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Pre-reg > Chaper 6- Endocrine System > Flashcards

Chaper 6- Endocrine System Flashcards

1
Q

What’s another name for anti-dietetic hormone and wheres it produced and stored

A

Vasopressin

Produced: Hypothalamus
Stored: pituitary gland

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2
Q

What is diabetes insipidus

A

Increased amount of dilute urine and extreme thirst Due to the body has a lower than normal amount of anti diuretic hormone (controls urine output) caused by complications to the hypothalamus or pituitary

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3
Q

What’s the difference between cranial and nephrogenic DI and what’s the treatments

A

Cranial is when the hypothalamus doesn’t make enough insulin
Treatment is vasopressin or desmopressin

Nephrogenic is when the kidney doesn’t respond to ADH
Treatment include thiazide diuretics

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4
Q

How is vasopressin and desmopressin different

A

Desmopressin is more potent and has a longer duration of action
Desmopressin has no vasoconstriction effect, unlike vasopressin

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5
Q

How else is desmopressin used in other than diabetes insipidus treatment

A

Used in the differential diagnosis of diabetes insipidus

Used to boost factor 8 concentration in haemophilia

Test fibrinolytic response

Has a role in nocturnal enuresis

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6
Q

What other uses beside diabetes insipidus does vasopressin have

A

Initial Control of oesophageal variceal bleeding in portal hypertension

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7
Q

What can be used in the treatment of hyponatraemia resulting from inappropriate secretion of anti diuretic hormone

A

Blocking the effect of anti diuretic hormone (demeclocycline)

Vasopressin receptor antagonist (tolvaptan)

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8
Q

What does syndrome of inappropriate anti diuretic hormone cause?

A

Hyponatraemia

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9
Q

Name a few mineralcorticoid side effects

A 
S/E:
Hypertension 
Sodium retention 
Water retention 
Potassium loss 
Calcium loss
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10
Q

Common side effects of glucocorticoids

A 
Diabetes (increase blood sugars)
Osteoporosis (mobilise calcium)
Avascular necrosis of the femoral head (death of bone tissue)
Muscle wasting 
Peptic ulcers (anti inflammatory effect)
Psychiatric reactions
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11
Q

How are side effects of steroids managed

A

Using the lowest effective dose for the shortest period possible

Take doses in the morning so they don’t suppress the natural adrenal activity which is most active at night

Alternate days prescribing (not in asthma)

Local treatment wherever possible

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12
Q

What’s the MHRA alert regarding corticosteroids

A

Report any blurred vision as chorioretinopathy risk have presented

And

Injections contain lactose

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13
Q

What steroid hormones does the adrenal cortex secrete?

A

(cortisol) -glucocorticoid

Aldosterone - mineralocorticoid

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14
Q

In replacement therapy what replaces cortisol and aldosterone

A

Cortisol is replaced by hydrocortisone

Aldosterone is replaced by fludrocortisone

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15
Q

In glucocorticoid therapy of other disease, why is hydrocortisone rarely used

A

As it also has mineralcorticoid activity which can lead to fluid retention

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16
Q

Why does prednisolone remain the drug of choice for most oral corticosteroid treatment

A

It has the largest margin of safety

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17
Q

What can abrupt withdrawal of a steroid cause

A 
Adrenal deficiency 
Hypotension 
Death 
Withdrawal symptoms 
Cold and flu like symptoms 
Itching 
Weight loss
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18
Q

When is gradual withdrawal or titration needed for steroids

A

If they’ve been taking >40mg of prednisolone (or equivalent) for more than a week

Been taking evening doses

Received more than 3 week treatment at any dose

Recently repeated courses

Taking short course within a year of stopping long term

Other causes of adrenal suppression

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19
Q

Why should high dose steroids be used with caution in patients with a history of psychiatric problems

A 
It can cause psychiatric reactions like 
Euphoria 
Nightmares 
Insomnia 
Behavioural changes
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20
Q

Who should people on steroids (immunosuppressive) stay away from

A

People with chicken pox, shingles, measles

Avoid live vaccines when receiving immunosuppressant

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21
Q

Why should steroids be used with caution in children

A

Possible growth restrictions

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22
Q

How does corticosteroids interact with warfarin

A

It enhances the anticoagulation effect at high doses

Reduced anticoagulation effect at low doses

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23
Q

How are potencies of corticosteroids in terms of their anti inflammatory effects compared

