E Flashcards
1
Q
Define diabetes insipidus?
A
Large amounts of dilute urine produced which causes extreme thirst
2
Q
State the two drugs used to treat pituitary diabetes insipidus?
A
Vasopressin and desmopressin
3
Q
Why is desmopressin preferred?
A
Long acting, more potent and has no vasoconstrictor effect
4
Q
What drug is used in the differential diagnosis of diabetes insipidus?
A
Desmopressin (can cause hyponatraemic convulsions)
5
Q
What drug is used in partial pituitary diabetes insipidus?
A
Carbamazepine but is unlicensed
6
Q
Which two drugs treat hyponatraemia?
A
Demeclocycline and tolvaptan
7
Q
How does demeclocycline work?
A
Blocks renal tubular effect of ADH
8
Q
How does tolvaptan work?
A
Vasopressin v2-receptor antagonist
9
Q
State a side effect of tolvaptan?
A
Rapid correction of hyponatraemia can cause osmotic demyelination
leading to serious neurological events
10
Q
State a side effect of desmopressin?
A
Hyponatraemic convulsions
11
Q
State one interaction with desmopressin?
A
With TCAS - increases risk of hyponatraemia
12
Q
State one counselling point with desmopressin?
A
Stop taking medicine whilst episode of vomiting / diarrhoea
13
Q
State a MHRA side effect of corticosteroids use?
A
Central serious chorioretinopathy - retinal disorder
14
Q
What are the mineralocorticoid side effects?
A
Potassium and calcium loss (hypokalaemia/hypocalcaemia) - sodium and water retention - hypertension
15
Q
What are mineral corticosteroids most marked in?
A
Most marked in fludrocortisone
Significant with hydrocortisone, corticotrophin and tetracosacitide
16
Q
What are the glucocorticoid side effects?
A
Diabetes
osteoporosis
muscle wasting
avascular necrosis
peptic ulceration
psychiatric reactions
17
Q
What are glucocorticoids most marked in?
A
Betamethasone, dexamethasone and Hydrocortisone
18
Q
State the conditions a patient can develop after taking prolonged use of corticosteroids?
A
Increased risk of infections
Increased risk of chicken pox
Increased risk of measles
Increased risk of psychiatric reactions/altered mood/ risk of suicide/depression
REPORT!
Glaucoma, cataracts
Purple stretch marks
Growth restriction in children
Hypertension
Diabetes - can increase blood-glucose concentration levels (polyuria, polydipsia, polyphagia, fatigue, blurred vision)
Osteoporosis
High doses cause Cushing syndrome - moon face, strae, acne
19
Q
What is Cushing’s syndrome?
A
Excessive amounts of cortisol in human body
20
Q
What are symptoms of Cushing’s syndrome?
A
Increased fat on chest and tummy
Build-up of fat on neck
Red, puffy, rounded moon face,
Purple stretch marks
Low libido
21
Q
What is the diagnosis test for Cushing’s syndrome:
A
Overnight suppression dexamethasone test
Low-dose dexamethasone suppression test (LDDST)
Your blood is drawn 6 hours after the last dose. Normally, cortisol levels in the blood drop after taking dexamethasone. Cortisol levels that don’t drop suggest Cushing’s syndrome. In the LDDST test, you will have blood drawn after taking a low dose of dexamethasone.
Dexamethasone is a synthetic glucocorticoid, which is similar to cortisol.
when dexamethasone is present in the body, it mimics the actions of cortisol and suppresses the release of CRH and ACTH. As a result, cortisol production by the adrenal glands decreases (body doesnt think it needs to produce so much cortisol- balance out)
therefore in cushings syndrome As a result, even though dexamethasone is administered, cortisol production remains elevated because the usual regulatory signals to decrease cortisol production are not effectively transmitted.
22
Q
Which drug is used in management of Cushing’s syndrome?
A
Metyrapone
Metyrapone acts by blocking the conversion of 11-deoxycortisol to cortisol by P450c11 (11β hydroxylase)
23
Q
Which drug is used in treatment of endogenous Cushing’s syndrome?
A
Ketoconazole
24
Q
State the symptoms of adrenal insufficiency?
