3D Endo - Pharmacology Flashcards
(57 cards)
What does the ‘25’ mean in Humalog Mix 25?
It means the insulin is a mix: 25% short-acting insulin lispro and 75% intermediate-acting insulin lispro protamine.
What is a basal-bolus insulin regimen?
A regimen where patients take long-acting (basal) insulin daily with short-acting (bolus) insulin at mealtimes.
How does a mixed (biphasic) insulin regimen differ from basal-bolus?
Mixed regimens involve 1–3 daily injections of a fixed combination of short- and intermediate-acting insulin, unlike basal-bolus where insulin is adjusted with meals.
What is carbohydrate counting and how does it affect insulin prescribing?
Patients calculate insulin bolus doses based on the grams of carbohydrate they eat.
→ This makes prescribing difficult as bolus doses vary and cannot be easily written as fixed prescriptions.
What advice can be given for difficult-to-treat morning hypoglycaemia?
Advise a late-night snack to help prevent early morning hypos.
How should you treat severe hypoglycaemia in a drowsy, nil-by-mouth patient like Julie (BM 3.4 mmol/L)?
- IV glucose (10% or 20% dextrose) over 15 minutes
- IM glucagon if no IV access (note: less effective in malnourished patients)
(as glycogen is mobilised from the liver and stores need replenishing) - Avoid oral glucose gel (e.g., Glucogel) as patient cannot swallow safely and is nil by mouth for surgery
What is a fixed rate insulin infusion?
A constant rate of 0.1 units/kg/hr, regardless of glucose levels.
→ IV dextrose is added if the patient becomes hypoglycaemic
What is a variable rate insulin infusion?
The insulin dose varies depending on capillary blood glucose
→ titrated accordingly every hour
What is the top priority in early DKA management?
Fluid resuscitation is the priority—IV access and fluids before insulin
Should you continue long-acting insulin during DKA treatment?
Yes – continue the patient’s long-acting insulin alongside the fixed rate infusion
- continue long-acting insulin, stop short-acting
When can the fixed rate insulin be stopped in DKA?
Only when ketonaemia and acidosis have resolved, even if blood glucose is normal.
What should you do if a patient becomes hypoglycaemic during fixed rate insulin?
Give IV dextrose while continuing the insulin infusion.
What should be prescribed as the first 3 fluid bags in DKA?
- First bag: No potassium
- Monitor potassium and prescribe based on VBG results at 60 mins, 1 hour, and 2-hourly thereafter
What is the likely explanation for Jack’s abnormal TFTs during hospitalisation for urosepsis?
Likely sick euthyroid syndrome – TFTs can be altered by acute illness. Repeat them when he’s recovered unless symptomatic.
What is the best approach to mild hypothyroidism picked up during acute illness?
Recheck thyroid function once recovered unless there are overt signs/symptoms of thyroid dysfunction.
What advice should you give patients about taking levothyroxine?
- Take 30–60 minutes before breakfast, caffeine, or other medicines.
- Absorption is reduced with calcium, iron, and some foods/drugs.
- Requires regular blood monitoring.
What are the possible side effects of levothyroxine?
Mostly due to over-treatment (iatrogenic hyperthyroidism).
→ Watch for palpitations, tremor, weight loss, insomnia.
Who needs a lower levothyroxine dose?
Elderly patients and those with cardiac disease.
A patient on steroids presents with confusion, hypotension, and abdominal pain. What are your top differentials?
Suspect adrenal crisis (likely due to steroid withdrawal, infection, or stress without adequate steroid cover).
What is your first step in managing suspected adrenal crisis?
- Give IV hydrocortisone 100 mg STAT
- Do not wait for blood tests (life-saving bolus dose of glucocorticoid needs to be given)
- Consider giving a fluid bolus
Why are 3 daily doses of hydrocortisone used in adrenal insufficiency?
Mimics the natural cycle of corticosteroid release – high in morning, lower/stable throughout the day
What must patients be told when starting lifelong steroid therapy?
- They will need lifelong replacement
- How to recognize symptoms of adrenal crisis
- How to use IM hydrocortisone
- Sick day rules
- To carry a steroid card
A patient has weight loss, palpitations, and labs show low TSH, high T4, positive TPO and TSH-receptor antibodies. Diagnosis?
Graves’ disease (autoimmune hyperthyroidism)
What symptomatic treatment can be offered before specialist input in Graves’ disease?
Propranolol can help with the adrenergic symptoms → palpitations, tremor, tachycardia, anxiety