A

High glucocorticoid activity whilst also accompanied by relatively low mineralcorticoid activity (that’s when they’re most useful)

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24
Q

Whys dexamethasone and betamethasone the most suitable for high dose therapy conditions that require suppression

A

They have very high glucocorticoid activity and insignificant mineralcorticoid activity avoiding fluid retention

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25
Q

Name corticosteroids with predominately glucocorticoid effects and insignificant mineralcorticoid activity

A

Dexamethasone
Betamethasone
Deflazacort

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26
Q

Name corticosteroids with predominately mineralcorticoid effects and insignificant glucocorticoid activity

A

Fludrocortisone

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27
Q

Name corticosteroids with predominately glucocorticoid effects and minimal mineralcorticoid activity

A

Prednisolone
Methylprednisolone
Triamcinolone

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28
Q

Name corticosteroids with equal glucocorticoid effects and mineralcorticoid activity

A

Hydrocortisone

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29
Q

What’s Cushing syndrome

A

Abnormally high levels of cortisol

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30
Q

What’s used for Cushing syndrome and how does it work

A

Ketoconazole and metyrapone

Potent inhibitor of cortisol and aldosterone synthesis by inhibiting an enzyme

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31
Q

What’s the MHRA alert for ketoconazole

A

The use of it to treat fungal infection should be stopped due to the risk of hepatotoxicity

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32
Q

What is diabetes mellitus

A

Persistent hyperglycaemia caused by deficient insulin secretion or by resistance to action of insulin
Leading to abnormalities of carbohydrate, fat and protein

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33
Q

What’s the advice from dvla regarding driving with diabetes

A

Inform them if you’re on insulin
If you have a hypo episode
If on insulin take reading 2 hours before journey and every 2 hours while driving
Blood sugars should always be above 5mmol
Keep a snack with you
If blood sugar less than 4mmol stop the vehicle

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34
Q

What does hb1ac measure and what does it tell you

A

Glycated haemoglobin so red blood cells that are exposed to glucose

Monitors glycaemic control
Reliable predictor of microvascular and macrovascular complications and mortality

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35
Q

What is type 1 diabetes

A

Absolute insulin deficiency in which there is little or no endogenous insulin secretory capacity due to destruction of insulin producing beta cells in the pancreatic islet of langerhans

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36
Q

What’s the target hb1ac concentration for patients with type 1 diabetes

A

48mmol/mol (6.5%) or lower

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37
Q

What’s the target blood-glucose concentrations for fasting on waking, before meals, 90 minutes after eating and when driving

A

Fasting on waking : 5-7mmol/L
Before meals: 4-7mmol/L
90 minutes after meals: 5-9mmol/L
Driving: 5mmol/L

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38
Q

What therapy do all patients with type 1 diabetes require

A

Insulin therapy

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39
Q

What’s the basal-bolus insulin regime

A

One or more daily injections of intermediate acting or long acting insulin as the basal insulin
Alongside multiple bolus injections of short acting insulin before meals

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40
Q

What’s the mixed (biphasic) insulin regime

A

1, 2 or 3 insulin injections per day of short acting insulin mixed with intermediate acting insulin
(Can be mixed by the patient at the time of injection or premixed)

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41
Q

What’s the continuous subcutaneous insulin infusion (insulin pump)

A

A regular amount of insulin in the form of rapid acting insulin analogue or soluble insulin delivered via a subcutaneous needle or cannula

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42
Q

What’s the first line insulin regime offered to patients

A

Multiple daily injection basal-Bolus regime

Long acting detemir BD (OD glargine if not tolerated)

And a rapid acting insulin analogue as the volume or mealtime insulin

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43
Q

When should continuous subcutaneous insulin therapy be initiated

A

Patients who suffer disabling hypoglycaemia or have a high hb1ac concentration (69mmol/mol) or above while on the multiple daily injection regime

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44
Q

How should a patients knowledge of hypoglycaemia be assessed

A

Annually using a gold score of the Clarke score

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45
Q

How does insulin work?

