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CHAPTER 6: Endocrine system > Chapter 6: Endocrine > Flashcards

Chapter 6: Endocrine Flashcards

1
Q

Diabetes insipidus

A

Lots of pee

HyperNa

Types: cranial and nephrogenic
Treatment:
cranial - desmopressin and vasopressin
Nephrogenic - thiazide like diuretics and nsaids

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2
Q

What does SiADH stand for?

A

Syndrome of inappropriate antiduiretic hormone

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3
Q

Name 2 SGLT inhibitors?

A

See revision notes

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4
Q

What is the MHRA warning for DPP4 and GLP1?
And what are the symptoms?

A

Pancreatitis
Stomach pain, N&V

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5
Q

What is the warning of pioglitazone?

A

HF
Bladder cancer
Hepatotoxic (rare)

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6
Q

What do u use in gestational diabetes?

A

Metformin
Insulin

OR glebenclamide (trimester 2 or after)

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7
Q

MHRA alert for carbimazole

A

Pancreatitis
Congeanital malformation

SE - Bone marrow suppression

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8
Q

What is the name for the adjunctive therapy for carbimazole treatment in hyperthyroidism?
And when is it not appropriate?

A

Blocking replacement therapy
In pregnancy - contra-indicated as high dose of carbimazole is required and has a risk of fetal/congenital. and it increases risk of fetal goitre

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9
Q

What medication can you use in pregnancy for hyperthyroidism?

A

1st trimester: propylthiouracil (as you cannot take carbimazole as it has a risk of foetal/congenital malformation)
2nd trimester: carbimazole (due to the hepatotoxicity of propylthiouracil)

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10
Q

What do you give to a patient to prepare them from thyroidectomy?

A

Iodine 10 to 14 days before the surgery
Carbimazole/propylthiouracil
Propanolol

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11
Q

Treatment of thyrotoxicosis?

A

hydrocortisone sodium succinate

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12
Q

What drug do you give to a man who is a hypersexual and sexual deviation (consented)?
What is a warning for this drug?

A

cyproterone acetate - inhibits spermatogenesis and produces reversible infertility.
Hepatotoxicity

Other use: metastatic prostate cancer refractory gandorelin; adjunct to prostate cancer; hirsutism in women

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13
Q

What electrolyte disturbance occurs in mineralocorticoid steroid?

A

Na and water in (hyper) = hypertension
K and Ca loss

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14
Q

Treatment for Cushing’s Syndrome?

A

Ketoconazole and metyrapone

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15
Q

A 57-year-old female, of African-Caribbean family origin, has just been diagnosed with Stage 1 hypertension. She has type 2 diabetes, and a QRISK2 score of 13%. She has no known allergies and renal function tests are within the normal range.

Which of the following drugs is the most appropriate first-line therapy according to national guidance?

Select one:
A. Amlodipine
B. Bisoprolol
C. Candesartan Correct
D. Doxazosin
E. Indapamide

A

NICE guidance NG136 recommends ACE or ARB as step 1 therapy for diabetics of any age or family origin. NICE also recommends an angiotensin II receptor blocker (ARB), in preference to an angiotensin-converting enzyme (ACE) inhibitor in adults of black African or African-Caribbean family origin.

The correct answer is: Candesartan

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16
Q

A regular patient from your community pharmacy has been discharged from hospital following a fall associated with hypoglycaemia. He is a 72-year-old man with Type 2 Diabetes who has recently had his medicines changed due to poor glycaemic control.

When reviewing his prescription list, which of the following medicines would you be most concerned about in relation to the risk of hypoglycaemia?

Select one:
A. Dapagliflozin
B. Glibenclamide Correct
C. Gliclazide
D. Metformin
E. Pioglitazone

A

Glibenclamide is a long-acting sulphonylurea and is more prone to causing hypoglycaemia, especially overnight, in the elderly. Gliclazide is a shorter acting sulphonylurea. Other classes of oral antidiabetic agents have a lower risk of hypoglycaemia compared with sulphonylureas.

Ref: https://bnf.nice.org.uk/treatment-summary/type-2-diabetes.html

The correct answer is: Glibenclamide

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17
Q

You are conducting a consultation with your patient, a 40-year-old-man, and he mentions he has recently been diagnosed with diabetes. After gaining his consent you test his blood glucose levels, the result is 3.7 mmol/L.

