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Endocrine Flashcards

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1
Q

Classes of anti diabetic drugs

A

SGLT2 inhibitors -gliflozolines
DDP4 inhibitors -gliptins
Buguanide -metformin
SU -gliclazide, tolbutamide, glibenclamide
GLP agonist (incretin) -xenitide, glutide
Acarbose
Thiazolidinedions

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2
Q

HMRA warning on carbimazole

A
  • neutropenia, agranulocytosis (report sign of inf eg sore throat, BWC)
  • risk of congenital malformation (1st trimester) use contraception
  • risk of acute pancreatitis NV,fever
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3
Q

carbimazole indication

A

hyperthyroidism

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4
Q

what is blocking-replacement therapy

A

simultaneous use of levothyroxine and carbimazole to block the endogenous synthesis of thyroid hormone, while maintaining a euthyroid state by providing exogenous hormone

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5
Q

how long should block-replace therapy last

A

18m

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6
Q

can you use block-replace therapy in pregnancy

A

NO

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7
Q

iodine can be used as adjunct to antithyroids 2 weeks before partial thyroidectomy, can it be used long term? why

A

no, antithyroid effect reduces with time

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8
Q

what is Diabetes insipidus

A

body produces a large amount of urine and often feel thirsty.

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9
Q

what is Vasopressin

A

antidiuretic hormone

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10
Q

Desmopressin / vasopressin, which is more potent and has a longer duration of action

A

Desmopressin

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11
Q

two types of diabetes insipidus

A
  1. cranial (not enough ADH produced)

2. nephrogenic (kidney doesn’t respond to ADH)

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12
Q

What trt are used in cranial diabetes insipidus

A

vasopressin or desmopressin (more potent)

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13
Q

what trt is used in nephrogenic diabetes insipidus

A

thiazide diuretics to give paradoxical effect

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14
Q

s/e of desmopressin

A

hyponatrameic convulsions (increase H20 absorption, dilute body fluid)

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15
Q

how to correct hypONatraemia if fluid restrction alone is ineffective

A

Demeclocycline- block renal tubular effect of ADH

Tolvaptan - vasopressin antagonist

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16
Q

rapid correction of hypONatraemia should be avoided because…

A

osmotic demyelination of neurones –> serious CNS effects

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17
Q

high mineralocorticoid activity = effect on body fluid level and BP

A

fluid retention = increase BP

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18
Q

which corticorsteroid has the most potent / standard / least potent mineralocorticoid effect

A

fludrocortisone / hydrocortisone / betamethasone, dexamethasone

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19
Q

glucocorticoid effect of hydrocortisone allows it to be used on short term basis via IV for..

A

surgeries or emergency e.g. asthma

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20
Q

effect of minerlocorticoid on K+ and Ca++ level

A

K+, Ca++ LOSS

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21
Q

which corticorsteroid has the most potent / standard / least potent glucocorticoid effect

A

betamethasone, dexamethasone / prednisolone, prednisone, deflazcort, hydrocortisone / fludrocortisone

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22
Q

what is the main use of glucocorticoid effect

A

anti-inflammatory (e.g. asthma, COPD)

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23
Q

what are the s/e of corticosteroid?

A 
ACHING BOSOM
A- adrenal supression (fatigue, hyPOtension, hyPOglycaemia, hypERK), appetite increase, abrupt w.d rxns (hypotension, death)
Cushing's syndrome, Cataracts
HypERglycaemia, hyperlipidaemia
Infections (IM suppression)
Nervous system, psychiatric rxn (mood, depression)
Glaucoma, GI ulcer (with food)
BP increase
Skin thinning
Osteoporosis (>3m, bisphosphonates), child growth
Obesity
Muscle wasting (caution w statin)
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24
Q

