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BNF 72/74 > Chapter 6- Endocrine System > Flashcards

Chapter 6- Endocrine System Flashcards

1
Q

What is vasopressin and desmopressin?

A

Antidiuretic hormone (ADH)

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2
Q

Which is more potent and has a longer duration of action: desmopressin or vasopressin?

A

Desmopressin

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3
Q

Which has a vasoconstrictor effect: desmopressin or vasopressin

A

Vasopressin

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4
Q

Vasopressin can be used to stop variceal bleeding in what?

A

Portal hypertension

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5
Q

Name two antidiuretic hormone antagonists

A

Demeclocycline

Tolvaptan

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6
Q

Rapid correct of hyponatraemia with tolvaptan can cause what

A

Osmotic demyelination leading to serious neurological events

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7
Q

The antidiuretic hormones vasopressin and desmopressin can cause what

A

Hyponatraemia

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8
Q

Name 5 mineralocorticoid side effects

A 
Hypertension 
Sodium retention 
Water retention 
Potassium loss
Calcium loss
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9
Q

Name 6 side effects from glucocorticoids

A 
Diabetes 
Osteoporosis 
Avascular necrosis of femoral head 
Muscle wasting 
Peptic ulceration 
Psychiatric reactions
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10
Q

Children under 15 years should use what to inhale corticosteroids

A

Large volume spacer

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11
Q

Name two drugs used in cushings

A

Ketoconazole

Metyrapone

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12
Q

Fasting blood glucose target

A

5-7 mmol/litre

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13
Q

Blood glucose target before meals and any other time of day

A

4-7mmol/litre

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14
Q

Blood glucose target 90 mins after eating

A

5-9 mmol/litre

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15
Q

Name 3 rapid acting insulin analogues

A

Insulin aspart
Insulin glulisine
Insulin lispro

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16
Q

When soluble insulin is injected subcutaneously what’s its onset of action, peak action and duration of action?

A

Onset: 30-60mins
Peak: 1-4hrs
Duration: 9 hours

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17
Q

When soluble insulin is given intravenously what’s its half life and onset of action - as a result of this when is it used

A

Half life: few mins
Onset: instantaneous
Used: in medical emergencies e.g DKA & Peri-operatively

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18
Q

Onset and duration of action of the rapid acting insulins (aspart, glulisine,lispro)

A

Onset: 15 mins
Duration: 2-5hrs

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19
Q

Name an intermediate acting insulin and what’s its onset of action and duration

A

Isophane insulin
Onset: 1-2hrs
Duration: 11-24hrs

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20
Q

Name three long acting insulins

A

Insulin degludec
Insulin detemir
Insulin glargine

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21
Q

Metformin when given alone does not cause hypos- why?

A

Because it does not stimulate insulin secretion

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22
Q

Name 5 sulfonylureas

A 
Glibenclamide 
Gliclazide 
Glimepiride
Glipizide
Tolbutamide
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23
Q

Sulfonylureas can cause hypos but it is more associated with the long acting sulfonylureas such as ?

A

Glibenclamide

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24
Q

True or false: sulfonylureas can cause modest weight gain

A

True

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25
Q

Name two meglitinides and what’s their onset of action and duration like?

A

Nateglinide
Repaglinide
Rapid onset of action
Short duration of activity

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26
Q

Name a thiazolidinedione

A

Pioglitazone

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27
Q

The dipeptidylpeptidase-4 inhibitors (gliptins) are not associated with weight gain and cause hypos to a lesser extent than the sulfonylureas, name these drugs

A 
Alogliptin
Linagliptin 
Sitagliptin
Saxagliptin 
Vildagliptin
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28
Q

Name three sodium glucose co-transporter 2 inhibitors

A

Canagliflozin
Dapagliflozin
Empagliflozin

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29
Q

Which class of oral diabetic medication is associated with DKA

A

Sodium glucose co-transporter 2 inhibitors

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30
Q

Name 4 glucagon- like peptide 1 receptor agonists

A 
Albiglutide 
Dulaglutide 
Exenatide 
Liraglutide 
Lixisenatide
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31
Q

What’s another indication for metformin

A

Used as an insulin sensitising drug in women with polycystic ovary syndrome who are not planning pregnancy (unlicensed)

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32
Q

Normal HbA1c target

A

48 mmol/mol

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33
Q

If someone is on an antidiabetic drug that causes hypos or two or more antidiabetic drugs, what’s their HbA1c target

A

53mmol/mol

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34
Q

When do you use glucagon-like peptide 1 receptor agonists

A

Triple therapy with metformin + sulfonylureas in patient with BMI 35+, or if <35 but have other conditions that would benefit from weight loss

35
Q

When should you review glucagon-like peptide 1 receptor agonists

A

6 months after initiation- only continue if there’s a reduction of at least 11mmol/mol in HbA1c and a weight loss of at least 3% of initial body weight

36
Q

True or false: ACEI can potentiate the hypoglycaemic effect of insulin and oral antidiabetic drugs

37
Q

MOA of acarbose

A

Inhibitor of alpha glucosidases, delays the digestion and absorption of starch and sucrose, it has small but significant effect in lowering blood glucose

38
Q

Cautions with acarbose

A

May enhance hypoglycaemia effects of insulin and sulfonylureas (hypoglycaemic episodes must be treated with oral glucose but not sucrose)

39
Q

MOA of metformin

A

Decreases gluconeogenesis and increases peripheral utilisation of glucose

40
Q

True or false: metformin acts only in presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells

41
Q

Metformin and pregnancy?