Which ONE of the following is the most appropriate next step?

Select one:
A. Advise him to eat some of his diabetic chocolate which he has bought with him
B. Ask him to immediately drink some of his fruit juice that he has got with him Correct
C. Ask the patient if they took their medicines for diabetes this morning as the glucose level is quite high
D. Nothing is needed, as that reading is normal, continue with the review
E. Refer him to his doctor as his diabetic medication is not keeping his blood glucose levels low enough

A

The patient requires sugar immediately as they are experiencing hypoglycaemia (any reading less than 4 mmol/L). Diabetic chocolate would not contain enough sugar required to increase the sugar level quick enough

The correct answer is: Ask him to immediately drink some of his fruit juice that he has got with him

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18
Q

One of your diabetic patients has recently passed his driving test. He tells you that he will be visiting his parents this weekend. You advise him that diabetic patients taking insulin to help manage their diabetes are required to notify the Driver and Vehicle Licensing Agency (DVLA).

Use the information about diabetes provided in the resource pack.

Which of the following statements regarding diabetics receiving insulin and driving is INCORRECT?

Select one:
A. Diabetics receiving insulin, driving on long journeys should test their blood glucose every four hours Correct
B. Drivers should monitor their blood glucose more frequently when their meal routine has been altered
C. Drivers treated with insulin should ensure that a supply of sugar is always available in the vehicle
D. If hypoglycaemia occurs, stop the vehicle in a safe place, wait until 45 minutes after blood glucose has returned to normal before continuing journey
E. If hypoglycaemia occurs, then drivers must stop the vehicle in a safe place and switch off the engine and move from the driver’s seat

A

They should test their blood glucose every 2 hours.

Ref: BNF section on driving/diabetes

The correct answer is: Diabetics receiving insulin, driving on long journeys should test their blood glucose every four hours

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19
Q

A 25-year-old man is discharged from hospital with lamotrigine 25 mg tablets which he is taking for epilepsy.

Select one:
A. Do not take indigestion remedies 2 hours before or after you take this medicine
B. Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
C. Take with a full glass of water
D. This medicine may colour your urine. This is harmless.
E. Warning: Do not drink alcohol
F. Warning. Do not stop taking this medicine unless your doctor tells you to stop
G. Warning: Read the additional information given to you with this medicine
H. Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

A

The correct answer is: Warning. Do not stop taking this medicine unless your doctor tells you to stop

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20
Q

A 48-year-old male is discharged from hospital with mirtazapine 15 mg tablets for major depression.

Select one:
A. Do not take indigestion remedies 2 hours before or after you take this medicine
B. Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
C. Take with a full glass of water
D. This medicine may colour your urine. This is harmless.
E. Warning: Do not drink alcohol
F. Warning. Do not stop taking this medicine unless your doctor tells you to stop
G. Warning: Read the additional information given to you with this medicine
H. Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

A

The correct answer is: Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

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21
Q

A 56-year-old woman taking lithium carbonate 400 mg for prophylaxis for bipolar disorder.

Select one:
A. Do not take indigestion remedies 2 hours before or after you take this medicine
B. Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
C. Take with a full glass of water
D. This medicine may colour your urine. This is harmless.
E. Warning: Do not drink alcohol
F. Warning. Do not stop taking this medicine unless your doctor tells you to stop
G. Warning: Read the additional information given to you with this medicine
H. Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

A

The correct answer is: Warning: Read the additional information given to you with this medicine

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22
Q

For each of the following scenarios, select the drug which is correct. Each option may be used once, more than once or not at all.
You are running a training session for a group of pharmacy students and one student wants to know which of the following drugs has anti-pyretic properties.

Aspirin
Apixaban
Clopidogrel
Dabigatran
Dalteparin sodium
Danaparoid sodium
Dipyridamole
Unfractionated heparin

A

Aspirin

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23
Q

Which medicine decreases gluconeiogenesis by increasing peripheral utilisation of glucose?

