

People with mental illness are often the perpetrators of violence.

False Signup and view all the answers

What is a major determinant of violence?

sociodemographic and socioeconomic factors, such as being young, male, and of low socioeconomic status Signup and view all the answers

Fear of _______________________ creates an environment where individuals feel hesitant to disclose any diagnosed mental illness.

discrimination Signup and view all the answers

Match the following communication strategies with their purposes:

Listen to the issue and hear the person's concerns = L of LOWLINE Offer reflective comments to show you have heard their concerns = O of LOWLINE Wait until the person has expressed their frustration and explained their feelings = W of LOWLINE Look and maintain appropriate eye contact to connect with the person = L of LOWLINE Signup and view all the answers

What is an important aspect of building relationships with people with mental illness?

Body language Signup and view all the answers

It is likely that people with mental illness will be the perpetrators of violence.

False Signup and view all the answers

What is a strategy to de-escalate a situation?

Listen to the issue and hear the person's concerns, offer reflective comments, wait until the person has expressed their frustration, etc. Signup and view all the answers

Whilst rare, you need to be cognisant that the behaviour of people with mental illness can change rapidly and you need to be able to safely respond in all _______________________.

situations Signup and view all the answers

What is the benefit of yoga for people with Schizophrenia?

Similar benefit to aerobic exercise Signup and view all the answers

Exercise has been shown to have a negative impact on PTSD symptoms.

False Signup and view all the answers

What is the recommended frequency of exercise for people with severe mental illness according to the European Psychiatric Association (EPA) Guidelines?

2-3 times per week Signup and view all the answers

_____________________ is a type of exercise that has been shown to have a small-to-moderate effect size on PTSD symptoms.

Exercise Signup and view all the answers

Match the following healthcare services with their descriptions:

General Practitioners = Most people access services through their GP Community Mental Health Care Services = Provide an array of services, including housing, support groups, and access to other medical services In-Patient Hospital Care = Provide specialised mental health care on an overnight basis in a domestic-like environment Signup and view all the answers

What is the primary focus of outcome measures in mental illness?

Characterising the severity of mental illness Signup and view all the answers

Stigma and shame increase the likelihood of people with mental illness seeking treatment.

False Signup and view all the answers

_____________________ is a questionnaire designed to characterise the severity of depression.

PHQ-9 Signup and view all the answers

What is the purpose of wearable technology in exercise for people with mental illness?

Motivation tool Signup and view all the answers

What is the result of exercise on neurotransmitters in people with Schizophrenia?

Increased production Signup and view all the answers

Study Notes

Oral Glucose-Lowering Medications

Biguanides:
- Examples: Metformin (Fortamet, Glumetza, Glucophage)
- Mechanism: Decrease hepatic glucose production, improve insulin resistance in muscles
- Low risk of hypoglycemia, not used in patients with abnormal creatinine clearance (CHF and CKD)
Sulfonylureas (1st Generation):
- Examples: Tolbutamide (Orinase), Tolazamide (Tolinase), Chlorpropamide (Diabenese)
- Mechanism: Increase insulin production in the pancreas
- Carry a significant risk of hypoglycemia, long half-life, rarely used in current clinical practice
Sulfonylureas (2nd Generation):
- Examples: Glyburide (Micronase, Diabeta, Glynase), Glipizide (Glucotrol, Glucotrol XL), Glimepiride (Amaryl)
- Mechanism: Increase insulin production in the pancreas
- Carry a risk of hypoglycemia, but less than 1st generation sulfonylureas

Thiazolidinediones

Examples: Pioglitazone (Actos), Rosiglitazone (Avandia, Avandamet, Avandaryl)
Mechanism: Decrease insulin resistance, increase glucose uptake, redistribute fat, decrease hepatic glucose output, preserve beta cell function, decrease vascular inflammation
No significant risks with exercise, but can cause mild to moderate oedema

Alpha-Glucosidase Inhibitors

Examples: Acarbose (Precose), Miglitol (Glyset)
Mechanism: Slow absorption of starch, disaccharides, and polysaccharides from the GI tract
No significant risks with exercise, but can cause gas, bloating, and occasionally diarrhoea

