Endocrinology

Question 1

Name two dopamine receptor (D2) agonists and what they are used to treat

Answer 1

Bromocriptine
Cabergoline
(Oral administration)
- Used to treat hyperprolactinaemia

Question 2

Name a somatostatin analogue and what it is used to treat

Answer 2

Octreotide

-Used to treat acromegaly (excess GH)

Question 3

Name a V1 and V2 selective vasopressin receptor peptidergic agonist

Answer 3

V1: Terlipressin
V2: Desmopressin (DDAVP)

Question 4

What is used to treat cranial DI ?

Answer 4

Desmopressin

Question 5

What is used to treat nephrogenic DI ?

Answer 5

Thiazides e.g. bendroflumethiazide

Question 6

What is used to induce nephrogenic DI to reduce renal water reabsorption ?

Answer 6

Demeclocycline

Question 7

What is used to treat SIADH ?

Answer 7

Vaptans- non-competitive V2 receptor antagonists

Question 8

What are the two thyroid hormone replacement therapies ?

Answer 8

Levothyroxine sodium (T4)
Liothyronine sodium (T3)

Question 9

Name two thionamides and what they are used to treat ?

Answer 9

Propylthiouracil (PTU)
Carbimazole (CBZ)
- Used to treat hyperthyroidism

Question 10

Name two inhibitors of steroid biosynthesis used to treat Cushing’s syndrome

Answer 10

Metyrapone and Ketoconazole

Question 11

What are the two mineralocorticoid receptor antagonists used to treat Conn’s syndrome ?

Answer 11

Spironolactone and Epleronone

Question 12

Name three synthetic glucocorticoids and what their mineralocorticoid activity is like

Answer 12

Hydrocortisone: mineralocorticoid activity at high doses
Prednisolone: weak mineralocorticoid activity
Dexamethasone: no mineralocorticoid activity

Question 13

Name an aldosterone analogue

Answer 13

Fludrocortisone

Question 14

What is used to treat Addison’s disease ? (Primary adrenocortical failure)

Answer 14

Hydrocortisone and fludrocortisone by mouth

Question 15

What is used to treat secondary adrenocortical failure (ACTH deficiency)

Answer 15

Treat with hydrocortisone

Question 16

What is given in an Addisonian crisis ?

Answer 16

I.V 0.9% Sodium Chloride
High dose hydrocortisone
5% dextrose if hypoglycaemic

Question 17

What is given in congenital adrenal hyperplasia (21- hydroxylase deficiency) ?

Answer 17

Dexamethasone 1/day or Hydrocortisone 2-3/day

AND Fludrocortisone

Question 18

What is used to treat PCOS ?

Answer 18

• Metformin
• Clomiphene: (anti-oestrogenic) - binds to oestrogen receptors in the hypothalamus thereby blocking the normal negative feedback, resulting in an increase in the secretion of GnRH and gonadotrophin
• Gonadotrophin therapy as part of IVF treatment

Question 19

Name two dopamine antagonist drugs

Answer 19

Anti-emetics (metoclopramide)

Anti-psychotics (phenothiazines)

Question 20

What are the different types of oestrogen preparations ?

Answer 20

Estradiol- low bioavailability
Estrone sulphate- ‘conjugated’ oestrogen
Ethinyl estradiol- ethinyl group protects molecule from first pass metabolism

Question 21

Name three drugs which could be given in HRT

Answer 21

Tibolone- oestrogenic, progestogenic and weak androgenic actions
Raloxifene- selective oestrogen receptor modulator (oestrogenic in bone, anti-oestrogenic in breast and uterus)
Tamoxifen- anti-oestogenic on breast tissue, used to treat oestrogen-dependent breast tumours and metastatic breast cancers

Question 22

What does the combined oral contraceptive pill contain ?

Answer 22

Oestrogen (ethinyl estradiol) + Progestogen (levonorgestrel or norethisterone)

Question 23

Name three emergency contraceptions

Answer 23

Copper IUD
Levonorgestrel
Ulipristal

Question 24

What is given to vitamin D deficient patients who have normal renal function ?

Answer 24

Ergocalciferol

Cholecalciferol

Question 25

What is given to vitamin D deficient patients with renal failure ?

Answer 25

Alfacalcidol

Question 26

What are the treatment options for osteoporosis ?

Answer 26

Oestrogen (+ progesterone for women with an intact uterus) Bisphosphonates- first line treatment- bind to hydroxyapatite and are ingested by osteoclasts, impairing their activity Denosumab- human monoclonal antibody binds to RANKL inhibiting osteoclast formation- 2nd line to bisphosphonates Teriparatide- recombinant PTH fragment increases bone formation - third line treatment for osteoporosis

Question 27

Treatment options for osteitis fibrosa cystica (hyperparathyroid bone disease) ? (occurs in renal failure)

Answer 27

Low phosphate diet/phosphate binders Alphacalcidol Parathyroidectomy in tertiary hyperparathyroidism

Question 28

Treatment options for Paget's disease ?

Answer 28

Bisphosphonates | Simple analgesia

Question 29

Name a long-lasting GLP-1 receptor agonist

Answer 29

Saxenda (liraglutide)

Question 30

Give three examples of short-acting insulin analogues

Answer 30

Lispro Aspart Glulisine

Question 31

Give three examples of long-acting insulin analogues

Answer 31

Glargine Determir Degludec

Question 32

What can be given to treat overweightness/obesity ?

Answer 32

Orlistat- GI lipase inhibitor- stops the breakdown of fat hence reducing fat absorption in the gut

Question 33

What can be given to treat hyperglycaemia ?

Answer 33

Metformin: biguanide (reduces production of f=glucose in the liver), insulin sensitiser- do not use if severe liver, severe cardiac or mild renal failure. Sulphonylureas e.g. Glibenclamide: blocks the ATP sensitive potassium channel and causes influx of calcium which leads to insulin secretion- causes weight gain. Alpha glucosidase inhibitor e.g. Acarbose: delays/prolongs the absorption of oligosaccharides hence overcoming first-phase insulin secretion deficit- side effects flatus. Thiazolidinediones e.g. Pioglitazone: acts on the PPAR-gamma receptor, insulin sensitiser SGLT2 inhibitors e.g. Empaglifozin: inhibits sodium/glucose transporter to increase glucose in the urine. GLP-1 agonists e.g. Exanatide, Liraglutide/DPPG-4 inhibitors e.g. Gliptins.

Question 34

What does the treatment of DKA involve ?

Answer 34

``` Fluid: normal saline Insulin Potassium Bicarbonate Other measures: cardiac monitor for arrhythmias, catheterise, antibiotics, NG tube (gastroparesis), consider heparin, consider arterial line (very acidotic) and central line (elderly or when cardiac failure) ```