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gphc exam > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is diabetes insipidus

A

excess dilute urine = extreme thirst due to too little ADH

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2
Q

hormones in the urine process in a normal person

A
  1. hypothalamus produces vasopressin (ADH) - stored in pituitary gland
  2. ADH released when water in body too low
  3. ADH retains water in body by reducing amount of water lost through kidneys
    = more concentrated urine
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3
Q

hormones in the urine process in diabetes insipidus

A
  1. reduced vasopressin so reduced ADH
  2. kidneys don’t retain as much water
  3. too much water passed from body = extreme thirst/polyuria
    = more dilute urine
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4
Q

Two types of diabetes insipidus

A
  1. pituitary (cranial)
  2. nephrogenic (partial)
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5
Q

What is pituitary (cranial) diabetes insipidus

A
  • lack of vasopressin (ADH) production
  • most common type
  • Tx = vasopressin or desmopressin
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6
Q

What is nephrogenic (partial) diabetes insipidus

A
  • you have ADH but kidneys don’t respond to it
  • Tx = thiazide like diuretic (paradoxical effect)
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7
Q

Desmopressin information

A
  • more potent and longer duration of action than vasopressin
  • no vasoconstrictor effect
  • side effects = hyponatraemia, nausea
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8
Q

What does too much ADH cause

A
  • body stores too much water = dilutes the salt conc in blood = hyponatraemia
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9
Q

Too much ADH treatment

A
  1. fluid restriction
  2. demeclocycline (blocks renal tubular effect of ADH)
  3. tolvaptan (vasopressin antagonist)
    - avoid rapid correction of hyponatraemia with tolvaptan as it causes osmotic demyelination = serious neurological events
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10
Q

What is diabetes mellitus

A
  • persistent hyperglycaemia
  • type 1 = deficient insulin secretion
  • type 2 = resistance to action of insulin
  • gestational = pregnant
  • secondary to medications
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11
Q

Diabetes and fitness to drive

A
  • treatment with insulin = notify DVLA
  • assess on awareness of hypoglycaemia - capability of bringing vehicle to a safe stop
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12
Q

Diabetes and group 1 driver rules

A
  • ‘normal’ drivers
    -adequate awareness of hypoglycaemia
  • no more that 1 episode of severe hypo while awake in last 12 months
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13
Q

Diabetes and group 2 driver rules

A
  • HGV/lorry/bus drivers
  • report all episodes of severe hypo including in sleep
  • full awareness of hypo
  • no episodes of severe hypo in last 12 months
  • must use glucose meter with sufficient memory to store 3 months of readings
  • visual complications = notify DVLA and don’t drive
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14
Q

DVLA advice for diabetics

A
  • tx with insulin = always carry glucose meter and strips
  • check glucose 2 hours before and every 2 hours during driving
  • glucose always > 5, if < 5 have a snack
  • ensure supply of fast-acting carbohydrate in vehicle e.g. glucose tablets, glucose drinks, full sugar soft drinks, sweets, biscuits
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15
Q

Hypoglycaemia whilst driving rules

A
  • considered as < 4mmol/L
    1. stop vehicle
    2. engine off, remove keys, move from drivers seat
    3. eat/drink suitable source of sugar
    4. wait 45 minutes after blood glucose back to normal
  • DONT drive if hypo awareness lost - notify DVLA
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16
Q

what is type 1 diabetes

A
  • insulin deficiency - destroyed b-cells in islets of langerhans
  • commonly before adulthood
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17
Q

Features of type 1 diabetes

A
  • hyperglycaemia (>11mmol/L)
  • ketosis
  • rapid weight loss
  • BMI<25
  • age < 50
  • family history of autoimmune disease
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18
Q

Type 1 diabetes blood glucose monitoring frequency and targets

A
  • at least QDS including before meals and bed
  • on waking = 5-7
  • fasting before meals/other times of day = 4-7
  • 90 mins after eating = 5-9
  • when driving = > 5
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19
Q