Dipeptidyl Peptidase 4 (DPP-4) Inhibitors

Examples: Sitagliptin (Januvia), Saxagliptin (Onglyza), Vildagliptin (Glavus), Linagliptin (Tradjenta)
Mechanism: Inhibit DPP-4 enzyme, increase incretin levels, inhibit glucagon release, increase insulin secretion, decrease BGLs
Low risk of hypoglycemia with exercise, not used in T1DM

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors

Examples: Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance), Erugliflozin (Steglatro)
Mechanism: Inhibit glucose reabsorption in the kidneys, lower BGLs
Can increase risk of ketoacidosis and UTI, may cause dehydration, ensure patients are well-hydrated with exercise

Injected (Non-Insulin) Medications

GLP-1 Receptor Agonists:
- Examples: Exenatide (Byetta), Dulaglutide (Trulicity), Liraglutide (Victoza), Semaglutide (Ozempic), Lixisenatide (Adlyxin)
- Mechanism: Decrease post-meal glucagon production, delay gastric emptying, increase satiety, decrease caloric intake
- Not suitable for T1DM, may reduce absorption of oral medications, increase risk of hypoglycemia with sulfonylureas
Amylin Analogue:
- Example: Pramlintide (Symlin)
- Mechanism: Decrease post-meal glucagon production, delay gastric emptying, increase satiety, decrease caloric intake
- Indicated for insulin-treated T2DM and T1DM, contraindicated in patients with hypoglycemia unawareness, should not be mixed with insulin, can increase risk of hypoglycemia with insulin

Insulin

Rapid Acting Insulin:
- Do not allow patients to exercise at the peak insulin dose (first 2 hours following administration)
Short Acting Insulin:
- No specific notes
Intermediate Acting Insulin:
- No specific notes
Long Acting and Ultra Long Acting Insulin:
- No specific notes

Non-Diabetes Medications

Statins:
- Effects of grapefruit: Increased statin levels, potential for abnormal high levels, avoid grapefruit products with statin therapy
Lipid-Lowering Medications:
- Niacin: Can cause flushing, skin rashes, gastrointestinal problems, and pruritus, not recommended for individuals with hypotension, liver dysfunction, or peptic ulcers
- Up to 25% of patients may experience medication intolerance, including muscle inflammation or damage, risk of rhabdomyolysis

PCOS – Pharmaceutical Intervention

Focuses on addressing reproductive dysfunction and insulin resistance
Oral contraceptives are used to treat menstrual irregularity, hirsutism, and acne

Kidney Structure

The renal fascia is the outer layer of dense fibrous connective tissue that anchors the kidney and adrenal gland to surrounding structures.
The perirenal fat capsule is a fatty mass that surrounds the kidney and cushions it against blows.
The fibrous capsule is a transparent capsule that prevents infections in surrounding regions from spreading to the kidney.

Internal Gross Anatomy of the Kidney

A frontal section through a kidney reveals three distinct regions: cortex, medulla, and pelvis.
The calyces collect urine, which drains continuously from the papillae, and empty it into the renal pelvis.
The urine then flows through the renal pelvis and into the ureter, which moves it to the bladder to be stored.

Blood and Nerve Supply of the Kidneys

Under normal resting conditions, the large renal arteries deliver one-fourth of the total cardiac output (about 1200mL) to the kidneys each minute.
The renal arteries exit at right angles from the abdominal aorta, and the right renal artery is longer than the left because the aorta lies to the left of the midline.
Each renal artery divides into five segmental arteries, which then branch into interlobar arteries within the renal sinus.
The interlobar arteries branch into arcuate arteries at the cortex-medulla junction, which then radiate outward as cortical radiate arteries.

Juxtaglomerular Complex (JGC)

Each nephron has a juxtaglomerular complex (JGC), a region where the most distal portion of the nephron loop lies against the afferent arteriole feeding the glomerulus.
The JGC includes cells that help regulate the rate of filtrate formation and systemic blood pressure.

Mechanisms of Urine Formation

Urine formation involves three processes: glomerular filtration, tubular reabsorption, and tubular secretion.
Glomerular filtration takes place in the renal corpuscle and produces a cell- and protein-free filtrate.
Tubular reabsorption is the process of selectively moving substances from the filtrate back into the blood, reclaiming almost everything filtered.
Tubular secretion is the process of selectively moving substances from the blood into the filtrate.

