Endocrinology Flashcards
(122 cards)
1
Q
What is diabetes
A
Metabolic disorder. Hyperglycaemia caused by limited insulin secretion and insulin resistance
2
Q
Drivers + Diabetes
A
Warn DVLA, carry glucose meter/strips, check <2hrs before driving and every 2 hours (must be >5mmol)
3
Q
Typical T1DM features
A
BMI<25, Young, glucose>11, ketosis
4
Q
T1DM HbA1C recommendation
A
<48mmol/mol (6.5%)
5
Q
Waking glucose(fasting):
A
4-7mmols/l
6
Q
Before food - glucose fasting
A
5-7mmols/l
7
Q
90 minutes after food (glucose fasting level)
A
5-9mmols/l
8
Q
When does insulin need decrease
A
Intercurrent illness, reduced food intake, impaired renal function, endocrine disorders e.g. Addison’s, coeliac disease, renal/ hepatic impairment
9
Q
When does insulin need increase
A
Trauma (accidental/surgery), infection, stress, puberty
10
Q
What T1DM patients benefit from metformin
A
> 25 BMI/ >23 in South Asian people to minimise effective insulin dose
11
Q
Who is continuous insulin offered to
A
Disabling hypos, high HBA1c>69
12
Q
What insulin regimen is preferred in T1DM
A
Basal bolus
13
Q
T2DM treatment goals
A
Reduce micro/macrovascular complications by maintaining effective glucose and maintaining HBA1c
14
Q
Microvascular
A
Retinopathy, neuropathy, nephropathy
15
Q
Macrovascular
A
Ischemic heart disease, peripheral vascular disease, and cerebrovascular disease
16
Q
Metformin effect
A
Lowers glucose, increases insulin sensitivity, inhibits gluconeogenesis, inhibits glycogenolysis
17
Q
Metformin contraindications
A
Renal impairment (<30), heart failure, liver failure, recent MI
18
Q
Key metformin side effect
A
lactic acidosis
19
Q
What diabetic drugs cause hypos
A
Sulfonylurea
Meglitinide
20
Q
Sulfonylureas end in:
A
Ide = tolbutamide, gilbenclamide
21
Q
When is long acting sulphonylurea not recommended:
A
Older patients because of hypos and confusion
22
Q
When to stop HRT
A
Severe chest pain, breathlessness, swelling in one calf, severe stomach pain, liver problems , Hypertension, immobile, neurological issues
23
Q
What activity does Tibolone have
A
It has oestrogenic, progestogenic and weak androgenic activity
24
Q
What is vasopresin and desmopressin, and what are they used for
A
Antidiuretic hormones used to treat pituitary cranial diabetes insipidus
25
Key differences between vasopressin and desmopressin
Desmopressin is more potent and has longer duration
26
Sulfonylureas side effects
```
Weight gain
Hypos
G6PD deficiency caution
Abdominal pain
diarrhoea
nausea
```
27
Sulfonylurea mechanism of action
Increase insulin acting on pancreatic beta cells (augmenting insulin secretion)
28
Acarbose mechanism of action
Slows digestion to reduce rate of glucose release
29
Meglitinide mechanism of action
Similar to Sulfonylurea but act on different receptor to stimulate insulin release
30
Thiazolidinone manifestation - e.g. pioglitazone
Reduces insulin resistance
31
Cautions/What to look out for with pioglitazone
Heart failure, nausea, toxicity, dark urine, bladder cancer
32
DPP4 mechanism of action
Inhibit glucagon release, increases insulin secretion
33
Dpp4 warnings
Pancreatitis
34
SGLT2 inhibitors mechanism of action
Prevent reabsorption of glucose in kidneys
35
GLP1 Receptor antagonist mechanism of action
Produce insulin as they are incretin mimetics, (increase insulin secretion, suppressing glucagon secretion,
slow gastric emptying)
36
When to take Exanatide
1 hour before food and 6 hours apart, never after food
37
Exanatide warning
Pancreatitis
38
GLP1 MHRA Warning
Diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
39
SGLT2i MHRA warnings
SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
Increased risk of lower-limb amputation (mainly toes)
reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
Risk of diabetic ketoacidosis with sodium-glucose co-transporter 2 (SGLT2) inhibitors
40
SGLT2i side effects
Balanoposthitis; constipation; dyslipidaemia; increased risk of infection;
nausea;
thirst;
urinary disorders; urosepsis
41