Acarbose
Empagliflozin
Exenatide
Gliclazide
Metformin
Repaglinide
Saxagliptin
Short-acting insulin

A

Metformin

Metformin decreases gluconeiogenesis by increasing peripheral utilisation of glucose.

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24
Q

Which medicine delays the digestion and absorption of starch and sucrose?

Acarbose
Empagliflozin
Exenatide
Gliclazide
Metformin
Repaglinide
Saxagliptin
Short-acting insulin

A

Acarbose

Acarbose delays the digestion and absorption of starch and sucrose.

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25
Q

Which medicine inhibits dipeptidylpeptidase-4 to increase insulin secretion and lower glucagon secretion?

Acarbose
Empagliflozin
Exenatide
Gliclazide
Metformin
Repaglinide
Saxagliptin
Short-acting insulin

A

Saxagliptin

Saxagliptin inhibits dipeptidylpeptidase-4 to increase insulin secretion and lower glucagon secretion.

26
Q

Which medicine binds to and activates the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion and slow gastric emptying?

Acarbose
Empagliflozin
Exenatide
Gliclazide
Metformin
Repaglinide
Saxagliptin
Short-acting insulin

A

Exenatide

Exenatide binds to and activates the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion and slow gastric emptying.

27
Q

A 23-year-old female who is taking carbimazole for hyperthyroidism.

Drowsiness may affect your driving. This effect is enhanced with alcohol consumption

Take this medication at night

Oral solution should be swallowed as a single 100 mL dose with plenty of water while sitting or standing upright

Take this medication on an empty stomach

Avoid factors which cause overheating or dehydration like exercise

Report symptoms including sore throat, mouth ulcers, bruising, fever, tiredness or non-specific illnesses to your doctor immediately

Report immediately if a skin rash develops or if any signs or symptoms of hypersensitivity develops

Take this medication after food

A

Report symptoms including sore throat, mouth ulcers, bruising, fever, tiredness or non-specific illnesses to your doctor immediately

28
Q

A 21-year-old male who is taking alendronic acid tablets for osteoporosis

Drowsiness may affect your driving. This effect is enhanced with alcohol consumption

Take this medication at night

Oral solution should be swallowed as a single 100 mL dose with plenty of water while sitting or standing upright

Take this medication on an empty stomach

Avoid factors which cause overheating or dehydration like exercise

Report symptoms including sore throat, mouth ulcers, bruising, fever, tiredness or non-specific illnesses to your doctor immediately

Report immediately if a skin rash develops or if any signs or symptoms of hypersensitivity develops

Take this medication after food

A

Take this medication on an empty stomach

29
Q

You are training to become an independent prescriber with the aim of specialising in diabetes. Choose the most appropriate next treatment step for each of the patients described. Each option may be used once, more than once or not at all.
A patient newly diagnosed with type 2 diabetes who has a raised HbA1c despite lifestyle interventions.
https://www.sign.ac.uk/media/1090/sign154.pdf

Address adherence
Basal insulin
DDP-4 inhibitor
GLP-1 agonist
Metformin
SGLT2 inhibitor
Soluble insulin
Sulphonylurea

A

Metformin

30
Q

You are training to become an independent prescriber with the aim of specialising in diabetes. Choose the most appropriate next treatment step for each of the patients described. Each option may be used once, more than once or not at all.
A patient who has been taking metformin for 4 months with a HbA1c of 7.3%, and who has cardiovascular risk factors.

Address adherence
Basal insulin
DDP-4 inhibitor
GLP-1 agonist
Metformin
SGLT2 inhibitor
Soluble insulin
Sulphonylurea

A

SGLT2 inhibitor

In a patient not reaching their target with cardiovascular risk factors, a SGLT2 inhibitor would be an appropriate treatment option.

31
Q

You are training to become an independent prescriber with the aim of specialising in diabetes. Choose the most appropriate next treatment step for each of the patients described. Each option may be used once, more than once or not at all.
A patient who was first prescribed metformin 3 months ago. The patient has a HbA1c of 7.4%. The patient’s record shows they collected a monthly prescription twice in this time.

Address adherence
Basal insulin
DDP-4 inhibitor
GLP-1 agonist
Metformin
SGLT2 inhibitor
Soluble insulin
Sulphonylurea

A

Address adherence

In a patient who is not taking their medicine, adherence should be addressed before prescribing additional medicines.