Urine Formation – Tubular Secretion

Tubular secretion moves selected substances from the peritubular capillaries through the tubule cells into the filtrate.
Tubular secretion is important for disposing of substances that are tightly bound to plasma proteins, eliminating undesirable substances or end products, ridding the body of excess potassium, and controlling blood pH.

Urea Recycling and the Medullary Osmotic Gradient

Urea recycling forms a pool of urea that recycles back into the ascending thin limb of the nephron loop and contributes substantially to the high osmolality in the medulla.
ADH enhances urea transport out of the medullary collecting duct, strengthening the medullary osmotic gradient and allowing more concentrated urine to be formed.

Diuretics

Diuretics increase urine flow by inhibiting sodium reabsorption and the obligatory water reabsorption that normally follows.
Examples of diuretics include alcohol, which inhibits release of ADH, and "loop diuretics" such as furosemide (Lasix), which inhibit formation of the medullary gradient.

Renal Clearance

Creatinine has a renal clearance of 140 mL/min, making it a useful indicator of glomerular filtration rate (GFR).

Renal Disease

Chronic renal disease is defined as a GFR of less than 60 mL/min for at least three months.
The leading causes of chronic renal disease are diabetes mellitus (44% of new cases) and hypertension (28% of new cases).
Renal failure (GFR < 15 mL/min) leads to uraemia, characterized by fatigue, anorexia, nausea, mental changes, and muscle cramps.

Urine – Colour and Transparency

Freshly voided urine is clear and pale to deep yellow due to the pigment urochrome.
Abnormal colours, such as pink, brown, or a smoky tinge, may result from eating certain foods or the presence of bile pigments or blood in the urine.

Clinical Considerations

Parathyroid hormone is a key factor in renal failure, as it is produced in excess due to hyperphosphataemia, which leads to reduced conversion of vitamin D to its active form.
Metabolic abnormalities associated with uraemia include insulin resistance, hyperglycaemia, and hypertriglyceridaemia with normal or low total cholesterol concentrations.
Treatments for dialysis or immunosuppression therapy can contribute to these metabolic abnormalities.

Treatment and Management

Treatment is multi-pronged, involving control of blood pressure and diabetes, use of ACEI/ARB, lowering urine protein, weight loss, smoking cessation, and regular exercise.
Dietary adjustments for protein, sodium, and fluid intake play an important role in the initial management of renal failure.
If treatments are not successful, renal replacement therapy (RRT) is required, with transplantation being the preferred method.

Renal Replacement Therapy (RRT)

Haemodialysis is the most common form of RRT, but it requires significant time at a renal centre.
Home dialysis, either as haemodialysis or peritoneal dialysis, is the modality of choice.
RCTs have demonstrated a better outcome for patients treated with five-plus dialysis treatments per week.

Signs and Symptoms

CKD patients often present with symptoms and signs resulting from diminished kidney function, including excess fluid retention, peripheral oedema, congestive heart failure, and pulmonary congestion.

Diagnostic Testing and Treatment

The decision to begin dialysis is determined by factors including cardiovascular status, electrolyte levels, chronic fluid overload, severe and irreversible oliguria, anuria, significant uraemic symptoms, and abnormal laboratory values.
RRT does not correct all signs and symptoms of uraemia and often results in other concerns and side effects.

Haemodialysis

Haemodialysis is a process of ultrafiltration and clearance of toxic solutes from the blood, necessitating vascular access by one of three methods: fistula, graft, or central venous catheter.
Fistula is the most common access method, providing the best long-term vascular access and having the lowest risk of complications.

Exercise and CKD

Exercise training can favourably alter kidney function, but evidence is inconsistent in human studies.
Exercise training improves overall fitness, seems to be of some benefit on resting blood pressure and visceral fat, but has little observed beneficial effect on serum lipids.
Exercise prescription for patients with CKD should be comprehensive and include aerobic, resistance, and flexibility exercises.