Type 1 diabetes insulin regimen

A
  • basal-bolus regimen
  • basal = long/intermediate
  • bolus = short/rapid - before meals
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20
Q

name the long acting insulins

A
  • detemir - BD
  • glargine - OD
  • degludec - OD
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21
Q

name the rapid acting insulins

A
  • asparte
  • lispro
  • glulisine
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22
Q

Name intemediate acting insulin

A
  • biphasic isophane
  • biphasic asparte/lispro (isophane + short acting)
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23
Q

what is biphasic insulin

A
  • short acting mixed with intermediate - 1-3x a day
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24
Q

Long acting insulin onset and duration

A
  • onset = 2-4 days to reach steady state
  • duration = 36 hours
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25
Q

Name soluble insulins

A
  • human + bovine/porcine
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26
Q

Soluble insulin details

A
  • 15-30 minutes before meals
  • onset = 30 to 60 minutes
  • peak action = 1-4 hours
  • duration = up to 9 hours
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27
Q

Rapid insulin details

A
  • immediately before meals
  • onset < 15 minutes
  • duration = 2-5 hours
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28
Q

Intermediate insulin details

A
  • onset = 1-2 hours
  • peak affect = 3-12 hours
  • duration = 11-24 hours
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29
Q

What is used for disabling/uncontrolled hyperglycaemia

A

continuous subcutaneous insulin infusion (insulin pump)

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30
Q

When to increase/decrease insulin

A
  • increase insulin when - infection, stress, trauma
  • reduce insulin when - physical activity, intercurrent illness, reduced food, reduced renal function, thyroid disease, addisons, coeliacs
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31
Q

Insulin administration

A
  • inactivated by GI enzymes - give subcut into fat e.g. abdo (fastest absorption), outer thigh, buttocks (slower absorption)
  • rotate site - lipohypertrophy = erratic absorption of insulin
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32
Q

What is type 2 diabetes

A
  • insulin resistance later in life
  • pre diabetes = HbA1c: 42-47
  • diabetes = 48 mol/mol
  • offer lifestyle advice 1st line
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33
Q

Type 2 diabetes treatment (low CVD risk)

A
  • assess HbA1c, kidney function and CVD risk
    1. Metformin
    2. + DPP-41 (gliptin), pioglitazone, sulfonylurea or SGLT2i (flozin)
    3. triple therapy (add/swap)
    4. specialised e.g. insulin, GLP1 agonist
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34
Q

Type 2 diabetes treatment (high CVD risk)

A
  • assess HbA1c, kidney function, CVD risk (high risk = established attherosclerotic CVD/HF or QRISK > 10%)
    1. metformin
    2. SGLTi (flozin)
    3. +DPP-4i (gliptin), pioglitazone or sulfonylurea
    4. triple therapy (add/swap)
  • if at any point develops high risk - consider SGLT2i
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35
Q

Type 2 diabetes metformin resistant treatment

A
  • if due to GI side effects - use MR prep
  • assess HbA1c, kidney function, CVD risk
    1. DPP-4i (gliptin), pioglitazone, sulfonylurea OR SGLT2i (flozin - in high CVD risk)
    2. DPP-4i + pioglitazone OR DPP-41 + sulfonylurea OR pioglitazone + sulfonylurea
    3. insulin
  • aim for individually agree threshold for HbA1c through tx
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36
Q

Diabetic complications - CVD treatment

A
  • low dose statin (T1DM, age > 40, diabetes > 10 yrs, nephropathy, other CVD)
  • ACEi to reduce CVD risk
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37
Q

Diabetic complications - diabetic nephropathy

A
  • nephropathy causing proteinurea = ACEi (including black and >55)/ARB
  • ACEi/ARB potentiate hypoglycaemic effect of anti diabetic drugs/insulin
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38
Q

Diabetic complications - diabetic neuropathy

A
  • painful peripheral neuropathy
  • anti-depressant, gabapentin, pregabalin
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39
Q