32
Q

You are training to become an independent prescriber with the aim of specialising in diabetes. Choose the most appropriate next treatment step for each of the patients described. Each option may be used once, more than once or not at all.
A patient who has been taking metformin for 4 months with a HbA1c of 7.2% with no other health concerns.

Address adherence
Basal insulin
DDP-4 inhibitor
GLP-1 agonist
Metformin
SGLT2 inhibitor
Soluble insulin
Sulphonylurea

A

Sulphonylurea

In a patient not reaching their target who does not have any specific considerations, a sulphonylurea would be an appropriate medicine to consider prescribing.

33
Q

You are training to become an independent prescriber with the aim of specialising in diabetes. Choose the most appropriate next treatment step for each of the patients described. Each option may be used once, more than once or not at all.
A patient who has been taking metformin for 5 months with a HbA1c of 7.6%, who is also obese.

Address adherence
Basal insulin
DDP-4 inhibitor
GLP-1 agonist
Metformin
SGLT2 inhibitor
Soluble insulin
Sulphonylurea

A

SGLT2 inhibitor

In a patient not reaching their target who is obese, a SGLT2 inhibitor would be an appropriate treatment option.

34
Q

Mrs XR is ready to be discharged home. The hospital policy is to give patients a 14 day supply of insulin on discharge, providing the patient does not have a supply at home. Mrs XR does not have a supply at home and she is now on NovoRapid® FlexPen 14 units three times daily and Levemir® FlexPen 20 units at night. How many insulin pens would cover the amount of insulin the patient will inject in 14 days?

One NovoRapid® and one Levemir®
Two NovoRapid® and one Levemir®
One NovoRapid® and two Levemir®
Two NovoRapid® and two Levemir®
Three NovoRapid® and two Levemir®

A

Two NovoRapid® and one Levemir®

NovoRapid® = 14 units x 3 times daily x 14 days = 588 units in total. Each disposable pen contains 300 units therefore will require 2 NovoRapid® pens. Levemir® = 20 units x 1 times daily x 14 days = 280 units in total. Each disposable pen contains 300 units therefore will require 1 Levemir® pen.

35
Q

A dispenser asks you about high strength insulin.
Which of the following medicines are considered a high strength insulin?

Insulin aspart 100 units/mL
Insulin degludec 100 units/mL
Insulin glargine 100 units/mL
Insulin glulisine 100 units/mL
Insulin lispro 200 units/mL

A

The correct answer was Insulin lispro 200 units/mL

Insulin strengths greater than 100 units/mL are considered high strength insulins.

36
Q

Mrs XR is a 25-year-old, weighing 50 kg and has type 1 diabetes. She is admitted to hospital with diabetic ketoacidosis. Mrs XR is currently taking NovoRapid® FlexPen 10 units three times daily and Levemir® FlexPen 15 units at night and is allergic to Tazocin®. She is also breastfeeding her 6-month-old baby.

Which one of the following medicines is NOT routinely used in the management of diabetic ketoacidosis?

Sodium chloride 0.9%
Potassium chloride adjusted according to plasma-potassium concentration
NovoMix® mixed with sodium chloride 0.9%
Actrapid® mixed with sodium chloride 0.9%
Insulin detemir

A

NovoMix® mixed with sodium chloride 0.9%

Soluble insulin should be diluted (and mixed thoroughly) with sodium chloride 0.9% intravenous infusion to a concentration of 1 unit/mL; infuse at a fixed rate of 0.1 units/kg/hour. Novomix is not a soluble insulin

37
Q

Mr Q, a 21 year old who weighs 55 kg, is admitted to hospital seriously ill with diabetic ketoacidosis. The doctor prescribes soluble insulin and intravenous fluid therapy with electrolyte replacement.
By which route will the soluble insulin be administered?