Special Exercise Considerations

Many CKD patients live sedentary lives and are not accustomed to being physically active.
Cardiovascular disease is the main cause of death in CKD patients.
Patients with CKD not yet receiving dialysis are likely to be diabetic, hypertensive, and overweight or obese.
Exercise recommendations should be made with these comorbid conditions in mind.

Exercise and Haemodialysis

Special considerations for haemodialysis patients include: extremely low fitness levels, timing of exercise sessions with dialysis sessions, frequent hospitalisations, and gradual progression.
Heart rate prescriptions are typically invalid, and the use of RPE is recommended.
Maximal exercise testing may not be feasible in all patients, but should be used whenever appropriate.

Exercise and Transplant

Special considerations for transplant patients include: gradual progression, normalised exercise heart rate responses, and excessive or abnormal blood pressure during exercise.
Patients may experience orthopaedic and musculoskeletal discomfort with strenuous exercise.
Weight management often becomes an issue following transplant.

Mental Illness Introduction

1 in 5 adults and 1 in 7 young people experience a mental illness in the past 12 months
In Australia, approximately $11.6 billion was spent on health services in 2020-21, representing 7.3% of total government health expenditure
Mental illness has an extensive impact on individuals, families, and the community more broadly

Terminology

Mental Illness: A health problem that significantly affects how a person feels, thinks, behaves, and interacts with others
Mental Health Problem: Does not meet the diagnostic criteria for a mental illness, often experienced temporarily as a reaction to life stress, and can progress to mental illness if not managed effectively
Mental Health Consumer: A person who lives with, or is in the process of recovering from, a mental illness or mental health problem
Recovery-Oriented Approach: Emphasises hope, social inclusion, goal-setting, and self-management, focusing on achieving optimal personal, social, and emotional wellbeing

Aetiology of Mental Illness

Aetiology of mental illness is believed to be related to a combination of three factors: biology, psychology, and environment
Mental illness is associated with personal distress and/or problems functioning in social, work, or family activities

Treatment Provision

Psychologist: A registered allied health professional who specialises in human behaviour and assists with managing how an individual thinks, feels, behaves, and reacts
Psychiatrist: A medical doctor who has completed specialised training in psychiatry, responsible for diagnosing, treating, and preventing mental, emotional, and behavioural disorders

Types of Mental Illness

Psychotic Disorders (Schizophrenia and Schizoaffective Disorder)
- Hallucinations and delusions
- Abnormal thinking and perceptions
Mood Disorders (Major Depressive Disorder and Bipolar Disorder)
- Disturbance in emotional state
- Increased risk of suicide
Trauma- and Stressor-Related Disorders (PTSD and Acute Stress Disorder)
- Anxiety and fear responses
- Associated with traumatic events
Anxiety Disorders (Generalised Anxiety Disorder, Panic Disorder, and Phobias)
- Excessive worry and fear
- Physical symptoms such as a fast heart rate and sweating
Feeding and Eating Disorders (Anorexia Nervosa and Binge-Eating Disorder)
- Disturbances in eating habits and weight management
- Negative impact on physical and mental health

Mental Health and Physical Activity Cycle

Regular physical activity can reduce the risk of developing mental health problems
Physical activity can improve mental health symptoms
Sedentary lifestyle is a risk factor for developing mental health problems### Exercise in MDD Treatment
Supervised exercise programs led by professionals tend to be more successful.
Exercise has been shown to be as effective as selective serotonin reuptake inhibitors (SSRIs) in treating major depressive disorder (MDD).
Over the long-term (6 months), exercise has been shown to be more effective than SSRIs in achieving MDD remission.
Most studies on exercise and MDD focus on aerobic exercise, but resistance training has also been shown to improve MDD symptoms.

Lifestyle Factors and MDD

Other lifestyle factors, such as dietary modification, smoking cessation, and sleep hygiene, can act additively or synergistically with exercise to improve MDD symptoms.

Mechanisms of Exercise in MDD

Exercise can reduce depression through both biological and psychological mechanisms.
Exercise can retard mechanistic pathways responsible for MDD development.

Dose-Response Relationship

There appears to be a dose-response relationship between exercise volume and reduction in MDD risk/symptoms.
The greatest differences in risk for MDD have been observed among those who were completely sedentary versus those engaging in low doses of physical activity.