Diabetic complications - diabetic foot

A
  • treat pain
  • manage infection
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40
Q

Diabetic complications - autonomic neuropathy

A
  • treat diarrhoea with codeine or tetracyclines
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41
Q

Diabetic complications - neuropathic postural hypotension

A
  • increase salt intake
  • OR fludrocortisone
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42
Q

Diabetic complications - gustatory sweating

A
  • antimuscarinic (propantheline bromide)
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43
Q

Diabetic complications - erectile dysfunction

A
  • sildenafil
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44
Q

Diabetic complications - visual impairment

A
  • annual eyes test - free
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45
Q

Metformin (biguanide) MoA

A

reduces gluconeogenesis and increases peripheral utilisation of glucose

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46
Q

Metformin side effects

A
  • lactic acidosis (DONT use if eGFR < 30)
  • GI effects (increase dose slowly/MR)
  • reduces vitamin B12
  • hold if AKI
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47
Q

Sulphonylureas MoA

A

augments insulin secretion

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48
Q

Name short acting and long acting sulphonylureas

A
  • short-acting: gliclazide, tolbutamide
  • long-acting: glibenclamide, glimepiride
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49
Q

Sulphonylureas side effects

A
  • prolonged/fatal hypoglycaemia (avoid elderly) (target - 7%)
  • avoid in acute porphyrias
  • avoid in hepatic and renal failure
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50
Q

Pioglitazone MoA

A

reduces peripheral insulin resistance

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51
Q

Pioglitazone side effects

A
  • avoid in history of heart failure
  • increase risk of bladder cancer - review in 3-6 months, report haematuria, dysuria, urinary urgency
  • increased risk of bone fractures and liver toxicity - report NV, abdo pain, fatigue, dark urine
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52
Q

Dipeptidylpeptidase-4 inhibitors MoA

A
  • alogliptin, linagliptin, saxagliptin, sitagliptin, vildagliption (new hepatotoxic)
  • inhibits DPP-4 to increase insulin secretion and lower glucagon secretion
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53
Q

DPP-4i side effects

A

cause pancreatitis - stop if persistent, severe abdo pain

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54
Q

Sodium Glucose Co-transporter 2 inhibitors MoA

A
  • canagliflozin, dapagliflozin, empagliflozin
  • inhibits SGLT2 in renal proximal convoluted tubule
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55
Q

SGLT2i MHRA warnings

A
  • life threatening/fatal DKA - monitor ketones
  • fourniers gangrene (necrotising fasciatis of genitalia/perineum)
  • canagliflozin: lower limb amputation (mainly toes)
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56
Q

SGLT2i side effects

A
  • volume depletion - correct hypovolaemia, monitor renal function
57
Q

GLP1 Agonist MoA

A
  • dulaglutide, eventide, liraglutide, lixisenatide
  • increase insulin secretion, suppresses glucagon secretion, slows gastric emptying
58
Q

GLP1 agonist MHRA warning

A
  • DKA with concomitant insulin rapidly reduced
59
Q

GLP1 agonist side effects

A
  • acute pancreatitis - persistent, severe abdo pain
  • dehydration - GI side effects
60
Q

Acarbose MoA and side effects

A
  • delays digestion and absorption of starch and sucrose
  • GI effects = reduce dose
61
Q

Meglitides (nateglinide or repaglinide) MoA and side effects

A
  • stimulates insulin secretion
  • stress exposure = tx interruption and replacement with insulin to maintain glycemic control
62
Q

Diabetes medications affecting weight

A
  • gain: pioglitazone, sulphonylureas
  • neutral: DPP-4i
  • loss: metformin, GLP1 agonist, SGLT2i
63
Q

what is diabetic ketoacidosis

A
  • severe hyperglycaemia
64
Q

DKA symptoms

A
  • polyurea
  • thirsty
  • pear drop breath (ketones)
  • deep/fast breathing
  • 4Ts: thin, thirst, toilet, tired
65
Q