Subcutaneous injection
Intradermal injection
Intramuscular injection
Intravenous injection
Intravenous infusion

A

Intravenous infusion

38
Q

Mr J is a 32-year-old male who comes to collect his prescription. As you hand over his medicines, you notice that he looks poorly and has a runny nose. He tells you that he is feverish, feels shaky and has a strong headache.
carbimazole 15 mg o.d.
ramipril 20 mg o.n.
amlodipine 10 mg o.d.
Given that Mr J is taking the medications below and that he has not travelled anywhere recently, which one of the following is the most suitable course of action?
Incorrect answer Recommend OTC paracetamol and an anti-inflammatory
Incorrect answer Recommend OTC paracetamol and an antihistamine
You chose the correct answer Refer Mr J to see a doctor immediately
Incorrect answer Advise Mr J that what he is experiencing is a common cold and it will resolve given time
Incorrect answer Recommend OTC paracetamol only
You were correct.

A

The correct answer was Refer Mr J to see a doctor immediately

Carbimazole may cause bone marrow suppression which presents as infection or flu-like symptoms (i.e. sore throat, fever and malaise). Therefore, patients taking this medication must be advised to immediately report to their doctor should they experience any of these symptoms.

39
Q

Mrs R is a 41-year-old sales assistant. She has been prescribed fludrocortisone for adrenal insufficiency and is unclear about its possible side-effects. She lists different conditions which she may develop as a result and asks you if they are correct.
Which one of the following is most likely to develop with fludrocortisone use?
Incorrect answer Avascular necrosis
Incorrect answer Diabetes
You chose the correct answer Hypertension
Incorrect answer Muscle wasting
Incorrect answer Osteoporosis
You were correct.

A

The correct answer was Hypertension

Mineralocorticoid side effects, listed in the BNF, are most marked with fludrocortisone. The other side effects listed are glucocorticoid steroid effects.

40
Q

You attend a CPD seminar on side-effects of mineralocorticoid and glucocorticoids.
Which one of the following effects is associated more with glucocorticoid use?
Incorrect answer Calcium loss
You chose the correct answer Diabetes
Incorrect answer Hypertension
Incorrect answer Potassium loss
Incorrect answer Water retention
You were correct.

A

The correct answer was Diabetes

Glucocorticoid side-effects include diabetes, osteoporosis and muscle wasting. The other listed side-effects are associated with mineralocorticoids.

41
Q

Mrs J is usually prescribed insulin for her diabetes, as well as warfarin and digoxin for atrial fibrillation. She complains of an increased frequency of urination over the past few days, nausea and vomiting and a headache. She compliments you on your yellow shirt, which is in fact white.
What is the most appropriate advice you should give Mrs J?
Incorrect answer This should resolve over the next few days
Incorrect answer You should suggest over the counter products for a possible urinary tract infection
Incorrect answer Mrs J should make an appointment with an optometrist as she may be suffering from cataracts
Incorrect answer Patient should be referred as osmotic diuresis is a sign of uncontrolled diabetes
You chose the correct answer Patient should be referred as she is exhibiting signs of digoxin toxicity and uncontrolled diabetes
You were correct.

A

The correct answer was Patient should be referred as she is exhibiting signs of digoxin toxicity and uncontrolled diabetes

Osmotic diuresis (a sign of uncontrolled diabetes) is associated with hypokalaemia, which would result in digoxin toxicity (which is presenting in this case as nausea and vomiting, headache and xanthopsia).

42
Q

Mr Q, a 21 year old who weighs 55 kg, is admitted to hospital seriously ill with diabetic ketoacidosis. Mr Q is diagnosed with type 1 diabetes. The doctor decides that Mr Q will be prescribed a ‘basal bolus regimen’.
What is the most appropriate regimen for this patient?

A

Humalog (insulin lispro) three times daily plus Novorapid (insulin aspart) once daily
Incorrect answer Actrapid (insulin soluble) three times daily plus Novomix 30 (insulin aspart) once daily
You chose the correct answer Novorapid (insulin aspart) three times daily plus Lantus (insulin glargine) once daily
Incorrect answer Humalog Mix25 (insulin lispro) twice daily
Incorrect answer Novorapid (insulin aspart) three times daily plus Actrapid (insulin soluble) once daily
You were correct.