A
Fatigue
anorexia
vomiting
hypotension
hypoglycaemia
hponatraemia
hyperkalaemia
25
State advice for ketoconazole?
Know the signs of liver toxicity
Nausea, vomiting, jaundice, abdominal pain, dark urine, anorexia
## Footnote
Ketoconazole works by inhibiting cortisol synthesis and can help reduce cortisol levels in patients with Cushing's syndrome who are awaiting surgery or for whom surgery is not an option.
Endogenous Cushing's syndrome refers to a condition where there is excessive production of cortisol within the body. This excess cortisol can stem from various sources
Treatment options for endogenous Cushing's syndrome depend on the underlying cause and may include surgery to remove tumors, medications to suppress cortisol production, or radiation therapy.
26
State DVLA advice for patients taking insulin:
Check blood glucose no more than 2 hours before driving and every 2 hours while driving
Blood glucose should always be above 5mmol/L
If it falls to 5 or below, a snack should be taken
If it falls below 4 mol/L the driver should stop driving
.
Have a sugary drink or snack + wait 45 mins before continuing the journey
27
What can mask symptoms of hypoglycaemia:
Alcohol, sulphonylureas and betablockers
28
What is diagnosed as pre-diabetic:
42-47 mmol (6%)
29
What is defined as having type 2 diabetes:
Over 48 mmol (6.5%)
30
State one common side effect of sulphonylurea:
Modest weight gain
31
How does sulphonylureas work:
increasing(augmenting) insulin secretion and only effective when some residual pancreatic beta-cell activity is present
32
State DPP4:
Gliptins
Less incidence of hypoglycaemia and no weight gain
33
How does DPP4 work:
Blocks the action of DPP4, an enzyme which destroys the hormone incretin
Incretins help the body produce more insulin only when it is needed and reduce amount of glucose being produced by the liver when it is not needed
34
State SGLT2:
Canagliflozin and empaglifozin can be beneficial in patients with diabetes + established heart disease
Flozins are at an increased risk of diabetic ketoacidosis
35
How does SGLT2 work:
Reversibly inhibits SGLT2 in renal proximal convoluted tubule to reduce glucose reabsorption an increase urinary glucose excretion
36
Which GLP1 agonist is has proven cardiovascular benefit in patients with diabetes and established CVD:
Liraglutide
37
Which antidiabetic medicine can be used for polycystic ovary syndrome:
Metformin - can cause weight loss, acne, hirsutism, regulation of menstrual cycle
38
State how does metformin work:
Decreases gluconeogenesis and increases peripheral utilisation of glucose
39
State some key information regarding metformin:
Can cause metallic altered taste, weight loss, B12 deficiency, avoid if egfr is 30 or less
Metformin lowers both basal and postprandial blood glucose concentrations not associated with weight gain and does not stimulate insulin secretion when given alone does not cause hypoglycaemia
40
State target HBA1C concentration when diabetes is managed by diet and lifestyle alone:
48 mmol - 6.5%
41
State target HBA1C concentration if a single sulphonylurea is used OR two or antidiabetic drugs used:
53 mmol - 7.0%
42
State initial treatment of diabetes:
1. Metformin (dose should be increased gradually to minimise risks of Gl effects.
If GI (gastro) effects noticed, then give M/R metformin
2. Metformin + DPP4/pioglitazone/sulfonylurea. Metformin + SGLT2 may be considered if sulfonylurea is not tolerated or if patient is at significant risk of hypoglycaemia
3. Metformin + sulphonylurea + DPP4 or Metformin + sulphonylurea + pioglitazone
43
For adults with type 2 diabetes at any stage after they have started first line treatment:
If they have or develop chronic heart failure or established atherosclerotic cardiovascular disease, offer an SLT2 with proven cardiovascular benefit
44
Which sulphonlyurea is indicated in elderly patients or those with renal impairment:
Short acting sulphonylurea: gliclazide / tolbutamide
45
Triple therapy with metformin + sulphonlyurea + GLP1RA:
Only prescribed with BMI over 35 kg/m2
46
GLPIRA:
After 6 months, drug should only be continued if at-least 11mmol/ 1% in HBAIC and 3% of weight loss of initial body weight has been achieved
Note: in patients with chronic heart failure or established atherosclerotic cardiovascular disease should also be offered a SGLT2
47
What can exacerbate or prolong hypoglycaemic effect?
