Core Medications

Question 1

examples of SABA

Answer 1

salbutamol

Terbutaline

Question 2

examples of LABA

Answer 2

salmeterol

formoterol

Question 3

MOA of beta agonist

Answer 3

beta2 receptors on smooth muscles, GI tracts, Heart and bronchi

activation of Beta2 receptors = relaxation of muscles by causing the Na+/K- ATPase pumps to shift K+ extacellular to intracellular

Question 4

indications for beta agonist

Answer 4

asthma
COPD
hyperkalaemia

Question 5

SE of beta agonist

Answer 5

tachycardia 
palpitation 
anxiety 
inc glucose level 
inc serum lactate level if high dose - cause the breakdown of smooth muscles 
muscle cramps

Question 6

examples of short-acting antimuscarinic

Answer 6

ipratropium

Question 7

examples of long-acting antimuscarinic

Answer 7

Tiotropium

Question 8

MOA of antimuscarinic

Answer 8

binds to the muscarinic receptors and act as competitive inhibitors of ACTH

block parasympathetic effects = dec smooth muscle tone and dec secretion

Question 9

indication of antimuscarinic

Answer 9

asthma

COPD

Question 10

contra-indications of antimuscarinic

Answer 10

angle closure glaucoma - can cause inc intraocular pressure

Question 11

SE of antimuscarinic

Answer 11

dry mouth

Question 12

examples of ICS

Answer 12

beclometasone
budesonide
fluticasone

Question 13

MOA of ICS

Answer 13

meds pass through the membrane to get into the nucleus of the cells to modify gene transcription

pro-inflammatory interleukins, cytokines and chemokines are downregulated

dec mucosal inflammation, widen the airways and dec mucus secretion

Question 14

Indications of ICS

Answer 14

asthma

COPD

Question 15

contra-indications of ICS

Answer 15

COPD patient with a pneumonia

child - growth stint

Question 16

SE of ICS

Answer 16

oral candida
horse voice
pneumonia in COPD pts

Question 17

advice to avoid pneumonia when using ICS

Answer 17

wash your mouth straight afterwards

Question 18

pathology of type 1 DM

Answer 18

autoimmune destruction of the pancreatic beta cell

Question 19

pathology of type 2 DM

Answer 19

insulin resistance - free fatty acids and pro-inflammatory cytokines in plasma

reduce glucose transport into muscle cells, inc hepatic glucose production and in break down of fate and dec insulin production

Question 20

RF for T1DM

Answer 20

other autoimmune diseases eg thyroid disease and coeliac disease

younger age (<50)

genetic (30%)

exact cause unknown

Question 21

RF for T2DM

Answer 21

older age
obesity
ethnicity - asian, african
FH - 80% genetics

low birth weight 
non-alcoholic liver disease 
excess alcohol 
hypertension 
previous gestational diabetes

Question 22

symptoms of T1DM

Answer 22

polyuria 
polydipsia 
lethargy
unexplained weight loss
hyperglycaemia 
ketosis

Question 23

symptoms of T2DM

Answer 23

polyuria
polydipsia
lethargy
recurrent infection - thrush

Question 24

symptoms of DKA

Answer 24

D+V
polyuria 
polydipsia 
weight loss 
inability to tolerate fluids 
abdo pain 
lethargy/confusion 

ketonuria
fruity smelling breathe - acetone
Kusmaul breathing

Question 25

hypoglycaemia

Answer 25

hypogylcaemia - 3.5 mmol 
lethargy 
confusion 
irriration 
hungry 
anixety/irritability 
tingling tips 
sweating 
impaired vision 

seizures
loss of consciousness
coma

Question 26

what are the signs of dehydration

Answer 26

mild - clinical detectable only - BP etc

moderate - dry skin/mucous membrane, reduced skin turgor

severe - sunken eyes, prolonged cap refill

shock

Question 27

diagnosis of T1DM

Answer 27

urine dip + cap blood glucose

C-peptide, anti-islet cells bodies, anti-glutamic acid decarboxylase antibodies - not routinely tested but if atypical presentation eg unusual pattern of symptoms BMI > 25, not in teenage/young adult

Question 28

diagnosis of T2DM

Answer 28

urine dip/ACR

diagnostic bloods - if symptomatic then 1 +ve test is enough, if not then 2 +ve tests are required

1) venous bloods - fasting >7, random > 11
2) HbA1c - > 48 (42-47 pre-diabetic state) - does not work with people who have anaemia

Question 29

when to refer a patient with DM?

Answer 29

same day referral to an endocrinologist if a young/teenage person suspected of T1DM

if stage 4/5 CKD - nephrologist

DKA

sudden loss of vision, rubeosis iriditis, pre-retinal/vitreous haemorrhage, retinal detachment

moderate-high risk of developing diabetic foot problems - refer to foot protection service

Question 30

what is the sick day rule of diabetes

Answer 30

continue to take insulin during illness to maintain blood sugar level and try to maintain a diet and good hydration 3L

if solid food not toleratable - try to drink sugary drinks and take ORS

measure blood glucose 3-4 hours a day

Question 31

what is the target of blood glucose level in T1DM

Answer 31

before meal/fasting - 4-7

after meal - 5-9

Question 32

who should you inform when you are diagnosed with diabetes

Answer 32

DVLA - due to risk of hypoglycaemia

Question 33

management of T1DM

Answer 33

3 regimes

1) basal-bolus - intermediate/long-acting throughout the day + rapid/short acting before/immediate after meal
2) multiple daily injections of short/rapid-acting insulin
3) continuous insulin pump - rapid/short-acting insulin

need to check blood glucose 4-5 times a day