3152 Endocrine

Question 1

Metformin (CI: 2, ADR: 3)

Answer 1

CI: eGFR < 30 & Hypoxic (O2 < 90)
ADR: Lactic acidosis, low B12, GI

Question 2

SGLT2i ADRs (2)

Answer 2

1. Genital / urinary infections
2. Diabetic ketoacidosis

Question 3

Sulfonylureas (ADR:2, avoid:2)

Answer 3

ADR: Hypoglycemia & weight gain
Avoid: T1DM, CYP2C9 inhibitors

Question 4

GLP-1 agonists CI (3)

Answer 4

1. Pancreatitis
2. Pregnancy
3. Thyroid cancer

Question 5

DPP4i (ADR:1, CI:1)

Answer 5

ADR: severe joint pain
CI: pancreatitis

Question 6

Acarbose (ADR:1, CI: 2)

Answer 6

ADR: flatulence
CI: CrCl < 25, liver cirrhosis

Question 7

Thiazolidinediones (TZDs) CI (3)

Answer 7

1. Active liver disease (stop if ALT > 3x ULN)
2. Hx of Heart failure
3. Hx of Bladder cancer

Question 8

Carbimazole & PTU ADRs (3)

Answer 8

1. Agranulocytosis / Aplastic anemia
2. SJS / TEN
3. Hepatotoxicity

Question 9

Levothyroxine administration

Answer 9

1. Take on empty stomach (> 30 min before breakfast)
2. Space > 2h apart from Ca/Fe/ antacids

Question 10

Levothyroxine ADRs (3)

Answer 10

1. Cardiac abnormality
2. Fracture
3. hyperthyroidism

Question 11

Alpha blocker ADR

Answer 11

1. Hypotension & syncope
2. Sexual disturbances (ejaculatory)
3. IFIS (intraoperative floppy iris syndrome)

Question 12

5ARIs (ADR:2, CI:1)

Answer 12

1. More sexual disturbances (ED)
2. Less risk of hypotension
   CI: teratogenic (avoid in pregnancy, child)

Question 13

Alpha blocker vs 5ARIs (BPH)

Answer 13

Alpha blocker: no reduction in prostate size –> fast Sx relief
5ARIs: reduce PSA, slow onset (obtain baseline PSA before initiation)

Question 14

PDE5i CI

Answer 14

Hypotension with antihypertensives (alpha blocker) or unstable angina (nitrate) +/- alcohol, CYP3A4 inhibitors

Question 15

PDE5i serious ADRs (2)

Answer 15

1. Non-arthritic Anterior Ischaemic Optic Neuropathy (decreased vision = emergency)
2. Prolonged priapism > 4h = emergency

Question 16

COC contraindications (7)

Answer 16

1. Hx of breast cancer
2. Hx of DVT/PE
3. Major surgery w Prolonged immobilisation
4. SBP > 160/100
5. DM > 20 years with complications
6. Smoking < 15 sticks/day (>35 yo)
7. Migraine w Aura

Question 17

COC initiation methods (3)

Answer 17

1. first day: 1st day of period, no need backup
2. Sunday: 1st sunday after period, backup for 7d
3. Quick start: start now, pack up >7d (until next cycle start)

Question 18

COC missed dose (3)

Answer 18

1. Miss 1 dose <48h: take miss dose immediately
2. Miss > 2 (>48h): take 1 missed dose & discard the rest, backup for 1 week
3. Miss during drug-free week: skip placebo and start new pack next day + backup for 1 week

Question 19

POP initiation (2)

Answer 19

1. Within 5 days of period: no need backup
2. Any other day: back up for 2 days

Question 20

POP Missed dose (2)

Answer 20

1. late >3h: take missed dose & continue the rest + backup 2d
2. Miss >2 pills: backup for 7d

Question 21

Hormone Replacement Therapy ADRs (3)

Answer 21

1. Breakthrough bleeding
2. Mood changes
3. Breast tenderness, bloating, fluid retention

Question 22

Tibolone (CI:3, indication)

Answer 22

CI: Risk of stroke, breast cancer, endometrial cancer
indication: > 12 months since last natural period
(also extremely expensive)