Alcohol consumption - advised to reduce
48
What are type 2 diabetic patients at risk of
Periodontitis (advised to go to see dentist regularly)
| Gum disease is where your gums are red and swollen
49
What screening should be done for patients with type 2 diabetes:
Retinopathy = diabetic eye screening annual once a year
Foot problems = diabetes foot check annual once a year
Diabetic kidney disease = annual once a year
Cardiovascular risk = annual once a year
50
State the 'Sick-day' rules:
Advise to temporarily stop some drug treatments during acute illness
Diuretics
ACE/ARB
METFORMIN
NSAIDs
## Footnote
DAMN
Stop above treatment if there is risk of dehydration to reduce risk of acute kidney injury
Stop metformin if there is risk of dehydration to reduce risk of lactic acidosis
Stop sulfonylureas as may increase risk of hypoglycaemia
Stop SGLT2, check ketones and stop treatment if acutely unwell due to risk of euglycemic DKA
Stop GLP1RA if there is risk of dehydration, due to risk of AKI
51
State treatment of diabetic nephropathy:
ACE or ARB
52
State treatment of painful diabetic peripheral neuropathy:
1. Amitriptyline, imipramine, duloxetine, venlafaxine
2. Pregabalin, gabapentin
53
State treatment of diabetic diarrhea in patients with autonomic neuropathy:
1. Tetracycline
2. Codeine
(erythromycin IV given for gastroparesis)
## Footnote
iabetic neuropathy can affect the bladder muscles,
Autonomic neuropathy is a form of polyneuropathy that affects the non-voluntary, non-sensory nervous system, affecting mostly the internal organs such as the bladder muscles
Gastroparesis is a condition characterized by delayed emptying of the stomach contents into the small intestine, leading to symptoms such as nausea, vomiting, bloating, and abdominal discomfort. Erythromycin, commonly known as an antibiotic, has an additional effect on gastrointestinal motility and has been used off-label for the treatment of gastroparesis.
There are several types of diabetic neuropathy, each with its own set of symptoms and effects:
Peripheral Neuropathy: This is the most common form of diabetic neuropathy and affects the nerves that control sensation, movement, and coordination in the limbs, particularly the feet and legs. Symptoms may include numbness, tingling, burning sensations, and pain in the affected areas. Peripheral neuropathy can also lead to muscle weakness, loss of balance, and changes in skin texture.
Autonomic Neuropathy: Autonomic neuropathy affects the nerves that control involuntary bodily functions, such as heart rate, blood pressure, digestion, and bladder function. Symptoms may include dizziness upon standing (orthostatic hypotension), gastrointestinal problems (such as gastroparesis or diabetic diarrhea), sexual dysfunction, and bladder dysfunction.
Proximal Neuropathy: Also known as diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathy, this type of neuropathy affects the nerves in the thighs, hips, buttocks, and lower back. It can cause severe pain, weakness, and muscle wasting in the affected areas.
Focal Neuropathy: Focal neuropathy, also called mononeuropathy, affects individual nerves, often in the torso, head, or limbs. It can cause sudden, severe pain in specific areas, as well as weakness or paralysis of the affected muscles.
54
State treatment of postural hypotension:
Midodrine
55
State treatment of neuropathic postural hypotension:
Increased salt intake + fludrocortisone (uncontrollable edema SE)
56
State treatment of gustatory sweating:
Propantheline bromide
57
State treatment of neuropathic oedema:
Ephedrine
58
State the symptoms of Diabetic ketoacidosis (severe hyperglycaemia and high blood ketones):
Rapid weight loss, nausea, vomiting, sweet metallic taste, different odour in sweat and urine, Confusion, tired, fast breathing, breathe smells fruity, thirsty
59
State treatment of diabetic ketoacidosis:
1. Soluble insulin IV mixed with sodium chloride 0.9% + potassium (no potassium if anuria)
60
Which drug to use in pregnancy:
1. Metformin
61
State insulin treatments in pregnancy:
Isophane insulin - first choice for long acting Or insulin detemir / glargine
Continuous S/C insulin infusion
62
Define gestational diabetes:
Women with gestational diabetes who have a fasting plasma glucose below 7mmol/litre at diagnosis should first attempt a change in diet and exercise alone to reduce blood-glucose levels.