The correct answer was Novorapid (insulin aspart) three times daily plus Lantus (insulin glargine) once daily

43
Q

A 36-year-old woman has been experiencing irregular periods, weight gain and hair loss in the past few months. Her GP has prescribed metformin 500 mg tablets. She presents in the pharmacy with her new prescription.
The instructions on the prescription are to take ‘as directed for one week, then return to GP’, however the patient cannot remember the dosage her GP advised. What is the recommended daily dosage of metformin 500 mg tablets that should be taken over the first week for her condition?
This was the correct answer 0.5 g
You chose the incorrect answer 1 g
Incorrect answer 2 g
Incorrect answer 4 g
Incorrect answer 5 g
You were incorrect.

A

The correct answer was 0.5 g

The patient has polycystic ovary syndrome and the initial recommended dose of metformin 500 mg immediate release tablets in 500 mg once daily for 1 week, then 500 mg twice daily for one week. This can then be increased between 1.5-1.7 g daily in 2-3 divided doses.

44
Q

Which of the following can be a side-effect of desmopressin?
The SPC is provided here: https://www.medicines.org.uk/emc/product/171
Incorrect answer Hypophosphataemia
Incorrect answer Hypomagnesaemia
Incorrect answer Hypocalcaemia
You chose the correct answer Hyponatraemia
Incorrect answer Hypokalaemia
You were correct.

A

The correct answer was Hyponatraemia

45
Q

The SPC is provided here: https://www.medicines.org.uk/emc/product/11457
You chose the correct answer Hypokalaemia
Incorrect answer Hyponatraemia
Incorrect answer Hypocalcaemia
Incorrect answer Hypomagnesaemia
Incorrect answer Hypophosphataemia
You were correct.

A

The correct answer was Hypokalaemia

46
Q

Mr Y enters your pharmacy and asks for some advice regarding buying an over the counter medication for a sore throat. On further enquiry, he mentions he also has mouth ulcers and generalised malaise. He has recently been prescribed carbimazole for hyperthyroidism.
What is the most appropriate advice you should give Mr Y?
Incorrect answer He has a mild infection and he can use over the counter medications for symptomatic relief
Incorrect answer Discuss oral hygiene measures
You chose the correct answer Mr Y should immediately report this to his GP
Incorrect answer Hyperthyroidism is usually associated with malaise and infection, so the dose of carbimazole should be increased
Incorrect answer Hyperthyroidism is usually associated with malaise and infection, so the dose of carbimazole should be decreased
You were correct.

A

The correct answer was Mr Y should immediately report this to his GP

Sore throat, mouth ulcers, fever and malaise are possible indicators of bone marrow suppression associated with the use of carbimazole and should be reported to the GP immediately.

47
Q

A 36-year-old woman has been experiencing irregular periods, weight gain and hair loss in the past few months. Her GP has prescribed metformin 500 mg tablets which she has been taking for 7 weeks.
She returns to the pharmacy and explains that she is experiencing diarrhoea. What is the most appropriate advice to give to the patient?
You chose the correct answer She is experiencing a side effect of metformin and can see her GP for a sustained-release formulation of metformin to help with this
Incorrect answer She is experiencing a side effect of metformin which is normally short-term
Incorrect answer She should reduce her dose of metformin to minimise the problem
Incorrect answer She should stop taking metformin and see her GP for further advice
Incorrect answer The symptom she describes is not known to be caused by metformin
You were correct.

A

The correct answer was She is experiencing a side effect of metformin and can see her GP for a sustained-release formulation of metformin to help with this

Gastrointestinal disturbances are a common side effect of metformin and may be minimised by sustained-release formulations.

48
Q

You are dispensing a high strength insulin for a patient.
What is an appropriate course of action, specific to high strength insulin, to take?
Supplement provided: http://www.ema.europa.eu/docs/en_GB/document_library/Regulatory_and_procedural_guideline/2015/11/WC500196980.pdf
Incorrect answer Check that the patient can attach a needle to the pen
Incorrect answer Check that the patient can hold the pen correctly
You chose the correct answer Check the patient can read the strength of the medicine on the pen
Incorrect answer No additional actions are required
Incorrect answer Refer the patient to their diabetes nurse for further advice
You were correct.

The correct answer was Check the patient can read the strength of the medicine on the pen

A

Pharmacists should check the patient can read the strength of the medicine on the pen.