mhra warning on methylprednisolone injectable

A

contains lactose, avoid use in cow milk allergic pts

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25
how to reduce adrenal suppression caused by corticosteroid
1. take dose OM (least suppressive action) 2. take two days worth dose on alternate day 3. intermittent short courses
26
avoid abrupt w.d of steroid if used prednisolone > x mg OD for more than 1 week
pred>40mg for over 1 week
27
what is addison's disease
lack of hydrocortisone and aldosterone, normally followed by adrenalectomy
28
trt for adrenalectomy / addisons disease
hydrocortisone and fludrocortisone (for both gluco-, mineralo effect)
29
trt for hypopituitarism
hydrocortisone, NOT fludrocortisone (aldosterone is regulated by a different system) and other hormones (sex, thryoid)
30
what is cushing syndrome
hyPERcortisolism
31
symptoms of cushing syndrome
SKIN THIINING- easy bruise, red strech marks, striae, red cheeks, fat deposits in face = moon face, acne, hirsutism, amenorrhea
32
causes of cushing syndrome
corticosteroids - reduce dose or w.d | tumour - surgery or cortisol-inhibting drugs: Metyrapone (competitive) or Ketoconazole (potent)
33
risks with ketoconazole in treating cushing syndrome MHRA
LIFE THREATENING HEPATOTOXICITY - report sign of liver impair eg dark urine, ab pain, jaundice, piritus, NV
34
risks with METYRAPONE cortisol-inhibiting drugs in treating cushing syndrome
adrenal insufficientcy - report fatigue, NV, hyPOtension, anorexia. hyPONataemia, hyPERKalaemia, hyPOGlycaemia
35
what are the complications of diabetes and the trts
1. retinopathy - treat hypertension 2. nephropathy - ACEi/ARB (ACEi potentiates hyPOglycaemic effect of anti-diabetic drug esp in renal impair) 3. neuropathy - a)diabetic foot - painkillers, duloxetine, TCA:ami,nortriptyline, antiepileptic: gabapentin,pregabalin, carbmazepine b) autonomic neuropathy - nerve damage in SM cause uncontrolled involuntary response e.g. diarrhoea, gastroparesis (feel full as stomach emptying slows): erythromycin, c) Erectile dysfunction: sildenafil 4. gustatory (taste) neuropathy: sweating head, face, neck: antimus 5. neuropathic postural hypotension: fludrocortisone, increase salt intake
36
HbA1C target for diabetic pregnant women
below 48mmol/L 6.5%
37
how much of the folic acid should diabetic preg women take and why
5mg folic acid as diabetes is high risk gp for neural tube defects
38
what is the preferred form of insulin used in pregnancy, example
longer acting insulin e.g. isophane insulin
39
what are the safe options (antidiabetic medicnes) in pregnancy
metformin and insulin (stop all other antidiabetic drug due to risk of hyPOglycaemia esp in 1st trimester) Glibenclimide in 2nd and 3rd
40
which antidiabetic drug can be used from 11 weeks gestation; after organgenesis
glibenclamide
41
what are the symptoms for DKA
severe hyPERglycaemia, high ketone level, ketonuria, pear drop breath, dehydration, ex thirst, polyuria, NV, anorexia, ab pain, confusion, drowsiness, coma, convulsion
42
trt for DKA
IV infusion 1. soluble insulin 2. fluid (saline) 3. K+ (avoided if anuria)
43
how frequent should you check BGL for long journeys
no more than 2h before driving and every 2h thereafter
44
avoid driving if BGL fall below...
< 4mmol/l = HYPO
45
2 types of soluble insulin... what are the indications and why (BOLUS)
human and beef/pork soluble | used in diabetic emergencies, surgery, due to SHORT acting
46
3 rapid acting analogue insulin (BOLUS) and how it should be taken
``` 1 lispro (Humalog) 2 aspart (novorapid) 3 glulisine (apridra) take immediately before or after meal ```
47
name 1 intermediate acting insulin and how it should be taken, which route of adm should be avoided (BASAL)
isophane, take BD in connection with soluble insulin | avoid give IV =THROMBOSIS
48
4 long acting analogue and how it should be taken