If blood-glucose targets are not met within 1-2 weeks, metformin is prescribed.
If metformin is not effective or contraindicated, then insulin is prescribed
63
How do you treat pregnant patient if fasting plasma glucose is above 7mmol/litre:
Treat with insulin immediately, with or without metformin in addition to a change in diet and exercise
64
How do you treat pregnant patient if fasting plasma glucose is between 6 and 6.9 mmol/litre alongside complications such as macrosomia or hydramnios:
Treat with insulin immediately, with or without metformin
## Footnote
The term "fetal macrosomia" is used to describe a newborn who's much larger than average.
Hydramnios, defined as a volume of amniotic fluid in excess of 2,000 mL
Amniotic fluid is a clear, slightly yellowish liquid that surrounds the unborn baby (fetus) during pregnancy
65
State treatment of gestational diabetes:
1. Metformin
2. Insulin if metformin C/I
66
Which insulin is the insulin of choice in pregnancy:
Isophane insulin is first choice for long-acting insulin during pregnancy
However, in women who have good blood-glucose control before pregnancy with the long-acting insulin analogues, insulin detemir or insulin glargine, it may be appropriate to continue using them
Continuous SC insulin infusion may be appropriate for pregnant women who have difficulty in achieving g glycemic control with multiple daily injections of insulin
67
How does metformin work:
Decreases gluconeogenesis and by increasing peripheral utilisation of glucose
68
State common side effects of metformin:
Transient diarrhea, taste altered, vitamin b12 cyanocobalamin deficiency, abdominal pain, appetite decreased, lactic acidosis, skin reactions
## Footnote
Acute diarrhea is transient — lasting for just a day or two, though sometimes as long as two weeks.
69
State symptoms of lactic acidosis:
Dyspnoea, muscle cramps, abdominal pain, hypothermia, asthenia,
| Most common with metformin
## Footnote
dyspnoea:difficult or laboured breathing
asthenia: abnormal physical weakness or lack of energy
70
State which egfr to avoid metformin in:
30 ml and under
71
How do DPP4's work:
Inhibits DPP4 to increase insulin secretion and lower glucagon secretion
72
Which DPP4 does not require a dosage change in renal impairment:
Linagliptin
Key: Linagliptin is the only anti-diabetic drug that does not require a dosage adjustment in renal impairment
73
Which DPP4 has a side effect of increased risk of infection:
Alogliptin
Saxagliptin
74
Patient is taking vildagliptin, state patient carer advice:
Pancreatitis = severe abdominal pain
Liver toxicity = nausea, vomiting, dark urine, fatigue, abdominal pain
75
State side effects of gliptins, DPP4:
Nausea, vomiting, diarrhea, dyspepsia, GORD, pancreatitis
76
How does GLP1A work:
Augments glucose dependent insulin secretion and slows gastric emptying
Supresses glucagon secretion
77
State handling and storage requirements for dulaglutide:
Fridge 2-8 degrees
Once opened - can stay unrefrigerated for up to 14 days less than 30 degrees
78
Which GLP1A can cause severe pancreatitis including haemorrhagic or necrotising pancreatitis:
Exenatide
But all GLP1A can cause acute pancreatitis
79
State conception advice for patients taking exenatide:
Women should use effective contraception during treatment and for 12 weeks after discontinuation
80
Which drug do you have to counsel patient potential risk of dehydration:
Liraglutide
81
Which drug has an increased risk of cholelithiasis and cholecystitis and increased HR:
Liraglutide
## Footnote
Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in your gallbladder.
Acute cholecystitis is inflammation of the gallbladder. It usually happens when a gallstone blocks the cystic duct.
82
How does SGLT2 work:
Reversibly inhibits sodium glucose co-transporter 2 in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion
83
Patient is taking canagliflozin and rifampicin, what do you advise dr:
Increase canagliflozin dose to 300 mg
84
State MHRA warning with SGLTZ:
Fatal cases of DKA
Increases lower limb amputation (mainly toes)
stop if patient develops skin ulcer, osteomyelitis or gangrene
Fournier's gangrene - severe pain, tenderness, erythema, swelling in genital or perianal area + fever, necrotising fasciitis
## Footnote
Osteomyelitis is a painful bone infection. It usually goes away if treated early with antibiotics. It can cause serious long-term problems if it's not treated.
