PPT Metabolic Flashcards by Sumaya L

What are the Sepsis Six interventions?

Oxygen: Administer high-flow oxygen if SpO2 < 92%
Cultures: Obtain blood cultures before antibiotics
Antibiotics: Administer broad-spectrum IV antibiotics promptly
Fluids: Administer IV fluids to maintain blood pressure
Lactate Measurement: Measure serum lactate
Urine Output Monitoring: Monitor urine output

These interventions are critical for the management of sepsis.

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What medications can cause pre-renal failure?

NSAIDs, ACE inhibitors/ARBs, cyclosporine

These drugs can lead to renal vasoconstriction.

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Which medications should be reduced during AKI?

LMWH
Opiates
Penicillin based antibiotics
Sulphonylurea based hypoglycaemic drugs
Aciclovir
Metformin

These medications can exacerbate renal impairment.

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What drugs interfere with renal perfusion?

ACE inhibitors, ARBs, NSAIDs

These drugs can compromise renal blood flow.

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Which drugs worsen hyperkalemia?

Trimethoprim
Spironolactone
Amiloride

These medications can increase potassium levels.

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What drugs need close monitoring in AKI?

Lithium
Aminoglycosides (e.g., gentamicin, tobramycin)
Warfarin

These drugs require careful oversight due to their renal clearance.

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How is creatinine clearance estimated?

Using the Cockcroft-Gault formula: (140-age) x body weight/plasma creatinine x 72

This formula is essential for assessing renal function.

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What does eGFR calculation using CKD-EPI involve?

Serum creatinine, cystatin C

This method provides a more accurate assessment of kidney function.

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When is Cockcroft and Gault preferred over eGFR?

When giving nephrotoxic drugs, in elderly patients, and patients at extremes of muscle mass

It is particularly useful for dose adjustments.

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What is the mechanism of action of aminoglycosides?

Inhibit the 30s ribosome causing misreading of mRNA code

This can lead to bacterial cell death.

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What are the side effects of aminoglycosides?

Hearing loss
Balance issues
Allergic reactions
Nausea and vomiting

Risk of ototoxicity increases with other ototoxic drugs.

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How is gentamicin typically administered?

Via IV, using lower of actual or ideal body weight for dosing

This is crucial for accurate dosing.

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What are muscarinic receptor antagonists used for?

Inhibit bladder contraction

Examples include Oxybutinin, Tolterodine, and Solifenacin.

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What are the side effects of muscarinic receptor antagonists?

Blurred vision
Constipation
Dry mouth
Urinary retention

These side effects can impact patient compliance.

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What is the first-line drug for BPH?

Alpha blockers like tamsulosin

These medications help relieve urinary symptoms.

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What are the adverse effects of alpha blockers?

First dose orthostatic hypotension
Dizziness
Retrograde ejaculation
Oedema
Rhinitis

These side effects can affect patient quality of life.

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What do 5-alpha reductase inhibitors do?

Prevent the conversion of testosterone into dihydrotestosterone

This helps in managing BPH symptoms.

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What is a significant side effect of 5-alpha reductase inhibitors?

Gynaecomastia
Depression
Sexual dysfunction

These effects can deter patients from continuing treatment.

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What are GnRH analogues used for in prostate cancer?

Goserelin
Leuprolide
Buserelin

They initially increase LH and FSH before suppression.

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What is the preferred chemotherapy for metastatic bladder cancer?

Platinum-based chemotherapy

These regimens are standard for treating this condition.

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What is the first-line treatment for iron deficiency anemia?

200mg ferrous sulphate once a day on an empty stomach

Hemoglobin should rise by 1-2g/L per day.

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What enhances iron absorption?

Vitamin C

It helps convert iron to a more absorbable form.

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What inhibits iron absorption?

- levothyroxine
Bisphosphonates
Ciprofloxacin
Tetracyclines
Calcium and zinc salts

These substances can decrease the efficiency of iron uptake.

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What is the essential for treating B12 and folate deficiency?