What sort of T2DM drug is needed for elderly
Short acting e.g. tolbutamide, gluclazide
42
When are GLP1 agonists used
After triple therapy
43
Meglitinide examples
Repaglinide, nateglinide
44
What antidiabetic is used concomitantly with weight management products
GLP1 agoists
45
How/when are meglitinides used
In combination with metformin when metformin alone inadequate
46
When to use short acting insulin
15-30 minutes before food
47
Soluble insulin peak
1-4 hours
48
Soluble insulin duration
9hrs
49
Rapid insulin names
Aspart, glulisine, lispro
50
Rapid insulin onset time
<15 minutes
51
Rapid insulin duration
2-5hrs
52
When to use rapid insulin
Just before meal
53
Intermediate insulin name
Isophane
54
Intermediate onset
1-2 hours
55
Intermediate peak
3-12hours
56
Intermediate action
11-24 hours
57
Biphasic insulin consists of what
Intermediate +short/rapid
58
Long acting insulin duration
Up to 36 hours
59
How long does it take for long acting to get to steady state
2-4 days
60
Diabetes pregnancy HbA1C aim
48
61
What oral diabetes medicine can be used in pregnancy
Only metformin possibly gilbenclamide during breastfeeding
62
Insulin in pregnancy preference
Isophane firstline then rapid, (long acting if good control)
63
When to pharmacologically treat Gestational diabetes
>7mmol/l fasting plasma
https://bnf.nice.org.uk/treatment-summary/diabetes-pregnancy-and-breast-feeding.html
64
Gestational diabetes treatment
Metformin, insulin or gilbenclamide
https://bnf.nice.org.uk/treatment-summary/diabetes-pregnancy-and-breast-feeding.html
65
Insulin adaptation for minor elective surgery in patient with good control
Normal but long acting reduced by 20% onday of surgery
66
Insulin adaptation for major surgery in patient or poor glycaemic control
Rate adjusted, long acting 80% and others normal. On the day only long acting (80%) , no other insulin until eating, iv infusion of KCl w/glucose and NaCl to prevent hypo
67
When should BD mixed insulin regimes be restarted after surgery
Breakfast/dinner
68
DKA symptoms
Nausea, drowsy, pear drop, vomiting
69
DKA treatment
Soluble insulin, KCl, NaCl, (and then long acting insulin)
70
Hypoglycaemia symptoms
'like hungry', agitated, drunk-like, confusion, sweating, Excessive sweating, pallor, palpitations, trembling
71
When is ACE/ARB given for diabetes
Three positive serum creatinine tests
72
What to with Sulfonylurea in patients having surgery
Stop until first meal after surgery
73
What to with SGLT2i in patients having surgery
Stop until stable
74
What to do with metformin when insulin given during surgery
Metformin does not need to be stopped
75
How to tackle nephropathy in diabetes patients
Attempt to lower BP and start ACE/ARB
76
How to treat diabetic foot infections
Flucloxacillin
77
DKA treatment
500ml 0.9% NaCl over 10-15min
Give KCl
Start IV soluble insulin Give long acting insulin subcutaneously
Aim to reduce glucose by 3mmol/hour and ketone by 0.5mml/l/hr once glucose below 14 give glucose with NaCl (continue insulin until patient can eat)
78
Examples of SGLT2
gliflozin's canagliflozin, dapagliflozin
79
Examples of DPP4i
gliptins, linagliptin, sitagliptin
80
What diabetes meds put patients at risk of pancreatitis
DPP4i, Meglitinide
81
Thiazolidinediones examples
Pioglitazone
| Rosiglitazone
82
Liothyronine vs levothyroxine
Liothyronine more rapidly metabolised
83
Hyperthyoidism drug treatment
Carbimazole if not then propylthiouracil. 12–18 month course using either a block and replace regimen (combination of fixed high-dose carbimazole with levothyroxine sodium), or a titration regimen (dose based on thyroid function tests). Radioacive iodine is however first line.
84
Thyrotoxicosis treatment
Propranolol/nadolol (beta blocker)+ radioactive iodine
85
What is a blocking replacement regimen
Giving combo of hyper and hypo thyroidism drugs
86
Hypothyroidism definition
Thyroid stimulating hormone (TSH) levels above the reference range and free thyroxine (FT4) levels below the reference range.