DKA monitoring

A
  • check blood sugar if > 11mmol/L, check ketones (urine/blood) if:
    = 0.6 - 1.5 mmol = slight risk (retest 2 hours)
    = 1.6 - 2.9 mmol = increased risk (GP)
    = 3 mmol + = medical emergency (hospital)
66
Q

DKA treatment

A
  1. If BP < 90, restore volume with 500mL IV NaCl 0.9%
  2. Once BP > 90 = maintenance IV NaCl 0.9%
  3. IV insulin with NaCl at rate so ketones fall at 0.5 mmol/L/hr and blood glucose falls at 3 mmol/L/hr
  4. when BG < 14 mmol/L give IV glucose 10%
  5. continue insulin until ketone < 0.3 mmol/L and pH > 7.3
  6. when able to eat, give fast acting insulin with meal
  7. stop tx 1 hour after food
67
Q

Insulin adjustment for elective & minor surgery

A
  • reduce OD basal by 20% day before surgery
68
Q

Insulin adjustment for elective and major surgery

A
  • reduce OD basal by 20% day before surgery
  • on the day = reduce OD basal by 20% - stop other insulin until eating, IV infusion of KCl + glucose + NaCl, variable rate IV insulin (soluble human) in NaCl via pump, hourly blood glucose measurements for first 12 hours, IV glucose 20% if drops under 6 mmol/L
69
Q

Insulin requirements post surgery

A
  • back to subcut when pt can eat/drink w/o vomiting
  • basal-bolus - restarted with first meal - infusions until 30-60 minutes after first meal that includes the short acting glucose administration
  • long-acting - continue at reduced by 20% until leaves hospital
  • BD regimen = restart at breakfast or evening meal - infusions until 30-60 minutes after first meal
70
Q

Sick day rules

A
  • Sugar levels - check BG regularly
  • Insulin - continue taking
  • Carbohydrates - keep eating, stay hydrated
  • Ketones - check ketones regularly
71
Q

Diabetes in pregnancy and breast feeding

A
  • diabetes in pregnancy = increase risks to mum and foetus - effective glucose control to reduce risk
  • before preg = if HbA1c > 48 mmol/mol, take folic acid 5mg
72
Q

Diabetes medication in pregnancy

A
  • stop all oral anti diabetic meds except metformin and replace with insulin
  • isophane is first choice as basal in preg
  • if taking statin/ACEi/ARBs - discontinue
  • aware of hypoglycaemia risk and always carry fast acting glucose
73
Q

What is gestational diabetes

A

developed during preg, stop treatment after birth as it is due to pregnancy

74
Q

Gestational diabetes treatment if FBG < 7 mmol/L

A
  1. diet & exercise
  2. metformin
  3. insulin
    - move to next step if requirement not met in 1-2 weeks
75
Q

Gestational diabetes treatment if FBG > 7mmol/L

A
  • diet and exercise + insulin +/- metformin
76
Q

Gestational diabetes treatment if FBG 6 - 6.9 mmol/L with complication

A
  • insulin +/- metformin
77
Q

Hypoglycaemia (< 4 mmol/L) symptoms

A
  • sweating
  • lethargic
  • dizziness
  • hunger
  • tremor
  • tingling lips
  • palpitation
  • extreme moods
  • pale
78
Q

Hypoglycaemia treatment if conscious and able to swallow

A
  • fast acting carbohydrate by mouth e.g.:
  • 4-5 glucose tabs
  • 3-4 heaped teaspoons of sugar
  • 150-200mL fruit juice
  • repeat every 15 minutes for 3 cycles
79
Q

Hypoglycaemia treatment if patient unconscious/oral doesn’t work

A
  • IM glucagon
  • then if unresponsive after 10 minutes, IV glucose
80
Q

Hypoglycaemia awareness

A

awareness of hypoglycaemia can become blunted preventing early recognition - can happen through increases numbers of hypos or taking b-blockers