Treating B12 deficiency first to reduce subacute combined degeneration of the cord

This is crucial in treating macrocytic anemia.

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What are the types of short-acting insulin?

* Humulin S * Humalog * NovoRapid It is given 30 minutes before a meal ## Footnote They differ in onset and risk of hypoglycemia.

What is the mechanism of action of Metformin?

Reduces gluconeogenesis and increases lactate production ## Footnote It is primarily excreted by the kidneys.

What is the role of DPP-4 inhibitors in diabetes?

Increase availability of incretin GLP-1, enhancing insulin availability ## Footnote They require dose adjustment for renal impairment.

What is a significant side effect of GLP-1 analogues?

* Pancreatitis * Nausea and vomiting ## Footnote They also promote weight loss and slow gastric emptying.

What is the recommended treatment for diabetic ketoacidosis?

500ml 0.9% NaCl over 15 mins for shock; 1L 0.9% NaCl over an hour if no shock ## Footnote Insulin should be administered via fixed rate infusion.

What should be monitored during potassium replacement?

Cardiac monitoring if K+ infusion > 20mg/hour ## Footnote Life-threatening hypokalemia can occur with insulin infusion.

What is the starting dose for carbimazole in thyrotoxicosis?

20mg to 60mg ## Footnote It inhibits TPO and can cause side effects like neutropenia.

What is the conversion process of T4 to T3 facilitated by?

* Beta blockers * Amiodarone * Thioamides * Iodine contrast media ## Footnote This conversion is crucial for thyroid hormone activity.

What is the primary treatment for hyperthyroidism?

Radio iodine therapy ## Footnote Except for Grave’s disease.

Which drug is given before radiodine therapy to reduce the risk of thyroid storm?

Carbimazole

List the risks associated with radiodine therapy.

* Hypothyroidism * Risk of thyroid storm * Salivary gland inflammation * Fertility issues

What is the recommended avoidance period for women after radiodine therapy?

6 months

What is the recommended avoidance period for men after radiodine therapy?

4-6 months

What is the role of thioamides in thyroid hormone synthesis?

Inhibit TPO for thyroglobulin production

Which medications facilitate the conversion of T4 to T3?

* Beta blockers * Amiodarone * Thioamides * Iodine contrast media

What type of agents are dopamine agonists derived from?

Ergot or synthetic

What is a significant risk associated with ergot-derived dopamine agonists?

Lung and heart fibrosis

Which dopamine agonist is administered once or twice a week?

Cabergoline

What is a common treatment for chronic hypocalcaemia?

Vitamin D compounds like cholecalciferol

What condition is defined as calcium levels below 1.9?

Hypocalcaemia

What is calcitriol?

Active form of vitamin D as 1,25 dihydroxyvitamin D3

What is the treatment for chronic hypercalcaemia?

* Bisphosphonates * Calcitonin * Cinacalcet

What is the emergency treatment for hypercalcaemia over 3.5 mmol/L?

IV 0.9% sodium chloride

What do nitrogen-containing bisphosphonates inhibit?

FFP enzyme to reduce osteoclast activity

What is the mechanism of action for cinacalcet?

Increases sensitivity of calcium sensing receptors in the parathyroid gland

What should bisphosphonates be taken with?

A large glass of water

What is the definition of severe hyponatremia?

Less than 125 mmol/L

What is the initial treatment for severe hyponatremia?

IV 3% hypertonic saline

What is the maximum allowable change in sodium levels in the first 24 hours when treating severe hyponatremia?

10 mmol/L

What is tolvaptan used to treat?

SIADH and polycystic kidney disease

What type of agents inhibit dopamine release?

* Neuroleptics * Antihypertensives * Psychotropic agents * Anti-ulcer agents * Opiates

What is ergocalciferol?

Ergocalcifero is vitamin D2. Cholecalciferol is vitamin D3 from 7-dehydrocholesterol.

What is given to treat stress incontinence?