49
Q

You are giving a training session on the effects of alcohol consumption with various drugs.
Regarding the concomitant use of alcohol with the following drugs which one is LEAST likely to be correct?
Incorrect answer Alcohol plus isoniazid increases the risk of isoniazid-related liver disease
Incorrect answer Alcohol plus phenytoin increases phenytoin metabolism
Incorrect answer Alcohol plus promethazine increases the risk of sedation
You chose the correct answer Alcohol plus glipizide increases the risk of hyperglycaemia
Incorrect answer Alcohol plus diazepam decreases a person’s motor skills
You were correct.

A

The correct answer was Alcohol plus glipizide increases the risk of hyperglycaemia

The antidiabetic effect of sulphonylureas is enhanced by alcohol - leading to a risk of hypoglycaemia.

50
Q

A patient calls you at your pharmacy at 8pm. They use Toujeo and usually administer their medicine at 6pm. The patient got stuck in traffic on his way home from work and his insulin was at home. He has only just arrived home. He asks what to do about taking his dose of Toujeo.
Which of the following would be appropriate advice to give the patient?
The SPC is provided here: https://www.medicines.org.uk/emc/product/6938
You chose the correct answer The patient can take his normal dose now
Incorrect answer The patient needs to see an out of hours practitioner for advice
Incorrect answer The patient should inject 1/6th of his daily dose in addition to his usual dose to make up for the missed time
Incorrect answer The patient should inject a double dose
Incorrect answer The patient should skip the dose and take as normal tomorrow
You were correct.

A

The correct answer was The patient can take his normal dose now

When needed, patients can administer Toujeo up to 3 hours before or after their usual time of administration.

51
Q

You are running a clinic for patients with diabetes.
You need to be vigilant for signs of diabetic ketoacidosis when withdrawing insulin on patients also taking which medicine?
Incorrect answer Dipeptidylpeptidase-4 inhibitor
This was the correct answer Glucagon-like peptide-1 receptor agonist
Incorrect answer Metformin
You chose the incorrect answer Sodium glucose co-transporter 2 inhibitor
Incorrect answer Sulfonylurea
You were incorrect.

A

The correct answer was Glucagon-like peptide-1 receptor agonist

Diabetic ketoacidosis has been reported in patients with type 2 diabetes on a combination of a GLP-1 receptor agonist and insulin who had doses of concomitant insulin rapidly reduced or discontinued.

https://www.gov.uk/drug-safety-update/glp-1-receptor-agonists-reports-of-diabetic-ketoacidosis-when-concomitant-insulin-was-rapidly-reduced-or-discontinued

52
Q

You are teaching a pharmacy student about medicines used in diabetes.
Which of the following medicines is a dipeptidylpeptidase-4 inhibitor?
Incorrect answer Canagliflozin
Incorrect answer Dulaglutide
You chose the correct answer Linagliptin
Incorrect answer Metformin
Incorrect answer Nateglinide
You were correct.

A

The correct answer was Linagliptin

Linagliptin is a dipeptidylpeptidase-4 inhibitor.

53
Q

A patient is prescribed oral prednisolone for polymyalgia rheumatica.
What is the greatest long-term risk with continued use of glucocorticoids?
Incorrect answer Hypernatraemia
Incorrect answer Hypotension
Incorrect answer Hypokalaemia
You chose the correct answer Osteoporosis
Incorrect answer Weight loss
You were correct.

A

The correct answer was Osteoporosis

Corticosteroids can cause weight gain and an increase in blood pressure. Osteoporosis is the main long-term risk.

54
Q

Which one of the following medicines does NOT stimulate the pancreas to release insulin? The drug monographs are provided here:
Gliclazide: https://bnf.nice.org.uk/drug/gliclazide.html
Exenatide: https://bnf.nice.org.uk/drug/exenatide.html
Canagliflozin: https://bnf.nice.org.uk/drug/canagliflozin.html
Vildagliptin: https://bnf.nice.org.uk/drug/vildagliptin.html
Repaglinide: https://bnf.nice.org.uk/drug/repaglinide.html
Incorrect answer Gliclazide
Incorrect answer Exenatide
You chose the correct answer Canagliflozin
Incorrect answer Vildagliptin
Incorrect answer Repaglinide
You were correct.