81
Q

What is osteoporosis

A

progressive bone disease causing reduced bone mass and density = increased risk of fractures

82
Q

osteoporosis risk factors

A
  • postmenopausal
  • men over 50
  • long term glucocorticoids
  • age increase
  • vitamin D and calcium deficiency
  • reduced exercise
  • low BMI
  • smoking, drinking
  • history of fractures
  • early menopause
83
Q

osteoporosis life style advice

A
  • increase exercise
  • stop smoking
  • reduce alcohol intake
  • maintain ideal BMI
  • increase vitamin D and calcium inake
84
Q

Osteoporosis treatment

A
  1. oral bisphosphonates (alendronic/risedronate)
    - review after 5 years (3 years for zoledronic)
85
Q

Oral bisphosphonates alternatives for treatment of osteoporosis in different patient groups

A
  • postmenopausal = ibandronic, denosumab, raloxifene, strontium
  • younger menopausal = HRT or tibolone
  • severe osteoporosis = teriparatide
  • men = zoledronic, denosumab, teriparatide, strontium
  • glucocorticoid induced = zoledronic, denosumab, teriparatide
86
Q

Glucocorticoid induced osteoporosis prophylaxis

A
  • for women 70 yrs+, previous fragility fracture, pred > >7.5mg daily or equivalent
  • for men > >70 yrs AND previous fragility fracture or pred > >7.5mg daily or equivalent
  • large doses of corticosteroids for > 3 months
87
Q

Bisphosphonates MHRA warnings

A
  • atypical femoral fractures - report thigh, hip, groin pain
  • osteonecrosis of jaw - report dental pain, swelling, non-healing sores, discharge
  • osteonecrosis of external auditory canal - report ear pain, discharge, infection
88
Q

Bisphosphonates side effects

A
  • oesophageal reactions - take with full glass of water whilst standing and remain upright for 30 minutes after
  • alendronic = 30 mins before breakfast/other meds
  • risedronate = 30 minutes before breakfast or leave 2 hours before and after food/drink if at other time in the day
89
Q

Mineral corticosteroids MoA

A
  • high fluid retention, low anti-inflammatory effect
  • highest mineral corticosteroids activity = fludrocortisone
  • hydrocortisone also mineral corticosteroid activity
90
Q

fludrocortisone indication

A

hypotension

91
Q

mineral corticosteroids side effects

A
  • sodium and water retention (oedema)
  • hypokalaemia
  • hypocalcaemia
  • these effects negligible with high potency glucocorticoids (betamethasone & dexamethasone)
92
Q

Glucocorticoids MoA

A
  • high anti-inflammatory effect, low fluid retention
  • highest glucocorticoid activity = dexamethasone/betamethasone
  • also prednisolone, prednisone, deflazacort
93
Q

glucocorticoids side effects

A
  • diabetes
  • osteoporosis -> fractures
  • avascular necrosis of the femoral head and muscle wasting
  • gastric ulceration and perforation
94
Q

All corticosteroids MHRA warning

A

central serous chorioretinopathy - report blurred vision/disturbances

95
Q

All corticosteroids side effects

A
  • psychiatric reactions = insomnia, irritability, mood change, suicidal thoughts, behavioural disturbances
  • adrenal suppression = prolonged use = adrenal atrophy. abrupt withdrawal = adrenal insufficiency, hypotension, death. illness, trauma, surgical procedure = increase dose
  • infection - immunosuppressed
  • chickenpox - vaccinate
  • measles - prophylactic AM normal immunoglobulin
  • insomnia - morning dose - when cortisol produced
  • children - stunted growth (incl. ICS), skin thinning (topical)
  • prolonged use = Cushing’s syndrome = moon face, striae, hirsutism, acne, managed with metyrapone, tx with ketoconazole
96
Q

