Chapter 6- Endocrine System Flashcards by Rachel Cornish

What is vasopressin and desmopressin?

Antidiuretic hormone (ADH)

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Which is more potent and has a longer duration of action: desmopressin or vasopressin?

Desmopressin

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Which has a vasoconstrictor effect: desmopressin or vasopressin

Vasopressin

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Vasopressin can be used to stop variceal bleeding in what?

Portal hypertension

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Name two antidiuretic hormone antagonists

Demeclocycline

Tolvaptan

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Rapid correct of hyponatraemia with tolvaptan can cause what

Osmotic demyelination leading to serious neurological events

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The antidiuretic hormones vasopressin and desmopressin can cause what

Hyponatraemia

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Name 5 mineralocorticoid side effects

Hypertension 
Sodium retention 
Water retention 
Potassium loss
Calcium loss

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Name 6 side effects from glucocorticoids

Diabetes 
Osteoporosis 
Avascular necrosis of femoral head 
Muscle wasting 
Peptic ulceration 
Psychiatric reactions

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Children under 15 years should use what to inhale corticosteroids

Large volume spacer

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Name two drugs used in cushings

Ketoconazole

Metyrapone

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Fasting blood glucose target

5-7 mmol/litre

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Blood glucose target before meals and any other time of day

4-7mmol/litre

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Blood glucose target 90 mins after eating

5-9 mmol/litre

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Name 3 rapid acting insulin analogues

Insulin aspart
Insulin glulisine
Insulin lispro

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When soluble insulin is injected subcutaneously what’s its onset of action, peak action and duration of action?

Onset: 30-60mins
Peak: 1-4hrs
Duration: 9 hours

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When soluble insulin is given intravenously what’s its half life and onset of action - as a result of this when is it used

Half life: few mins
Onset: instantaneous
Used: in medical emergencies e.g DKA & Peri-operatively

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Onset and duration of action of the rapid acting insulins (aspart, glulisine,lispro)

Onset: 15 mins
Duration: 2-5hrs

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Name an intermediate acting insulin and what’s its onset of action and duration

Isophane insulin
Onset: 1-2hrs
Duration: 11-24hrs

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Name three long acting insulins

Insulin degludec
Insulin detemir
Insulin glargine

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Metformin when given alone does not cause hypos- why?

Because it does not stimulate insulin secretion

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Name 5 sulfonylureas

Glibenclamide 
Gliclazide 
Glimepiride
Glipizide
Tolbutamide

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Sulfonylureas can cause hypos but it is more associated with the long acting sulfonylureas such as ?

Glibenclamide

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True or false: sulfonylureas can cause modest weight gain

True

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Name two meglitinides and what's their onset of action and duration like?

Nateglinide Repaglinide Rapid onset of action Short duration of activity

Name a thiazolidinedione

Pioglitazone

The dipeptidylpeptidase-4 inhibitors (gliptins) are not associated with weight gain and cause hypos to a lesser extent than the sulfonylureas, name these drugs

``` Alogliptin Linagliptin Sitagliptin Saxagliptin Vildagliptin ```

Name three sodium glucose co-transporter 2 inhibitors

Canagliflozin Dapagliflozin Empagliflozin

Which class of oral diabetic medication is associated with DKA

Sodium glucose co-transporter 2 inhibitors

Name 4 glucagon- like peptide 1 receptor agonists

``` Albiglutide Dulaglutide Exenatide Liraglutide Lixisenatide ```

What's another indication for metformin

Used as an insulin sensitising drug in women with polycystic ovary syndrome who are not planning pregnancy (unlicensed)

Normal HbA1c target

48 mmol/mol

If someone is on an antidiabetic drug that causes hypos or two or more antidiabetic drugs, what's their HbA1c target

53mmol/mol

When do you use glucagon-like peptide 1 receptor agonists

Triple therapy with metformin + sulfonylureas in patient with BMI 35+, or if <35 but have other conditions that would benefit from weight loss

When should you review glucagon-like peptide 1 receptor agonists

6 months after initiation- only continue if there's a reduction of at least 11mmol/mol in HbA1c and a weight loss of at least 3% of initial body weight

True or false: ACEI can potentiate the hypoglycaemic effect of insulin and oral antidiabetic drugs

TRUE

MOA of acarbose

Inhibitor of alpha glucosidases, delays the digestion and absorption of starch and sucrose, it has small but significant effect in lowering blood glucose

Cautions with acarbose

May enhance hypoglycaemia effects of insulin and sulfonylureas (hypoglycaemic episodes must be treated with oral glucose but not sucrose)

MOA of metformin

Decreases gluconeogenesis and increases peripheral utilisation of glucose

True or false: metformin acts only in presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells

True dat

Metformin and pregnancy?