A

It increases glucose uptake by adipose tissue and muscles and suppresses the hepatic glucose release
The role of Insulin is to lower blood glucose concentrations in order to prevent hyperglycaemia and its associated complications

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46
Q

Why are human insulin or human insulin analogues more preferred than animal insulin

A

Less immunogenic

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47
Q

Why’s insulin given IV

A

It is inactivated by GI enzymes

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48
Q

What can occur from injecting the same site with insulin and what’s the outcome

A

Lipohypertrophy

Erratic absorption of insulin, poor glycaemic control, lump under the skin

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49
Q

The three types of insulin preparations and how they act

A

Short acting: onset of action is 30-60min, duration of upto 9 hour

Intermediate: onset of 1-2HOURS, duration of 11-24 hours

Long acting: last upto 36 hours and take 2-4 days to produce a steady state

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50
Q

What is type 2 diabetes

A

A chronic metabolic condition characterised by insulin resistance. Insufficient insulin production also occurs overtime (more often diagnosed in adults)

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51
Q

Why does metformin not cause hypoglycaemia

A

It doesn’t stimulate insulin secretion

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52
Q

Why’s MR metformin sometimes indicated

A

Reduce GI side effects

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53
Q

Why may DPP-4 inhibitors (gliptins) be preferred over sulfonylureas?

A

No association to weight gain and less hypoglycaemic events

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54
Q

What negative side effect have sodium glucose co-transporter 2 inhibitors been associated with

A

Diabetic ketoacidosis

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55
Q

What hb1ac level should a patient being treated with a hypoglycaemic agent or 2 or more anti diabetic drugs aim for

A

53 mol/mol

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56
Q

What’s the first line for type 2 diabetes and why

A

Metformin

Weight loss
No hypo episodes
Long term CV benefits

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57
Q

What do you at if metformin is not sufficient alone

A

A second anti diabetic drug

Sulfonylurea (eg: gliclazide)
Pioglitazone
Dpp4 inhibitor (eg: linagliptin)

Sodium glucose cotransporter 2 inhibitor (eg: dapagliflozin)- if sulfonylurea not tolerated

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58
Q

If dual anti diabetic treatment not sufficient what do you do

A

Use 3 anti diabetic meds

Consider insulin based treatment

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59
Q

What’s given in diabetic nephrology to reduce incidence and why?

What’s the risk

A

ACEi or ARB
To reduce proteinurea and microalbunuria

ACEi potentials hypoglycaemic effects of anti diabetic drugs and insulin especially in renal impairment

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60
Q

How is diabetic neuropathy managed

A

Monotherapy with TCA, SNR for painful peripheral neuropathy (pregabalin or gabapentin can be considered)

Addition of opioid if not adequately controlled

Diabetic diahrrrhoea can be controlled by TCA or codeine

In neuropathic postural hypotension the mineralcorticoid fludrocortisone can be used

Antimuscarinic can be given for sweating

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61
Q

What are the symptoms of DKA- increased level of ketones (develop from high sugar in the blood due to a lack of insulin) (type 1) and HONK- high osmolarity without significant ketoacidosis (type 2) and How are they managed

A

Dehydration, acute hunger, thirst, abdominal pain, fruity breath and urine smell (DKA)

NG tube 
IV assess 
LMWH 
Urinary catheter 
Sliding scale insulin 
Replacement of fluid and electrolytes
Consider abx
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62
Q

What are women with pre existing diabetes advised to take when becoming pregnant

A

Folic acid 5mg

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63
Q

What antidiabetics are suitable for pregnant or breastfeeding women

A

Metformin and insulin’s

Globenclamide (2nd and 3rd trimester)

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64
Q

How long should statins be discontinued for in a planned pregnancy

A

3 months

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65
Q

How is diabetic nephropathy measured?