CORTICOSTEROID USE acronym

A
  • Cushing’s
  • Osteoporosis
  • Retardation of growth
  • Thin skin
  • Immunosppressed, Insomnia
  • Chlorioretinopathy
  • Oedema (water retention)
  • STriae
  • Emotional disturbance
  • Rise in BP
  • Obesity (truncal)
  • Increased hair growth (hirsutism)
  • Diabetes (hyperglycaemia)
  • Ulcers (peptic)
  • Suppression (adrenal)
  • Electrolyte imbalance (reduced K+)
97
Q

Managing corticosteroid side effects

A
  • lowest effective dose for minimum period
  • single dose in morning
  • total dose for 2 days can be taken as single dose on alternate days
  • intermittent therapy with short courses
  • local tx rather than systemic e.g. cream, intra-articular injections, inhalations, eye drops, enemas
98
Q

Gradually withdraw steroids if

A
  • > 40mg pred (or equiv) daily for >1 weeks
  • repeat evening doses
  • > 3 weeks treatment
  • recently received repeated courses
  • taken short course within 1 year of stopping long-term therapy
  • other possible causes of adrenal suppression
  • all patients to be given steroid card
99
Q

Topical steroid potencies

A
  • mild: hydrocortisone
  • moderate: clobetasone
  • potent: betamethasone
  • very potent: clobetasol
100
Q

What is adrenal insufficiency

A
  • medical emergency
  • caused by addison’s or congenital adrenal hyperplasia
  • can lead to adrenal crisis = severe dehydration, hypovolaemic shock, altered consciousness, seizures, stroke, cardiac arrest = death if untreated
101
Q

adrenal insufficiency treatment

A
  • hydrocortisone mainly
  • fludrocortison as well if primary adrenal insufficiency
102
Q

Name natural oestrogens

A
  • estradiol
  • estrone
  • estriol
103
Q

Name synthetic oestrogens

A
  • ethinylestradiol
  • mestranol
104
Q

Name progestogens

A
  • norethisterone
  • levenorgestrel
  • desogestrel
105
Q

Tibolone

A

= oestrogen, progestognenic, and weekly androgenic

106
Q

HRT treatments

A
  • oestrogens (+ progestogen if uterus) alleviates menopausal symptoms e.g. vaginal atrophy (topical), vasomotor instability (systemic), reduces postmenopausal osteoporosis
  • clonidine for vasomotor symptoms, but large side effects profile
107
Q

HRT risks

A
  • benefits > risks especially age < 60
  • breast cancer - increased in combined over oestrogen only
  • endometrial cancer with tibolone - if uterus - reduced risk with combined over oestrogen only
  • ovarian - small risk, disappears after stopping
  • DVT
  • stroke - slight increase, tibolone increased by 2.2x in first year of tx
  • coronary heart disease - increased risk with combined if started more than 10 years after menopause
108
Q

Choosing HRT if have uterus

A
  • oestrogen throughout with cyclical progestogen for last 12-14 days of cycle
  • continuous oestrogen and a progestogen
  • avoid continuous combined and tibolone in perimenopausal or if within 12 months of last menstrual period
109
Q

Choosing HRT if dont have uterus

A
  • continuous oestrogen use
  • if endometriosis = + progesterone
110
Q

HRT and surgery

A
  • elective = stop HRT 4-6wks before surgery, reinitiate when fully mobile
  • non-elective = prophylactic heparin, graduated compression stockings
111
Q

Reasons to stop HRT

A
  • sudden severe chest pain/SOB - PE
  • swelling/severe pain in calf of one leg - DVT
  • severe stomach pain - hepatotoxicity
  • serious neurological effects - unusual, severe, prolonged headache, fainting, epileptic seizure, motor disturbances, numbness
  • hepatitis/jaundice
  • BP > 160 systolic of 95 diastolic
  • prolonge immobility - risk of VTE
112
Q

Thyroid disorders MoA

A
  • circulated thyroid hormone regulated by negative feedback loop
  • increased T3/T4 = suppression of TSH or TRH produced by hypothalamus = inhibits their own production
113
Q

hyperthyroidism signs and symptoms

A
  • high T3/T4, low TSH
  • increased metabolism/activity
  • hyperactive
  • insomnia
  • heat intolerance
  • increased appetite
  • weight loss
  • diarrhoea
  • goitre
114
Q