The correct answer was Canagliflozin

A

Canagliflozin reversibly inhibits SGLT2 in the kidney to reduce glucose reabsorption and increase urinary glucose excretion.

55
Q

Which one of the following statements regarding the treatment of nocturnal enuresis in a 7-year-old is FALSE?
http://patient.info/doctor/nocturnal-enuresis-in-children
Incorrect answer Avoid caffeine-based drinks before going to bed
Incorrect answer Ensure the child eats a healthy diet
You chose the incorrect answer Encourage the child to use the toilet to pass urine at regular intervals during the day and before sleep
Incorrect answer Reward the child for going to the toilet before bed
This was the correct answer When the enuresis alarm goes off the child should go back to sleep if there is no urge to urinate
You were incorrect.

A

The correct answer was When the enuresis alarm goes off the child should go back to sleep if there is no urge to urinate

56
Q

Mrs K is a 62-year-old computer analyst who has been initiated on hormone replacement therapy (HRT). She has heard many rumours from her friends and is concerned about any serious effects which her new medication may cause. During your discussion, you mention that there are some instances when HRT should be stopped immediately.
Which one of the following is a reason for Mrs K to stop her HRT immediately?

Incorrect answer Alopecia
Incorrect answer Exfoliative dermatitis
Incorrect answer Nausea
This was the correct answer Severe stomach pain
You chose the incorrect answer Severe unexplained sore throat, fever or malaise
You were incorrect.

A

The correct answer was Severe stomach pain

Hormone replacement therapy should be stopped (pending investigation and treatment), if severe stomach pains occur.

57
Q

A concerned patient, Mrs TV has just started taking tibolone tablets. She asks you for advice regarding side effects.
The SPC is provided here: https://www.medicines.org.uk/emc/product/4429
Which of the following is a side effect of tibolone?
Incorrect answer Taste disturbance
Incorrect answer Seizures
You chose the correct answer Nipple pain
Incorrect answer Lethargy
Incorrect answer Alopecia
You were correct.

A

The correct answer was Nipple pain

Nipple pain is a side effect of tibolone.

58
Q

Regarding exenatide, which one of the following statements is NOT true?

It is a GLP-1 receptor antagonist
Incorrect answer It suppresses glucagon secretion
Incorrect answer It is administered by the subcutaneous route
Incorrect answer It may be combined with metformin and pioglitazone
Incorrect answer It may cause weight loss
You were correct.

A

The correct answer was It is a GLP-1 receptor antagonist

Exanitide is a GLP-1 agonist belonging to the class of incretrin mimetics. It is NOT therefore a GLP-1 receptor antagonist.

59
Q

Which ONE of the following is most likely to cause ketoacidosis?
You chose the correct answer Intravenous salbutamol
Incorrect answer Salmeterol
Incorrect answer Ipratropium
Incorrect answer Tiotropium
Incorrect answer Inhaled salbutamol
You were correct.

A

The correct answer was Intravenous salbutamol

Beta 2 agonists must be used with caution in patients with diabetes. Intravenous salbutamol can cause ketoacidosis.

60
Q

A 26-year-old woman with a history of hypothyroidism and antiphospholipid syndrome becomes pregnant. Which one of the following is contraindicated in pregnancy?

  • Aspirin
  • Low-molecular weight heparin
  • Warfarin
  • Levothyroxine
  • Unfractionated heparin
A

Warfarin is contraindicated in pregnancy. Most women are switched to low-molecular weight heparin for the duration of the pregnancy.

Prescribing in pregnant patients

Very few drugs are known to be completely safe in pregnancy. The list below largely comprises of those known to be harmful. Some countries have developed a grading system - see the link.

  • Antibiotics
  • tetracyclines
  • aminoglycosides
  • sulphonamides and trimethoprim
  • quinolones: the BNF advises to avoid due to arthropathy in some animal studies

Other drugs

  • ACE inhibitors, angiotensin II receptor antagonists
  • statins
  • warfarin
  • sulfonylureas
  • retinoids (including topical)
  • cytotoxic agents

The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk

CHAPTER 6: Endocrine system (6 decks)

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