Duloxetine can be given which is an SNRI that enhances glutamergic activation fo pudendal nerve to innervate stronger contraction of external urethral sphincter. It is reccomended for poor surgery candidates.

How is prostate severity asseessed?

international prostate severity score.

What is an important interaction with 5 alpha reductase dtasteride?

Dutasteride has an important drug interaction with non-DHPs (verapamil and CCB) that these calcium channel blockers will increase the level of dutasteride.

Which forms of chemotherapy are used for bladder cancer?

Cisplatin based chemotherapy Platinum based chemotherapy

What is done for renal cell carcinoma when advanced?

In renal cell carcinoma, radiotherapy and chemotherapy are ineffective. Tyrosine kinase inhibitors are used like sorafenib and sunitinib. MTOR inhibitors can be used which block cell growth and include everolimus. Tyrosine kinase recpetor can be used like bevacizumab which blocks signal transduction.

What are the parenteral forms of iron?

* iron dextran * Iron sucrose * Ferric carboxymaltose * Iron ismaltoside

Where is iron absorbed?

Iron is absorbed in the proxima jejunum and duodenum. It needs to be converted from dietary form Fe3+ to Fe2+ by duodena cytochrome B. It is taken up by divalent metal transporter DMT1.

What regulates iron absorption?

Iron absorption is regulated y hepcidin which can manage iron absorption in small intestine and release from macrophages.

What is the long acting insulin?

human insulin *detemir *glargine *degludec

What is the form of insulin for type 1 diabetic regime?

Most type 1 diabetics have a multiple daily injection regime of short acting insulin like aspart or layspro or glusine. Type 1 diabetics can do continuous insulin insulin of rapid acting insulin, where there is a breakfast bolus, lunch bolus and dinner bolus.

How do type 2 diabetics receive insulin?

What are the methods of treating thyroid storm?

Block and replace Dose titration

What is block and replace?

provide amide like carbimazole to block carbimazole production and give levothyroxine to maintain euthyoridism. There is a greater risk of agranulocytosis.

What is dose titration?

carbimazole is started at moderate dose at lowest effective and dose is gradually reduced to maintain euthyroid.

Which regime is preferred generally?

Dose titration is preferred over block and replace and is better for adults and those with comorbidities. It has a lower risk of hypothyroidism and in side effects overall. It requires regular thyroid function tests and more dose adjustment.

When is block and replace ideal?

Recurrent or unstable thyrotoxicosis, Poor compliance with frequent monitoring (simplifies management) and Patients who have difficulty achieving stability on titration alone. It is beneficial at achieving more stable thyroid hormone levels.

How are thyroid hormones synthesised?

Iodine trapping by thyroid follicular cells, transport of iodine into colloid, oxidation of iodide -> tyrosine residues and formation of T4 and T3.

When are ergot dopamine agents best for?

prolactinomas due to prolactin lowering effect. This includes bromocriptine and cabergoline.

Which medications inhibit dopamine release?

* neuroleptics like phenothiazines and haloperidol * Antihypertensives like CCBs and methyldopa * Psychotropic agents * Anti-ulcer agents * Opiates

What is the immediate management of hypocalcaemia?

IV calcium gluconate stat

What is vitamin D2?

Ergocalciferol

What is vitamin D3?

Cholecalciferol is vitamin D3 from 7-dehydrocholesterol.

What is calcitriol?

calcitriol is the active form of vitamin D as 1,25 dihydroxyvitamin D3 from cholecalciferol (D3) or ergocalciferol (D2) after conversion in liver and kidneys.

What is the calcium replacement in renal failure?

calcitriol or alfacalcidol can be used.

What is alfacalcidol?

Vitamin D but it already has hydroxylase group so it doesn’t require activation in kideny

When is alfacalcidiol preferred?

Alfacalcidol is preferred in: Patients with impaired kidney function (CKD, ESRD) Those at risk of hypercalcemia or difficult-to-control calcium levels Hypoparathyroidism where kidney function may be compromised

PPT Metabolic Flashcards

(82 cards)