Hyperthyroidism treatment

A
  1. carbimazole
  2. propylthiouracil
  3. b-blockers - symptomatic relief
115
Q

carbimazole MHRA warnings

A
  • neutropenia & agrunolocytosis - sore throat, malaise, fever, bleeding gums
  • congenital malformations - use contraception
  • acute pancreatitis - report and stop if severe abdo pain
116
Q

propylthiouracil side effects

A

cautions of liver disorder - jaundice, dark urine, nausea

117
Q

Graves disease treatment (severe hyperthyroidism)

A
  1. radioactive iodine
    - if remission likely with anti-thyroids, consider carbimazole
  2. carbimazole if iodine or surgery not suitable - block and replace regimen in combo with levothyroxine for 12-18 months
118
Q

hyperthyroidism treatment in pregnancy

A
  • 1st trimester = propylthiouracil (carbimazole = congenital defects)
  • 2nd and 3rd trimester = carbimazole (propylthiouracil = hepatotoxicity)
119
Q

Hypothyroidism signs and symptoms

A
  • low T3/T4, high TSH
  • reduced metabolise/activity
  • fatigue
  • weight gain
  • constipation
  • depression
  • dry skin
  • cold intolerance
  • menstrual irregularities
120
Q

Hypothyroidism treatment

A
  1. levothyroxine
  2. liothyronine
121
Q

Levothyroxine details

A
  • monitor TSH every 3 months until stable, then annually
  • OM 30 minutes before breakfast/caffeinated drinks
  • MHRA - potentially feel symptoms if alternating brands
122
Q

Liothyronine details

A
  • more rapid and potent output than levo (20-25mcg = 100mcg of levo)
  • non-UK brands may not be bioequivalent
123
Q

Which statin and dose is used in T2DM and established CVD

A

atorvastatin 80mg

124
Q

How often should HbA1c be monitored if the patient is stable

A

every 6 months

125
Q

What should the HbA1c be before another anti diabetic medication is added

A

58mmol/mol

126
Q

Which anti diabetic medication causes vaginal thrush

A

SGLT2 inhibitors

127
Q

which anti diabetic medication causes UTIs

A

dapagliflozin

128
Q

T2DM and HTN - HTN target

A
  • 140/90
  • if > 80 years old then 145/95
129
Q

When should a GLP-1agonist be continued

A

if at least 3% reduction in initial body weight and 1% reduction of HbA1c within 6 months

130
Q

AKI symptoms

A
  • oedema
  • SOB
  • confusion
  • nausea
  • seizures
  • chest pain
  • oliguria (abnormally small amounts of urine)
131
Q

which anti diabetic medications cause hypotension

A

sulfonylureas

132
Q

which anti diabetic medication has a risk of bladder cancer

A

pioglitazone

133
Q

why is ramipril cautioned in diabetes

A

it may lower blood glucose

134
Q

Insulin aspart administration directions

A

TDS before meals

135
Q

eGFR range that indicates severe renal impairment

A
  • 15-29
  • also indicates stage 4 CKD
136
Q

Reasons to stop HRT

A
  • PE (chest pain, SOB)
  • DVT (calf swelling, red, hot)
  • severe stomach pain (pancreatitis)
  • neurological affects
  • hepatitis/jaundice/liver enlargement
  • BP > 160/95
  • prolonged immobility
137
Q

Recommended blood glucose levels if fasting and if not fasting

A
  • fasting < 5.5
  • non-fasting < 11.1
138
Q

What is the recommended HbA1c when T2DM is managed by diet alone or with a single anti diabetic drug not associated with hypoglycaemia

A

48 mmol/mol (6.5%)

139
Q

Rapid insulin administration directions post op

A
  • PRN
  • can be adjusted according to glucose levels

gphc exam (22 decks)

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