A

Urinary microalbumuria (earliest sign of nephropathy)
Urinary protein
Serum creatinine

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66
Q

What’s considered hypoglycaemic and what are the symptoms and treatment both conscious and unconscious

A

Bsl< 4mmol/L

Symptoms: Pale skin, sweaty, tremor, rapid heart rate, confusion, affirmation, impaired consciousness

Treatment:
Conscious =10-20g oral glucose
Unconscious = IV dextrose
No IV access= glucagon IM injection

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67
Q

Which medications enhance blood glucose lowering activity

A 
Antidiabetics 
ACEi
MAOIs
Salicylate
Sulphonamide antibiotics
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68
Q

What medications may reduce blood glucose lowering activity

A 
Corticosteroids 
Dietetics 
Sympathomimetics 
Thyroid hormones 
Contraceptives 
Beta blocker
Alcohol
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69
Q

What drug class is metformin, how does it work and what’s a common side effect

A

Biguanides

Decreases glucogenesis and increases peripheral utilisation of glucose- acts only in the presence of endogenous insulin(taken 3times a day with food)

S/e: GI disturbances, metallic taste, lactic acidosis in renal impairment

70
Q

Name a few sulphonyureas, how they work and side effects

A

Gliclazide, glipizide, glimepiride, tolburamide

It increases insulin secretion from the pancreas so requires at least some beta cell activity to be effective
(Should be taken once a day with food)

May cause hypoglycaemia and weight gain
Hypersensitivity is common

71
Q

What drug class is pioglitazone, how does it work and what are side effects?

A

Thiazolidinedione

It reduces peripheral insulin resistance

S/e:
GI upset, weight gain, oedema, hypoglycaemia, anaemia, headache, liver toxicity, haematuria, visual disturbances
STOP OF LIVER TOXICITY PERSISTS

72
Q

What are the MHRA alert for pioglitazone

A

Risk of heart failure when pioglitazone is combined with insulin

Risk of bladder cancer

73
Q

Name drugs in the meglitinides drug class, how they work and side effects

A

Nareglinide, repaglinide

They stimulate insulin secretion, should be taken 30 minutes before food

May cause hypoglycaemia, hypersensitivity and GI upset

74
Q

DPP4 inhibitors (gliptins) how they work and common side effects

A

Alogliptin, linagliptin, saxglipton, sitaglipton, vidagliptin

Inhibits DPP4 enzymes that break down incretins (incretins are produced in the gut in response to food and trigger insulin secretion and lower glucagon secretion)

Side effects:
Hypoglycaemia URTI, GI upset, peripheral oedema, pancreatitis

STOP IF PANCREATITIS OR LIVER TOXICITY OCCUR

75
Q

SGLT2 inhibitors (gliflozin), how they work and side effects

A

Canagliflozin, empagliflozin, dapagliflozin

They inhibit SGLT2 in the renal tubules to reduce glucose reabsorption and increase glucose excretions

S/e: hypovalaemia, GI illness and complicated UTI

76
Q

MHRA Alert for SGLT2 inhibitors

A

Risk of DKA

Increased risk of lower limb amputation

77
Q

Glucagon like peptide-1 (GLP-1) receptor agonist, how they work and side effects

A

Exenatide, albiglutide, dulaglutide, liraglutide and lixisenatide

Mimic incretins by binding to the GLP-1 receptor and increasing insulin secretion

S/e: GI upset, headaches, weight loss, pancreatitis
STOP IF PANCREATITIS OCCURS

78
Q

What other medications would you usually see diabetics on excluding antidiabetics and why

A

ACEi/ ARB
Statin
Aspirin

As diabetes is a risk factor for CVD so these reduce the risk

79
Q

What do you do when a diabetic patient that takes their medication orally is going for surgery

A

Omit their medication and give insulin

80
Q

Which sulphonyurea can you give in renal failure

A

Tolbutamide as it’s short acting

81
Q

When do nice recommend treatment is continued for pioglitazones

A

If Hb1ac conc is reduced by atleast 0.5% within 6 months of use

82
Q

What is osteoporosis

A

A progressive bone disease characterised by low bone mass measures by bone mineral density and deterioration of bone tissue

83
Q

What’s the most common thing osteoporosis leads to

A

Increases risk of fragility fracture

84
Q

What group of people does osteoporosis commonly occur in

A

Post menopausal women
Men over 50
Patients taking long term corticosteroids (glucocorticoid)

Other conditions like diabetes and rheumatoid arthritis

85
Q

What’s the first class drug treatment is post menopausal osteoporosis

A

Oral bisphosphonates:

Alendronic acid and risedronate sodium

86
Q

What can you give for post menopausal osteoporosis in patients that can’t take oral bisphosphonates

A

Iv bisphosphonates (Ibandronic acid or zolendronic acid)
Denosumab
Raloxifene
HRT- Teriparatide (for younger postmenopausal women <50ish)

87
Q

Which HRT is reserved for postmenopausal women with severe osteoporosis at very high risk of vertebral fracture

How long is the treatment limited to

A

Teriparatide

24 months

88
Q

What should be given with steroids for prophylaxis of glucocorticoid induced osteoporosis

A

Oral bisphosphonates

IV if oral not appropriate

89
Q

What can be given for osteoporosis in men?

A

Oral bisphosphonates
Iv bisphosphonates if oral not indicated
denosumab if bisphosphonates not indicated

90
Q

What group of men are at most risk of fracture

A

Men having long term androgen deprivation therapy for prostate cancer

91
Q

When should bisphosphonates treatment be reviewed

A

5 years for oral, 3 years for IV

92
Q

How do bisphosphonates work

A

Theure absorbed onto hydroxyapatite crystals in bone, slowing down both their rate of growth and dissolution- reducing the rate of bone turnover

93
Q

What are MHRA alerts for bisphosphonates

A

Atypical femoral fractures

Osteonecrosis of the jaw

Osteonecrosis of the external auditory canal (ear)

94
Q

How does denosumab work

A

It inhibits osteoclasts formation, function and survival so decreasing bone resorption

95
Q

What are MHRA alerts for denosumab

A

Atypical femoral fractures

Osteonecrosis of the jaw

Osteonecrosis of the external auditory canal (ear)

Risk of hypercalcaemia following discontinuation

96
Q

What OTC items can a patient buy to reduce risk of osteoporosis

A

Vitamin D

Calcium

97
Q

Administration advise for alendronic acid

A

take with a full glass of water while sitting or standing
Taken 30 minutes before breakfast
Remain upright for a further 30 minutes after taking

98
Q

What should be monitored with bisphosphonates and side effects that are alarming

A

Regular dental check up
Any thigh, groin pain

Oesaphageal reactions, ulcers, heartburn, abdo pain regurgitation

99
Q

What’s are the anterior pituitary hormones

A

Corticotrophins (adrenocorticotropic hormones)

Gonadotrophins (follicle stimulating hormone and leutanising hormone)

Growth hormone

100
Q

How does calcitonin work

A

It decreases blood calcium concentrations and is involved with PTH in the regulation of bone turnover and maintenance of calcium balance

101
Q

What’s the most potent bisphosphonates

A

Zolendronic acid

102
Q

What’s given to women to help with menopausal symptoms

A

Oestrogen together with progestogen- in women with a uterus

Colonidine for women who can’t take oestrogens

103
Q

What does HRT increase the risk of

A 
Thromboembolism 
Stroke 
Endometrial cancer 
Breast cancer 
Ovarian cancer
104
Q

How does HRT affect chances of breast cancer

A

Increased risk 1-2 years of starting treatment

Risk related to duration of use but disappears within 5 years of stopping

105
Q

How does HRT affect endometrial cancer risk?

A

Depends on dose and duration of oestrogen only HRT, risk is eliminated if progestogen is given continuously

106
Q

How does HRT affect the risk of ovarian cancer

A

Long term use affected with increased risk, risk disappears within a few years of stopping

107
Q

How does HRT affect risk of VTE

A

Increased risk mainly in the first year of use

108
Q

How does HRT affect stroke risk

A

Risk increased with age

109
Q

How does HRT affect risk of CHD

A

Increased risk in women who start 10 years after menopause

110
Q

Reasons to stop HRT

A 
Sudden severe chest pain 
Sudden breathlessness 
Unexplained swelling or pain in their leg 
Severe stomach pain 
Neurological effects 
Hepatitis, jaundice 
High BP
111
Q

