Endocrine, Diabetes, Osteoporosis

Question 1

Hyperthyroidism - symptomatic treatment (tachycardia, arrhythmia, angina, tremor, agitation )

Answer 1

Propanolol

Beta blocker - DONT use with Ca channel blocker verapamil

Question 2

Hyperthyroidism - prolonged, or short term before surgery

Answer 2

Carbimazole, thionamide

Question 3

Hyperthyroidism - Grave’s disease

Answer 3

Carbimazole, thionamide

Question 4

Hyperthyroidism - short term for throtoxic criss, prep for thyroidectomy

Answer 4

Iodine/ iodide supplement

Question 5

Hyperthyroidism and thyroid carcinoma

Answer 5

Radioactive iodine - not for pregnant ladies.

Side note, low iodine for pregnant female, results in baby with cretinism

Question 6

Hypothyroidism drug of choice

Answer 6

T4 - thyroxine

Question 7

Hypothyroidism treatment 2 drugs

Answer 7

T4 thyroxine

T3 triiodothyronine

Question 8

Medicines that weaken bone

Answer 8

Glucocorticoids (prednisolone)
thyroid hormone
heparin 
antiepileptic drugs
glitazones 
aromatase inhibitors (anastrazole)

Question 9

Osteoporosis - preventative treatment

Answer 9

Calcitriol (Vit D)

Question 10

Osteoporosis - what drug is not generally recommended for use to prevent bone loss or fractures

Answer 10

Hormone replacement therapy

Question 11

Osteoporosis - what drug has beneficial effects on the bone without effect on other tissues?

Answer 11

Raloxifene

Selective estrogen receptor modulator (SERM)

Question 12

Osteoporosis - what drug is 1st line management for post menopausal osteoporosis?

Answer 12

Alendronate - a biphosphate.

DO NOT take with glucocorticoids, due to increased risk of atypical fractures.

Question 13

Biphosphate alendronate what are three main side effects -

and why low compliance?

Answer 13

1. Oesophagitis
2. Atypical fractures
3. Osteonecrotising Jaw

Take in morning before breakfast, remain standing for thirty minutes afterwards.

Question 14

Osteoporosis - what do you give if biphosphate are unsuitable?

Answer 14

Densumab - monoclonal antibody against RANKL

Question 15

What’s the relationship between RANKL, RANK and OPG

Answer 15

RANK Ligand found on osteoblasts - activate RANK found on osteoclast progenitors. OPG (osteoprotegerin) act as antibodies against RANKL inhibiting osteoclast activation.

Question 16

Osteoporosis drug with low efficacy

Answer 16

Calcitonin

Question 17

Osteoporosis drug of choice when there is a high risk of fractures or other treatments are unsuitable.

Answer 17

Teriparatide (PTH/PTH fragments), anabolic bone agent

Question 18

Diabetes drug - take immediately before a meal

Answer 18

Insulin lispro, insulin aspart, ultra short acting insulin

Question 19

Diabetes - IV in hyperglycaemic emergency or before a meal.

Answer 19

Soluble insulin (neutral), short acting insulin

Question 20

Diabetes - combine with short acting and give twice a day (mimics basal release)

Answer 20

Isophane - intermediate acting insulin

Question 21

Diabetes- give AT BREAKFAST with short acting given at meals (mimics basal release)

Answer 21

Ultralente Long acting insulin

Question 22

Diabetes - first choice sensitising agent unless renal problems

Answer 22

Metformin - insulin sensitisor

Question 23

Diabetes - less efficacious than metformin or sulphonureas

Answer 23

Thiazolidinediones

TZDs/glitazones, insulin sensitiser

Question 24

Diabetes - useful in early stages of diabetes

Answer 24

Glicazides

Sulphonylureas - insulin secretion

Question 25

Diabetes - may be used in patients with allergy to sulphonylureas

Answer 25

Repaglinide - glitinide. | Insulin secretion

Question 26

Diabetes- usual when postprandial BG remains high despite dietary modification

Answer 26

Acarbose A-glucosidase inhibitor Oral hypoglycaemic agent

Question 27

Propanolol BB S/E

Answer 27

Bronchoconstriction, bradycardia, AV block, depression, sedation, exacerbate diabetes, mask hypoglycaemia, impotence

Question 28

Carbimazole - thionamide S/E

Answer 28

Agranulocytosis, cross placenta and milk, rashes, headache, nausea, joint pain

Question 29

Iodine/iodide supplement S/E

Answer 29

possible allergic reactions.

Question 30

Radioactive iodine S/E

Answer 30

Hypothyroidism, thyroid cancer (small increase in risk)

Question 31

T4 (thyroxine) S/E

Answer 31

Elderly at risk of angina, arrhythmia, heart failure, osteoporosis

Question 32

Calcitriol (Vit D) S/E

Answer 32

Hypercalcaemia, hypercalciuria

Question 33

Hormone Replacement Therapy S/E

Answer 33

Increased risk of cancers (breast), adverse cardiovascular effects

Question 34

Raloxifene (Selective estrogen receptor modulator SERM) S/E

Answer 34

May affect breast and endometrial tissue, adverse cardiovascular effects

Question 35

Alendronate (Biphosphate) - S/E

Answer 35

Osteonecrosis of jaw, effect limited after 5 years, GI effects, compliance issues, atypical fractures

Question 36

Densumab (Monoclonal Antibody RANKL) - S/E

Answer 36

Lacks long term safety and efficacy data

Question 37

Teriparatide (PTH/PTH fragments bone anabolic agent) - S/E

Answer 37

Possible increase in osteosarcoma, stopped after 18 months

Question 38

Insulin - all duration - S/E

Answer 38

Hypoglycaemia, formation of antibodies, local allergic reactions

Question 39

Metformin - insulin sensitiser - S/E

Answer 39

Weight loss, nausea, diarrhoea

Question 40

Thiazolidinediones (glitazone, insulin sensitiser) S/E

Answer 40

Weight gain, long term safety still unsure

Question 41

Glicazide - sulphonylureas insulin secretion - S/E

Answer 41

Hight protein binding, hypoglycaemia, weight gain (stimulate appetite)

Question 42

Repaglinide - glitinide insulin secretion - S/E

Answer 42

Hypoglycamia

Question 43

Acarbose - A-glucosidase inhibitor - S/E

Answer 43

Flatulence diarrhoea

Question 44

Hyperaldosteronism; often used with thiazides or loop diuretics to prevent hypokalaemia, resistant hypertension, CHF

Answer 44

Spironolactone Aldosterone receptor antagonist (K+ sparing)