85
State patient carer advice for SGLT2:
Told about symptoms of DKA
Canagliflozin has extra one = report symptoms of volume depletion and postural hypotension and dizziness
With Empagliflozin and Ertugliflozin = Correct hypovolaemia
86
State common symptoms of SGLT2:
Balanoposthitis, hypoglycaemia, increased risk of infection, thirst, urinary disorders
## Footnote
Balanoposthitis is inflammation of the head of your penis and foreskin
87
State cautions of sulphonylureas:
Can encourage weight gain, G6PD deficiency, elderly (long-acting ones)
## Footnote
G6PD deficiency is when the body is missing or doesn't have enough of an enzyme called G6PD (glucose-6-phosphate dehydrogenase). This enzyme helps red blood cells work correctly. A lack of this enzyme can cause hemolytic anemia.
Severe symptomatic hypoglycaemia is the most serious adverse effect of sulphonylurea drugs and this becomes progressively more likely with increasing age
88
State common side effects of sulphonylureas:
Abdominal pain, diarrhea, nausea, hypoglycaemia
Jaundice may occur it is common side effect
89
State max dose for gliclazide:
320 mg
Can cause angioedema, dyspepsia, anemia, hyponatraemia
Safe in elderly and renal impairment
90
State max dose for glimepiride:
6 mg
91
Which sulphonylurea is considered safe in acute porphyrias:
Glipizide
Max 20 mg daily
## Footnote
Acute porphyrias include forms of the disease that usually cause nervous system symptoms
92
State max dose for tolbutamide:
2mg
Safe in elderly and renal impairment
93
How does pioglitazone work:
Reduces peripheral insulin resistance
Max dose is 45 mg
94
State the MHRA warning with pioglitazone:
Not be used in patients with heart failure or history of heart failure
Increased risk of bladder cancer
Report promptly any haematuria, dysuria, urinary urgency during treatment
- (not MHRA but increased risk of bone fractures in women)
95
State common side effects of pioglitazone:
Bone fracture, increased risk of infection, weight gain, numbness, visual issues
Monitor liver function before and annually
Liver toxicity = dark urine, nausea, vomiting, severe abdominal pain, fatigue
96
State the fast-acting insulin:
LISPRO
ASPART
GLUISINE
| LAG
97
State the slow-acting long-acting insulin:
DETEMIR
DEGLUDEC
GLARGINE
## Footnote
Learn as DDG (David de gea, former Manchester united legend!)
98
Define osteoporosis:
Progressive bone disease characterised by low bone mass measured by bone mineral density and microarchitectural deterioration of bone tissue.
Leads to increased risk of fragility as a result
99
State who osteoporosis is most common in:
Postmenopausal women
Men over 50
Patients taking long term oral glucocorticoids
100
State risk factors of osteoporosis:
Age
Low BMI
Cigarette smoking
Excess alcohol intake
Lack of physical activity
Vitamin D deficiency
Family history of hip fractures
Low calcium levels
101
State lifestyle advice for patients with osteoporosis:
Regular exercise
Have a balanced diet
Stop smoking
Limit alcohol intake to 14 units weekly
102
State the treatment of osteoporosis in men:
1. Alendronic acid 10 mg daily or 70mg weekly / risedronate 35 mg weekly
Note: denosumab is alternative if bisphosphonates are contraindicated
103
What is denosumab:
Human monoclonal antibody
104
What is teriparatide:
A parathyroid hormone
105
What is raloxifene:
HRT, a selective estrogen receptor modulator
106
State treatment of postmenopausal osteoporosis:
1. Alendronic acid / risedronate
2. IV ibandronic acid, zoledronic acid, denosumab, raloxifene
107
State treatment of postmenopausal women with severe osteoporosis at very high risk of vertebral fractures:
Teriparatide and duration limited to 24 months
108
Who should be given prophylactic treatment:
Women aged 70 years
Prednisolone> 7.5 mg daily
109
State treatment of duration:
5 years with alendronic acid /risedronate/ibandronic acid
3 years with zoledronic acid
110
How do bisphosphonates work:
Adsorbed onto hydroxyapatite crystals in bone, slowing both rate of growth and dissolution
111
State MHRA warning with bisphosphonates:
Atypical femoral fractures
Patients advised to report any thigh, hip, groin pain
Osteonecrosis of jaw
Dental check ups
Report any oral swelling, sores, discharges
Benign idiopathic osteonecrosis of external auditory canal
Report any ear pain, ear infection
112
Which bisphosphonate has highest risk for developing osteonecrosis of jaw:
Zoledronate
113
State side effects of alendronic acid:
Gastrointestinal disturbances, vertigo, severe esophageal reactions (seek medical attention if they develop esophageal irritation, dysphagia, pain or swallowing or retrosternal pain, new or worsening heartburn
114
State monitoring requirements for ibandronic acid:
Calcium, phosphate and magnesium
115
State directions of administration for risedronate:
30 mins before breakfast
Or 2 hours before or after taking risedronate
Avoid calcium containing products e.g., milk - also avoid iron and mineral supplements and antacids
116
State directions of administration for alendronic acid:
30 mins before breakfast
117
State treatment of risedronate in Paget's disease of bone:
30 mg daily for 2 months
118
State MHRA warning with denosumab:
Atypical femoral features
Report any new or unusual thigh, hip, groin pain
Risk of osteonecrosis of jaw and risk of hypocalcaemia
Report any mobility, pain, swelling, sores, discharge Osteonecrosis of external auditory canal reported
Ear pain, ear infection, discharge
Hypercalcaemia reported up-to 9 months after discontinuation Note: denosumab can cause a hypocalcaemia electrolyte disturbance
119
State symptoms of hypocalcaemia:
Muscle spasms, twitches, cramps, numbness, tingling in fingers, toes or around mouth
120
State conception advice for patients taking denosumab:
Effective contraception in women during treatment and for at least 5 months after stopping treatment
121
State use of bromocriptine:
Galactorrhoea and for treatment of prolactinomas
122
What is most effective treatment of acromegaly:
Octreotide (somatostatin analogue)
Bromocriptine too
123
What is quinagolide:
Non-ergot dopamine D2 agonist
Monitor BP
Excessive daytime sleepiness and sudden onset of sleep can occur with dopamine-receptor agonists
124
State treatment of endometriosis and for relief of severe pain and tenderness in benign fibrocystic breast disease:
Danazol
125
Why are estrogens necessary:
Development of female secondary characteristics
126
State the natural ostrogens:
estradiol
Oesterone
Estriol
127
State features of tibolone:
Oestrogenic, progestogenic and weak androgenic activity
128
State what age HRT therapy can be given to a female patient:
Until 50
129
What drug can be used to reduce vasomotor symptoms in patients with menopause:
Clonidine for facial flushing
130
# *
What risks with all HRT meds?
All HRT medication (including tibolone) increases risk of breast cancer within 1-2 years of initiating treatment. This risk disappears after 5 years of stopping.
Small increased risk of ovarian cancer
Slightly increases risk of stroke
Tibolone increases risk of stroke about 2.2 time from first vear of treatment
Increased risk of CVD
131
Patient is undergoing general anesthesia, orthopedic surgery, vascular leg surgery and is taking HRT what do you advise:
Stop taking HRT 4-6 weeks before surgery
If It can't be stopped add in unfractionated or low molecular weight heparin
132
State the reasons to stop COC / HRT?