Metformin can be used for both pre-existing and gestational diabetes

Metformin- avoid if what renal impairment?

If eGFR < 30ml/min/1.73m^2

Potential signs of lactic acidosis with metformin

``` Dyspnoea Muscle cramps Abdominal pain Hypothermia Asthenia ```

Side effects/ caution with DPP-4 inhibitors (gliptins)

Pancreatitis

Which DPP-4 inhibitor has reports of liver toxicity

Vildagliptin

How do the meglitinides work (nateglinide + repaglinide)

Stimulates insulin secretion

Mode of action of sodium glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin, empagliflozin)

Reversible inhibits SGLT2 in the renal proximal convoluted tubule to reduce glucose reabsorbtion and increase urinary glucose excretion

Patients on canagliflozin and rifampicin - increase the SGLT2 dose to want?

300mg OD

MHRA warning with all SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin

Risk of DKA

In addition to risk of DKA, what other caution is there with canagliflozin

Increased risk of lower limb amputation (mainly toes)

The SGLT2 inhibitors have an increased risk of volume depletion - true or false?

True - therefore caution in hypotension, elderly, heart failure

MOA of sulfonylureas

Augment insulin secretion therefore effective only when there's some residual pancreatic beta cell activity

Cautions for sulfonylureas

Weight gain Elderly (hypos) G6PD deficiency

Contraindication for glibenclamide

Acute porphyrias

True or false: the sulfonylurea 'glibenclamide' can be used in the second and third trimesters to treat gestational diabetes

True

Sulfonylureas should be avoided in porphyria- which two are thought to be safe?

Glimepiride | Glipizide

MOA of the thiazolidinedione 'pioglitazone'

Reduces peripheral insulin resistance

Contraindication to pioglitazone

History of heart failure Previous or active bladder cancer Univestigated macroscopic haematuria

Patient and carer advice for pioglitazone

Seek immediate medical attention if symptoms of nausea, vomiting, abdominal pain, fatigue and dark urine develop

HRT is of most benefit for the prophylaxis of postmenopausal osteoporosis if started early in menopause and continued for how long?

Up to 5 years

If bisphosphonates for treating postmenopausal osteoporosis what can be considered

Calcitriol or strontium ranelate

There is no consistent evidence of any further benefit from continuing treatment with a bisphosphonate beyond how many years in patients with osteoporosis

3 years

Name the anabolic steroid that can be used (but not recommended) in postmenopausal women

Nandrolone

Highest potency bisphosphonate

Zoledronate

Three MHRA warnings of bisphosphonates

Atypical femoral fractures Osteonecrosis of the jaw Osteonecrosis of external auditory canal

What is denosumab

Monoclonal antibody that inhibits osteoclast formation, function and survival thereby decreasing bone resorption

Name three dopamine agonists used to suppress lactation

Bromocriptine Cabergoline Quinagolide

Name a growth hormone receptor antagonist

Pegvisomant

Name the recombinant growth hormone used in Turner syndrome and deficiency of growth hormone

Somatropin

What are the risks of HRT

``` VTE Stroke Endometrial cancer Breast cancer Ovarian cancer Condo art heart disease ```

How can you reduce the increased risk of endometrial cancer with HRT

By a progestogen

Cyproterone is an anti-androgen given to prevent tumour flare with what initial therapy?

Gonadorelin analogue therapy

Name two drugs used for hyperthyroidism

Carbimazole | Propylthiouracil

Hypothyroidism in pregnancy can cause what to the baby

Fetal goitre

What's the block and replace regimen, how long is it used and when should it not be used

Carbimazole and levothyroxine for 18 months - do not use block and replace in pregnancy

Beta blockers can be used for rapid relief of thyrotoxic symptoms - in particular which beta blocker?

Propranolol (nadolol can also be used)

Can propylthiouracil and carbimazole be used I preganancy

In the smallest doses possible - propylthiouracil is preferred in first trimester and carbimazole has beeen associated with congenital defects (but consider switching in 2nd trimester due to hepatotoxicity risk with propylthiouracil)

What do you need to recognise with carbimazole

Bone marrow suppression - signs of infection, WCC and stop promptly if lab evidence of neutropenia

Name two drugs used in hypothyroidism and what's the difference between them?

Levothyroxine | Liothyronine (rapidly metabolised and quicker onset)

How do insulin requirements change in the second or third trimester

They increase

True or false: insulin causes hyperkalaemia

FALSE it causes hypokalaemia cos it drive potassium into cells

In obese patients would you choose pioglitazone or a sulfonylureas

Pioglitazone cos sulfonylureas can cause weight gain

True or false: in second and third trimester patients often need lower dose of levothyroxine

False they often need higher