``` 1 glargine (Lantus) 2 detemir OD/BD )Levemir 3 degludec (tresiba) 4 protamine zinc take OD at same time each day to cover 24h period ```
49
2 things to avoid when giving protamine zinc
never give IV = THROMBOSIS | never MIX with SOLUBLE = binds in syringe
50
under which 4 conditions, insulin requirements will increase
pregnancy puberty stressful accident, trauma infections
51
under which 2 conditions, insulin requirements will reduce
``` endocrine disorders eg Addisons, hypopituitarism coeliac disease (gluten) ```
52
Which two drugs can increase hyPOglaemic effect of insulin
ACEI (hyPERKalemia and hyPOglycaemia LINKED) | B-blocker - mask sympt of hyPO)
53
Which three types of D antagonise hyPOglycaemic effect of insulin
Corticosteroid CC loop/thiazide diuretics (low K)
54
storage condition for insulin once opened
once opened, room temp and use by 28 days
55
beef insulin to human insulin conversion
beef to human = reduce dose by 10%
56
pork insulin to human insulin conversion
pork to human = no dose change
57
MOA of metformin (1st line in ALL T2DM)
decrease liver gluconeogenesis | increase peripheral use
58
SE of metformin (5)
1. lactic acidosis 2. GI (N,V,D) 3. weight loss 4. taste disturbance 5. reduce VitB12 absorption
59
metformin should be avoided in which pt gp
avoid in pt with renal impairment eGFR<30ml/min
60
MOA of SU
increase insulin secretion
61
which two SU can be used in eldery and renal impaired pt and why
short acting ones eg gliclazide, tolbutamide as lower risk of hypo
62
which SU is suitable for pregnancy pt in which trimesters
glibenclamide in 2 and 3rd trimesters
63
three main SE of SU are...
1. hyPONa 2. hyPOs (must trt in hospital) 3. weight gain
64
which drugs can interact with SU and change BGL / excretion
ACEi and warfarin can increase hyPO | NSAID can reduce renal excretion of SU
65
Blood glucose target Pre prandial
4-7 mmol/L
66
Blood glucose target Post prandial
< 9 mmol/L
67
HbA1C target measures every 3/6 months for diabetic Pt
6.5-7.5% (< 48-59 mmol/L)
68
HbA1C target measures every 3/6 months for diabetic Pt with high risk of arterial disease
< or = 6.5%
69
HTN in DM w/o complications BP target is
140/80
70
BP target for DM with compilations
130/80
71
How long does insulin last if left outside the fridge at room temp
Max 48 hours then discard
72
Recommend insulin regime for T1DM
Multiple injection regimen
73
Recommend insulin regime for T2DM
Start with isophane insulin OD or BD | Then add short acting (soluble) insulin as a biphasic or multiple injection regimen
74
How does metformin work
Decrease gluconeogenesis | Increase peripheral use
75
Se of metformin
``` Lactic acidosis esp in pt with HF, tissue hypoxia, resp depression, severe infection, dehydration GI - N V D use MR weight loss Taste disturbance Reduce vit B 12 absorption C/I in renal Impairment ```
76
A deficiency of which vitamin could cause Scurvy (swollen bleeding unhealed wound in gum)
Vitamin C
77
Max duration of usage of loperamide
5days
78
Dosage of loperamide
Take 2 cap (4mg) initially Take one after each loose stool Max 16mg daily
79
What’s the criteria for selling tamsulosin?
Male 45-75 BPH symp for THREE MONTHS
80
How many tamsulosin can u supply initially then thereafter
2 weeks worth to see improvement then another 4 weeks then review for more
81
Which anti diabetic medication need to be stopped prior to Iodine contain in contrast media due to risk of renal failure
Metformin
82
License to age for Seretide inhaler
12+
83
Which asthmatic drug can cause liver disorder
Zafirlukast
84
What is nabilone and what is it indicated for
It is a cannabinoid used for nausea and vomiting caused by chemotherapy
85
What class is Apomorphine
Non ergot DAR agnost
86
How does stoma in children affect on electrolytes
Hypo potassium
87
What formulation of iron supplement should be supplied to a patient with a stoma
Iron cause loose stool can complicate stoma IV IRON indicated MR AVOID

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