What needs to be added to oestrogen in women with a uterus

A

Progestogen to avoid cystic hyperplasia

112
Q

What is endometriosis

A

Growth of endometrial like tissue outside the uterus

113
Q

What’s the drug treatment for endometriosis

A

Pain management and contraceptives to suppress ovarian function

114
Q

What’s heavy menorrhagia

A

Heavy menstrual bleeding (80mL or more) for longer than 7 days

115
Q

What can be given for heavy menstrual bleeds

A

NSAIDs for pain
Tranexamic acid
Combined hormonal contraceptives
Cyclical oral progestogen

116
Q

What do androgens (testosterone) cause

A

Masculinisation

117
Q

What is clomifene used for and what’s the caution for it

A

Anti- oestrogen: stimulates ovulation so used in the treatment of infertility

It should not be used for longer than 6 chocked due to an increased risk of ovarian cancer

118
Q

What’s cyproterone and what’s it used for

A

Anti androgen to inhibit the effect of testosterone

Used in the treatment of Aw set hyper-sexuality and sexual deviation in men

119
Q

What’s treatment options for hyperthyroidism

A

Carbimazole for drug treatment (most common)

Propyl thiouracil

Or

Surgery

120
Q

What’s often used to treat thyrotoxic crisis (thyroid storm) before surgery

A

IV fluids, Propanolol, iodine, carbimazole and hydrocortisone

121
Q

What major adverse affect does carbimazole have and what synptom is the patient told to report immediately

A

Bone marrow suppression, neutropenia and agranulocytosis

Report any signs of a sore throat or infection

122
Q

What’s the MHRA alert of carbimazole

A

Increased risk of congenital malformation

Risk of acute pancreatitis

123
Q

What’s the treatment of choice for hypothyroidism

A

Levothyroxine sodium

124
Q

What’s used in hypothyroid coma and why

A

Liothyronine as it is more rapidly metabolised so it’s effects are seen faster

125
Q

What’s the side effects of levothyoxine

A 
Diarrhoea 
Arrhythmia 
Palpitations 
Tachycardia 
Tremor 
Restlessness 
Sweating 
Fever 
Weight loss
126
Q

What’s an interaction of thyroid hormones

A

They enhance the anticoagulation effect of warfarin

127
Q

Apart from anti thyroid drugs, what else are good thyroid suppressing drugs

A

Iodine and propanolol

128
Q

Why should bisphosphonates be taken before food

A

They bind calcium and iron salts so absorption will be reduced

129
Q

Diabetes symptoms

A 
Polydipsia 
Polyuria
Tiredness / lethargic 
Vaginal itching 
Weight loss
Frequent infections 
Boils
130
Q

Symptoms of hypoglycaemia

A

Sweating
Confusion
Coma

Blunted by BB

131
Q

Which SGLT-2 inhibitor is not recommended in combination with pioglitazone

A

Dapagliflozin

132
Q

All possible corticosteroids side effects (clue: aching bosom)

A 
Adrenal suppression 
Cushing syndrome, cataracts 
Hyperglycaemia 
Infection, insomnia 
Nervous system (psychiatric)
Glaucoma, GI ulcers 
Blood pressure increase 
Osteoporosis 
Skin thinning 
Obesity 
Muscle wasting
133
Q

Symptoms of diabetes

A 
Polyphagia 
Polydipsia 
Polyuria
Weight loss
Fatigue 
Blurred vision 
Poor wound healing
134
Q

What’s the first line long acting insulin in pregnancy

A

Isolhane insulin

135
Q

How does insulin requirement change during and after pregnancy

A

You will need more insulin in the 2nd and 3rd trimester and it will need to be immediately reduced after birth

136
Q

What is diabetes gestational and how is it managed

A

Diabetes that develops during pregnancy

Fasting glucose < 7mmol = dietary and exercise then metformin

Fasting glucose >7mmol = insulin (with or without metformin)

137
Q

When do you need to notify dvla in diabetes

A

Treatment with insulin (an anti diabetic for bigger vehicles)
Visual or renal or limb complications that affect driving
Two episodes of hypoglycaemia in the past 12 months
Hypoglycaemia while driving

138
Q

When are insulin requirements increase or decrease

A

They are increased in an infection stress puberty and pregnancy

They are decreased in Endo crying disorders for example Addison’s disease and hypopituitarism

