Endocrine Flashcards
MOA Canaglifozin
Canagliflozin reversibly inhibits sodium-glucose co-
transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose
reabsorption and increase urinary glucose excretion.
HbA1C
forms when red blood are exposed to glucose in plasma
reflects average plasma glucose over the past 2-3 mths
monitor ev 3-6 mths in T1DM
monitor ev 3-6 initially in T2DM and then ev 6 mths when stable
use with caution in pt with abnormal HB, anaemia, altered red cell lifespan or had a recent blood transfusion.
Clinical presentation T1DM
Hyperglycaemia ketosis weight loss BMI under 25 age younger than 25 Hx/family Hx autoimmune disease
treatment T2DM - not C/I metformin
- metformin and aim HbA1C 48
- if HbA1C above 58, HbA1C of 53
Metformin and dpp-4 (-gliptin, alogliptin, linagliptin, sitagliptin, saxagliptin, vildagliptin)
Metformin and pioglitazone
Metformin and sulphonylurea (glibenclamide, gliclazide, glimepriride, glipizide, tolbutamide)
Metformin and SGLT-2 (canagliflozin, dapaliflozin, empagliflozin) - if HbA1C still/above 58, aim HbA1C 53
Metformin + DPP-4 + Sulpho
Metformin + pioglitazone + sulpho
Metformin + pioglitazone OR sulpho + SGLT-2
Mineralocorticoid S/E
hypertension sodium retention water retention potassium loss calcium loss fluid retention
Mineralcorticoid corticosteroids
Corticotropin
Fludrocortisone v.high mineralocorticoid activity (no equivalence in steroid conversion due to this)
Hydrocortisone high mineralocorticoid activity but equivalent glucocorticoid activity
tetracosactide
Glucocorticoid S/E
diabetes osteoporosis avascular necrosis of the femoral head muscle wasting (myopathy) peptic ulceration and perforation psychiatric reactions
glucocorticoid corticosteroids
Dexamethasone and betamethasone - v.high gluco
prednisolone and prednisone - predominant gluco
deflazacort - high gluco (derived from pred)
Triamcinolone - high gluco
methylprednisolone - v.high gluco
Hydrocortisone - equivalent gluocoirticoid and mineralocorticoid activity
Withdrawal requirement corticosteroids
Do not abruptly withdraw in patients with:
1. >40mg OD (or equivalent) for >1 week
KIDS: OR 2mg/kg for 1 wk
OR 1mg/kg for 1 mth
2. repeat doses in the evening
3. >3wks treatment
4. recent repeat doses esp if >3wks treatment
5. short-course corticosteroid within one year of stopping long term corticosteroid treatment
6. any other possible causes adrenal supression
Reduce quickly down to physiological dose (= 7.5mg prednisolone OD; KIDS: prednisolone 2-2.5mg/m2 OD) then stop slowly
Factors to abruptly stop corticosteroids
not at risk of relapse of disease AND:
+ received treatment for 3 wks or less
+ not included in at risk group
Associated risk factors with corticosteroids
ADRENAL SUPPRESSION - if abrupt withdrawal, can happen in 1 year or more after stopping - NEED STEROID CARD
INFECTION - increase susceptibility and severe infections - may have atypical symptoms or delayed symptoms presentation
CHICKENPOX: risk of severe chickenpox infection - avoid people with chickenpox
MEASLES: avoid exposure to measles
PSYCHIATRIC SYMPTOMS: get help if worrying psychological symptoms and suicidal thoughts/ideation
corticosteroids C/I
injection containing benzyl alcohol in neonates
live-virus vaccines with immunosuppressive doses
active/dormant systemic infection (unless specific)
Betamethasone BNF
for suppression of allergic disorder/congenital adrenal hyperplasia
S/E: hiccups
steven-johnson syndrome
STEROID CARD
deflazacort BNF
suppression of inflammatory and allergic disorder
S/E: oedema
STEROID CARD
Dexamethasone
suppression of inflammatory and allergic disorder
mild - severe croup
congenital adrenal hyperplasia
adjunct bacterial meningitis (unlicensed)
palliative care symptoms control
cerebral oedema
S/E: hiccups, hyperglycaemia, myocardial rupture (following recent MI), protein catabolism, perineal irritation (if IV given at large doses)
Fludrocortisone acetate
neuropathic postural hypotension (unlicensed)
mineralocorticoid replacement in adrenocortical insufficiency
S/E: conjunctivitis, idiopathic intracranial hypertension., muscle weakness, thrombophlebitis
MONITORING: monitor closely in hepatic impairment
Hydrocortison BNF
equal glucocorticoid and mineralocorticoid activity
thyrotoxic crisis
adrenal insufficiency
acute hypersensitive reactions
corticosteroid replacement in pt who take corticosteroid and where abrupt withdrawal = adrenal suppression
UC/ proctitis
severe/life-threatening acute asthma
C/I: X with rectal use if local/abdominal infections, perforation, obstruction
S/E: dyslipidemia, MI rupture (after recent MI), oedema, hiccups (parenteral), kaposi’s sarcoma
ABLE TO USE POM IF LIFE-THREATENING EMERGENCY - restriction don’t apply
methylprednisolone BNF
suppression inflammatory and allergic disorder
treatment graft rejection
relapse multiple sclerosis
MHRA: CONTAINS LACTOSE, DO NOT USE IN PT WITH COW’S MILK ALLERGY
!rapid IV injection = CV collapse
S/E: hiccups
MONITORING: BP and creatinine in pt with systemic sclerosis
Prednisolone BNF
exacerbation COPD/Asthma
mild-severe croup
suppression inflammatory and allergic response
idiopathic thrombocytopenic purpura
UC/Chron’s/Proctitis
Neuropathic pain
myasthenia gravis
Rheumatoid arthirtis or osteoarthritis, giant cell arteritis
C/I: X with rectal use if local/abdominal infections, perforation, obstruction
!Duchene’s muscular dystrophy - transient rhabdomyolysis and myoglobinuria following sternous activity.
S/E: hiccups
MONITORING: pregnant women with fluid retention
infants for adrenal suppression in breastfeeding mothers on pred higher than 40mg OD
BP and creatinine in pt with systemic sclerosis
Triamcinolone BNF
suprresion of inflammatory and allergic disorder
!high dosages = proximal myopathy
!avoid in chronic therapy
S/E: dizziness, flushing, hyperglycaemia
Biphosphonates in renal impairment
risedronate C/I eGFR < 30
Alendronic acid C/I in eGFR < 35
conditions causing hypoglycaemia
sport decrease food intake renal impairment endocrine impairment intercurrent illness
conditions causing hyperglycaemia
stress
infection
trauma accidental or surgical
stages of CKD
above 90: stage 1, kidney functions are normal but urine findings suggest kidney disease
60-89 ml/min: stage 2, mild kidney impairment
30-59 ml/min: stage 3, moderate kidney impairment
15-29 ml/min: stage 4 severe kidney impairment
under 15 ml/min: stage 5, kidney failure
risk factor AKI
age over 65 liver disease CKD HF Diabetes hx AKI oliguria (decrease urine output) sepsis neurological or cognitive impairment (esp when reliant on carer) hyvoloaemia drug that can exacerbate AKI - ACEI/ARB, Metformin, NSAID, diuretics, aminoglycoside, contrast media symptoms or hx of urlogical impairment deteriorating early warning signs