A

Metformin can be used for both pre-existing and gestational diabetes

42
Q

Metformin- avoid if what renal impairment?

A

If eGFR < 30ml/min/1.73m^2

43
Q

Potential signs of lactic acidosis with metformin

A 
Dyspnoea
Muscle cramps
Abdominal pain 
Hypothermia
Asthenia
44
Q

Side effects/ caution with DPP-4 inhibitors (gliptins)

A

Pancreatitis

45
Q

Which DPP-4 inhibitor has reports of liver toxicity

A

Vildagliptin

46
Q

How do the meglitinides work (nateglinide + repaglinide)

A

Stimulates insulin secretion

47
Q

Mode of action of sodium glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin, empagliflozin)

A

Reversible inhibits SGLT2 in the renal proximal convoluted tubule to reduce glucose reabsorbtion and increase urinary glucose excretion

48
Q

Patients on canagliflozin and rifampicin - increase the SGLT2 dose to want?

49
Q

MHRA warning with all SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin

A

Risk of DKA

50
Q

In addition to risk of DKA, what other caution is there with canagliflozin

A

Increased risk of lower limb amputation (mainly toes)

51
Q

The SGLT2 inhibitors have an increased risk of volume depletion - true or false?

A

True - therefore caution in hypotension, elderly, heart failure

52
Q

MOA of sulfonylureas

A

Augment insulin secretion therefore effective only when there’s some residual pancreatic beta cell activity

53
Q

Cautions for sulfonylureas

A

Weight gain
Elderly (hypos)
G6PD deficiency

54
Q

Contraindication for glibenclamide

A

Acute porphyrias

55
Q

True or false: the sulfonylurea ‘glibenclamide’ can be used in the second and third trimesters to treat gestational diabetes

56
Q

Sulfonylureas should be avoided in porphyria- which two are thought to be safe?

A

Glimepiride

Glipizide

57
Q

MOA of the thiazolidinedione ‘pioglitazone’

A

Reduces peripheral insulin resistance

58
Q

Contraindication to pioglitazone

A

History of heart failure
Previous or active bladder cancer
Univestigated macroscopic haematuria

59
Q

Patient and carer advice for pioglitazone

A

Seek immediate medical attention if symptoms of nausea, vomiting, abdominal pain, fatigue and dark urine develop

60
Q

HRT is of most benefit for the prophylaxis of postmenopausal osteoporosis if started early in menopause and continued for how long?

A

Up to 5 years

61
Q

If bisphosphonates for treating postmenopausal osteoporosis what can be considered

A

Calcitriol or strontium ranelate

62
Q

There is no consistent evidence of any further benefit from continuing treatment with a bisphosphonate beyond how many years in patients with osteoporosis

63
Q

Name the anabolic steroid that can be used (but not recommended) in postmenopausal women

A

Nandrolone

64
Q

Highest potency bisphosphonate

A

Zoledronate

65
Q

Three MHRA warnings of bisphosphonates

A

Atypical femoral fractures
Osteonecrosis of the jaw
Osteonecrosis of external auditory canal

66
Q

What is denosumab

A

Monoclonal antibody that inhibits osteoclast formation, function and survival thereby decreasing bone resorption

67
Q

Name three dopamine agonists used to suppress lactation

A

Bromocriptine
Cabergoline
Quinagolide

68
Q

Name a growth hormone receptor antagonist

A

Pegvisomant

69
Q

Name the recombinant growth hormone used in Turner syndrome and deficiency of growth hormone

A

Somatropin

70
Q

What are the risks of HRT

A 
VTE 
Stroke
Endometrial cancer 
Breast cancer 
Ovarian cancer 
Condo art heart disease
71
Q

How can you reduce the increased risk of endometrial cancer with HRT

A

By a progestogen

72
Q

Cyproterone is an anti-androgen given to prevent tumour flare with what initial therapy?

A

Gonadorelin analogue therapy

73
Q

Name two drugs used for hyperthyroidism

A

Carbimazole

Propylthiouracil

74
Q

Hypothyroidism in pregnancy can cause what to the baby

A

Fetal goitre

75
Q

What’s the block and replace regimen, how long is it used and when should it not be used

A

Carbimazole and levothyroxine for 18 months - do not use block and replace in pregnancy

76
Q

Beta blockers can be used for rapid relief of thyrotoxic symptoms - in particular which beta blocker?

A

Propranolol (nadolol can also be used)

77
Q

Can propylthiouracil and carbimazole be used I preganancy

A

In the smallest doses possible - propylthiouracil is preferred in first trimester and carbimazole has beeen associated with congenital defects (but consider switching in 2nd trimester due to hepatotoxicity risk with propylthiouracil)

78
Q

What do you need to recognise with carbimazole

A

Bone marrow suppression - signs of infection, WCC and stop promptly if lab evidence of neutropenia

79
Q

Name two drugs used in hypothyroidism and what’s the difference between them?

A

Levothyroxine

Liothyronine (rapidly metabolised and quicker onset)

80
Q

How do insulin requirements change in the second or third trimester

A

They increase

81
Q

True or false: insulin causes hyperkalaemia

A

FALSE it causes hypokalaemia cos it drive potassium into cells

82
Q

In obese patients would you choose pioglitazone or a sulfonylureas

A

Pioglitazone cos sulfonylureas can cause weight gain

83
Q

True or false: in second and third trimester patients often need lower dose of levothyroxine

A

False they often need higher

BNF 72/74 (17 decks)

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