Exercise in Anxiety Treatment

Less research has been conducted on exercise in anxiety disorders compared to MDD.
Aerobic exercise has been shown to be effective in reducing symptoms in those with diagnosed anxiety disorders (mostly generalized anxiety disorder) and those with raised anxiety.
Higher intensity aerobic exercise has been shown to be more effective than lower intensity aerobic exercise.

Mechanisms of Exercise in Anxiety

Physiological mechanisms hypothesized to be responsible for the benefits of exercise for anxiety have some overlap with those proposed for MDD.

Barriers to Exercise in Anxiety

Exposure to physical exercise can provoke anxious feelings in some individuals, leading to reluctance to undertake exercise (anxiety sensitivity).
Exposure to physical training may increase tolerance to these symptoms and decrease anxiety sensitivity.

Psychological Mechanisms of Exercise in Anxiety

Engagement with exercise may lead to an increased sense of self-efficacy as patients see an increase in their ability to cope with physiological challenges.
Exercise represents a change in social behavior (emotion action tendencies) for patients with anxiety disorders who tend to withdraw from social situations.
The "distraction theory" proposes that exercise provides a "time out" from daily activities, decreasing anxious rumination and allowing patients to think anxiolytic thoughts instead.

The Impact of Severe Mental Illness

People with schizophrenia have a reduced life expectancy of 15-25 years compared to the general population, largely due to cardiometabolic sequelae.
This reduction increases to 25-30 years when drug or alcohol abuse/misuse is combined with a schizophrenia diagnosis.
Severe mental illness also leads to a significant reduction in quality of life, resulting in a notable non-fatal burden.

The Impact of Schizophrenia

Strong social support networks are key correlates of mental health.
Setting social engagement and community participation goals can be worthwhile endeavors.

Exercise in Schizophrenia Treatment

People with schizophrenia often have reduced physical activity and aerobic fitness levels.
Barriers to exercise include fatigue, low motivation, lack of confidence, anxiety, and stress about exercising in public.
Exercise can improve aerobic fitness and reduce cardiometabolic risk factors in those with schizophrenia.
Psychiatric symptoms, including positive, negative, cognitive, and mood symptoms, can be reduced with 90 minutes of moderate-to-vigorous aerobic exercise per week.

Evidence for Exercise in Schizophrenia

Exercise appears to have a favorable impact on psychiatric symptoms, particularly in group settings with supervision.
Higher intensity aerobic exercise is associated with better outcomes, but dropout rates increase with intensity.
Consider individual comorbid conditions and situations when prescribing exercise intensity.
Social support from medical and allied health professionals, family, and friends plays a significant role in initiating and maintaining exercise programs.

Exercise in PTSD Treatment

There is limited data on the effect of exercise on PTSD symptoms, but exercise has a positive impact.
There appears to be a dose-response relationship, but it's difficult to draw certain conclusions due to limited data.
Exercise has a small-to-moderate effect on PTSD symptoms and improves secondary effects like depressive symptoms, sleep disturbances, and quality of life.

General Exercise Progression and Regression Principles for Mental Illness

Practical recommendations include limiting competition, encouraging self-selection, and focusing on moderate intensity initially.
Consider individual differences and avoid overtraining.

Healthcare Services and Providers

General Practitioners (GPs) play a crucial role in accessing services for mental illness, with 13% of all GP encounters related to mental illness.
GPs can diagnose, prescribe medication, and refer to other medical and allied health practitioners.
Community Mental Health Care Services provide various services, including housing, support groups, and access to other medical services.
In-Patient Hospital Care is required for acute hospitalisation, and Residential Care provides specialized mental health care on an overnight basis.

Outcome Measures in Mental Illness

Various questionnaires assess the severity of mental illness, with a focus on depression.
The DASS-21 is a commonly used and widely applicable scale for clinical practice.

Communication and De-Escalation

Build relationships through respect, genuine interest, and non-verbal communication.
Communicate effectively by focusing on the person, not the condition, and involving families and carers.
Strategies to de-escalate a situation include active listening, reflective comments, and empathy.

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This quiz covers oral glucose-lowering medications, including biguanides and sulfonylureas. Learn about their mechanisms, examples, and precautions.