Drugs & Doses: Endocrine

Question 1

Diabetes

Answer 1

1. Biguanide (Metformin) – GIT side effects, care with renal
2. Max 1g daily if CrCl 30-60, CI if <30
3. Sulfonylureas (Gliclazide) – weight gain, risk of hypos
4. DPP-4 inhibitors (Sitagliptin) – GIT, rash, pancreatitis (rare)
5. GLP-1 agonist (Exanetide) – weight loss, nausea, vomits, pancreatitis
6. SGLT2 inhibitor (Empagliflozin) – weight loss, increase urogenital infections, dehydration, dizziness. Risk of DKA
7. Cease if CrCl <45
8. Acarbose – flatulence, bloating
9. Thiazolidinediones (pioglitazone) – risk of heart failure, bladder cancer, weight gain, #s in women
10. Insulin – risk of hypos, weight gain - start with 0.2U/kg
11. Add fenofibrate 145mg daily if diabetic retinopathy
12. Consider bariatric surgery if BMI >40
13. Consider meds if BMI >27 - orlistat, liralutide, phentermine, naltrexone+buproprion

Question 2

Hypothyroidism

Answer 2

Start thyroxine 1.6mcg/kg, adjust every 4-8 weeks

Question 3

Thyroiditis (Graves)

Answer 3

Carbimazole 10-30mg/day in 2-3 doses. Titrate 4 weekly as required to avoid hypothyroidism
If T3/T4 drops by 1/2, reduce dose by 1/2
Cease after 12-18mos
Use propylthiouracil in pregnant women

Question 4

Subacute thyroiditis

Answer 4

Aspirin 600mg QID

If severe, bred 40mg daily, decrease over 2-4 weeks

Question 5

Post partum thyroiditis

Answer 5

Symptomatic tx with propranolol during hyper phase

Thyroxine during hypo phase, continue for 6-12mo