139
Q

What blood and urine Ketone levels require immediate action

A

Urine 2+

Blood > 3mmol/L

140
Q

When should you stop taking Metformin and why

A

If you’re dehydrated fever vomiting diarrhoea due to increased risk of lactic acidosis

141
Q

What does thyroid hormones regulate

A 
Metabolic rate
Heart rate
Digestive function
Muscle control
Brain development
142
Q

Symptoms of hyperthyroid disorder

A 
Heat intolerance
Weight loss
Diarrhoea
Tachycardia
Excitability
Angina pain
Tremors
Sweating
Arrhythmia
143
Q

Symptoms of hypothyroidism

A 
Cold intolerance
Weight gain
Constipation
Bradycardia
Lethargic
Muscle cramps
Slow movement
Slow thoughts
Depression
Hair thinning
144
Q

What would you give in a thyroidectomy

A

Iodine for 10 to 14 days before the partial thyroidectomy and then antithyroid drugs but not long-term

145
Q

What would you give for hyperthyroidism in pregnancy

A

First trimester= propylthiouracil

2nd and 3rd= carbimazole

146
Q

What’s the rapid acting insulin’s

A

Aspart (novorapid)
Glulisine (apidra)
Lispro (humalog)

147
Q

Intermediate acting insulin

A

Isophane

148
Q

Long lasting Insulin’s

A

Deglubec (tresiba)
Detemir (levemir)
Glargine (absaglar Lantus)

149
Q

When would you give glucose in a patient being treated with DKA

A

When below 14mmol/L

150
Q

When is a continuous subcutaneous insulin pump indicated

A

Suffer recurrent unpredictable hypoglycaemia

Glycaemic control >8.5%

Children under 12 where MIR is impractical (must undergo MIR training when 12-18)

151
Q

How should insulin be stored

A

Fridge between 2-8

Once opened store at room temp for 28 days

If frozen discard

If left outside for 48hours discard

152
Q

What’s the most common cause of hyperthyroidism

A

Graves’ disease

153
Q

When are the most potent glucocorticoids used

A

When fluid retention is disadvantages (eg heart failure)

154
Q

What can be a side effect of taking corticosteroids with anaesthesia

A

Dangerous fall in blood pressure

155
Q

What’s given for type 2 diabetes post birth for breastfeeding

A

Metformin or glibenclamide

156
Q

What type of induced hypoglycaemia should be treated in hospital and why

A

Sulphonylurea

as it can persist for hours

157
Q

What doses of levothyroxine should you question

A

Doses above 200mcg

158
Q

What drug enhances the effect of sulphonylurea

A

Chloramphenicol

159
Q

What diabetic medication can you give to elderly of people woth poor kidney function

A

DDP4 inhibitor - eg: linagliptin

160
Q

What should you monitor if linagliptin (dpp4 inhibitor) is given with other diabetic meds

A

Hypos

161
Q

Which anti diabetic medication can reduce vitamin b12 absorption

A

Metformin

162
Q

What should you counsel with acarbose and why

A

Take immediately before food as can cause bloating

163
Q

Which DPP4 inhibitor is linked to Steven Johnson syndrome

A

Sitagliptin

164
Q

What’s the first line anti hypertensive for a 70 year old patient also diabetic

A

ACEi

165
Q

Which diabetic oral medication can lower vitamin b12

A

Met for in

166
Q

What patients should be given a steroid card

A

Patients on long term corticosteroids (> 3 weeks)

167
Q

Risk factors for DKA

A 
Low beta cell function 
Alcohol
Surgery
Sudden reduction in insulin 
Acute illness
168
Q

Symptoms of thyrotoxicosis

A 
Increased HR >140 bpm
Tachycardia, arrhythmia 
Heat intolerance >41 degrees
Diarrhoea, nausea, vomitting, dehydration 
Seizures
169
Q

MHRA alert regarding glp1 and insulin use

A

Increased risk of DKA

Especially when on both and insulin dose rapidly reduced or discontinued

170
Q

3 MHRA alerts for SGLT2

A

DKA
Monitor ketone during treatment interruption for surgery
Reports of Fournier gangrene

171
Q

Crcl cut off point for alendronic acid

A

35 ml/min

Pre-reg (27 decks)

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