Sudden severe chest pain
Sudden breathlessness (or cough with blood-stained sputum)
Unexplained swelling or severe pain in calf of one leg
Severe stomach pain
Severe prolonged headache / complete loss of vision / sudden disturbance of hearing / dysphasia / bad fainting / first seizure / marked numbness
Hepatitis / jaundice / liver enlargement
160 mmHg / 95 mmHg
133
Define endometriosis:
Growth of endometrial-like tissue outside the uterus
Women report pain, which can be frequent or chronic and severe, tiredness, more sick days and impacts sexually and psychologically
134
State treatment of endometriosis:
1. Paracetamol AND/OR NSAID for first 3 months
2. COC or progestogen only pill
Such as: Nexplanon, depo-provera or sayana press
135
Describe menorrhagia:
Excessive menstrual blood loss of 80 ml or more for duration of more than 7 days
Heavy menstrual bleeding occurs regularly, every 24-35 days
136
State the treatment of menorrhagia (in patients with fibroids less than 3 cm in diameter):
1. Levonorgestrel releasing intra uterine system (LNG - CIUD)
2. Tranexamic acid or NSAID or COC, Cyclical oral progestogen i.e., norethisterone
137
State some serious side effects with tibolone and when to withdraw treatment:
Vaginal bleeding - investigate for endometrial cancer if bleeding continues 6 months
Abnormal LFTs
Cholestatic jaundice, Thromboembolic disease
138
Which drug is used for treatment of severe hypersexuality and sexual deviation in males:
Cyproterone acetate
139
Define cholestasis:
Impairment of bile formation and/or bile flow, which may clinically present with fatigue, pruritus, dark urine, pale stools, jaundice and signs of fat soluble vitamin deficiencies
140
State treatment of cholestatic pruritus:
1. Colestyramine is drug of choice
2. Ursodeoxycholic acid has a small and variable impact
3. Rifampicin
4. Sertraline
141
State the treatment of intrahepatic cholestasis in pregnancy:
Ursodeoxycholic acid
142
A low strength of this medication can be used for treating male-pattern baldness in men
Finasteride
143
State a common side effect of testosterone:
Hypertriglyceridemia
## Footnote
Hypertriglyceridemia means you have too many triglycerides (fats) in your blood. This raises your risk of atherosclerosis and related heart diseases
144
State lab results for hyperthyroidism:
High T3,T4
LOw TSH
Malaise, fever, agitation, polyuria, thirst, diarrhea, increased sweating, heat intolerance, anxiety, reduced libido, weight loss
145
State treatment of hyperthyroidism:
1. Carbimazole (can cause blood disorder, and can lower neutrophils thus filgastrim drug can be given to increase the neutrophils count)
2. Propylthiouracil
146
What is blocking-replacement therapy:
Carbimazole + levothyroxine given for 18 months
147
State treatment of thyrotoxicosis (thyroid storm):
IV fluids
Propranolol + hydrocortisone + iodine + carbimazole/propylthiouracil
148
Which two beta-blockers can be used for treating rapid relief of thyrotoxic symptoms:
Propranolol / nadolol
149
State treatment of hyperthyroidism in pregnancy:
1. Propylthiouracil in FIRST trimester (as carbimazole associated with congenital defects, aplasia cutis of neonate)
2. Carbimazole in SECOND trimester (as propylthiouracil can cause risk of hepatotoxicity
150
State patient carer advice with carbimazole:
Sore throat / mouth ulcer / bruising / fever / fever / son-specific illness / blood disorder - stop medicine
Female should use effective contraception during treatment
Signs of low neutropoenia / type of low WBC = stop
151
State MHRA warning with carbimazole:
STOP if symptoms of acute pancreatitis occur
152
State patient carer advice for propylthiouracil:
Nausea, vomiting, fatigue, abdominal pain, jaundice, dark urine, pruritus - monitor for hepatotoxicity and then stop medicine if develops
Discontinue if significant liver enzymes develop
153
State use of propylthiouracil in pregnancy:
Used in first trimester
High doses can cause foetal goitre and hypothyroidism
154
State symptoms of hypothyroidism:
Fatigue, Cold intolerance, Weight gain, myalgia, dry skin, hair loss, changes to hair and skin, deepening of voice goitre, depression
155
State lab results for hypothyroidism:
High TSH
Low T3, T4
156
State treatment of hypothyroidism:
1. Levothyroxine
2. Liothyronine sodium (has a more rapid effect and more potent. Ideal in severe hypo emergencies)
157
What can primary hyperparathyroidism lead to:
Hypercalcaemia, hypophosphatemia, hypercalciuria
158
State the drug treatment of primary hyperparathyroidism:
Treatment with cinacalcet may be considered in patients with primary hyperparathyroidism if surgery has been unsuccessful