87
Hypothyroidism in pregnancy definition
Elevated TSH levels (using trimester-specific reference ranges) regardless of FT4 levels.
88
Hyperparathyroidism pharmacological treatment
Vitamin D and cincalcet
89
Hyperparathyroidism symptoms
Hypercalacaemia = thirst high urine output, constipation, fatigue ,memory problems , CVD, kidney stones, osteoporosis, fractures
90
Hyperthyroidism symptoms
Goitre, hyperactivity, disturbed sleep, fatigue, palpitations, anxiety, heat intolerance, increased appetite with unintentional weight loss, and diarrhoea
91
Gonadotrophin inhibitors
Cetorelix, ganirelix, danazol
92
Endometriosis treatment
Danazol, pituitary gonadotrophin inhibitors
93
How to treat cushings
Metyrapone surgery
94
Heavy menstruation treatment
Tranexamic acid, NSAID, ulipristal acetate, a levonorgestrel-releasing intrauterine system(first line in less severe),
95
When should a bisphosphonate free period start
5 years, but continued if they actually have broken something
96
First line osteoporosis treatment
Alendronic, risedronate
97
When/how to take bisphosphonate
Empty stomach.
30 mins before first food of the day, 2 hour before/after other meals.
To sit upright. Particularly avoid milk/calcium containing.
Take same time each week
98
Bisphosphonate counselling points
Osteonecrosis of jaw and auditory canal when taken for more than 2 years so report related issues
99
Osteoporosis risk factors
Age, low body mass index (BMI), cigarette smoking, excess alcohol intake, lack of physical activity, vitamin D deficiency and low calcium intake, family history of hip fractures, a previous fracture at a site characteristic of osteoporotic fractures and early menopause.
100
What does HRT alleviate
Menopausal symptoms e.g. Vaginal atrophy or vasomotor instability
101
Risks that arise due to HRT
Venous thromboembolism, stroke, endometrial cancer (reduced by a progestogen), breast cancer, and ovarian cancer
102
What hormone should be added to oestrogen in women with a uterus and why
Progestogen to reduce risk of cystic hyperplasia
103
Hyperthyroidism complications
Graves' orbitopathy, thyroid storm (thyrotoxic crisis), pregnancy complications, reduced bone mineral density, heart failure, and atrial fibrillation
104
Graves disease
An autoimmune disorder mediated by antibodies that stimulate the thyroid-stimulating hormone (TSH) recepto
105
Hyperthyroidism and TSH/FT4/FT3
TSH levels below the reference range and free thyroxine (FT4) and/or free tri-iodothyronine (FT3) levels above the reference range
106
Non-drug hyperthyroidism treatment
Radioactive iodine or surgery
107
What laxative safe in pregnancy
Bulk forming as not absorbed
108
What drug is used in bed wetting
Desmopressin
109
Where is hydrocortisone (Cortisol) secreted
Adrenal cortex normally secretes
110
Dopamine-receptor agonists indication
Inhibits release of growth hormone
treats acromegaly
and galactorrhea
111
Endometriosis treatment
gonadotropin-releasing hormones, pain relief, contraceptive
112
Glucorticoid vs mineralocoricoid
High glucocorticoid is useless if mineralocorticoid activity is also high e.g. Fludrocortisone
113
5mg Prednisolone is equivalent to how much dexamethasone and hydrocortisone
20mg hydrocortisone, 750 mcg dexamethasone
114
Betamethasone mineralo vs gluco
low mineralocorticoid, high glucocorticoid
115
Dexamethasone mineralo vs gluco
low mineralocorticoid, high glucocorticoid
116
Prednisolone glucocorticoid vs mineral
Mainly glucocorticoid
117
Hydrocortisone mineralocorticoid vs glucocorticoid
High mineralocorticoid
118
When is corticosteroid needed
Asthma , rheumatoid arthritis, haemorrhoids, ulcerative colitis , crohn's , raised intracranial pressure
119
Corticosteroid side effects
Insomnia, suicidal thoughts, irritability, euphoria, nightmares
120
What class of antidiabetic drugs increases likelihood of thrush
SGLT2i
121
What antidiabetic drugs result in weight loss and increase insulin utilisation
Metformin
122
What combinations of antidiabetic drugs may result in hypos
Sulfonylurea and DPP4, Dose of concomitant sulfonylurea or insulin may need to be reduced.
