Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BNF/Pre-Reg 2017-2018 U > Endocrine > Flashcards

Endocrine Flashcards

Androgens, anti-androgens and anabolic steroids. Antithyroid drugs. Bone metabolism. Corticosteroids (general use) Corticosteroids (replacement therapy) Cushings syndrome Diabetes (general) Diabetes (complications) Diabetic ketoacidosis. Dopamine-receptor agonists. Glucocorticoid therapy. Gonadotrophins, drugs affecting. Hypoglycaemia. Hypothalamic and anteroir pituitary hormones. Insulin. Posterior piruitary hormones. Sex hormones.

1
Q

What do androgens cause and what are they used for?

A

Cause masculinisation; they may be used as replacement therapy in castrated adults and in those who are hypogonadal due to either pituitary or testicular disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What effect does the administration of androgens on normal males have?

A

Inhibit pituitary gonadotrophin secretion and depress spermatogenesis. Androgens also have an anabolic action which led to the development of anabolic steroids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When can androgens be used as a treatment of impotence and impaired spermatogenesis?

A

Only after the hypogonadism has been properly investigated and treatment should be under expert supervision.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the effect of giving androgens to patients with hypopituitarism? what can it not achieve?

A

Can lead to normal sexual development and potency but not to fertility. If fertility is desired, the usual treatment is with gonadotrophins or pulsatile gonadotrophin releasing hormone which will stimulate spermatogenesis as well as androgen production.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If fertility is desired in a patient with hypopituitarism what is the usual treatment? Why is not androgens?

A

Androgens will lead to normal sexual development and potency but not to fertility. Treatment with gonadotrophins or pulsatile gonadotrophin releasing hormone will stimulate spermatogensis as well as androgen production.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What form of administration is preferred for testosterone replacement therapy?

A

IM depot preparations. Testosterone enantate, propionate or undecanoate alternatively Sustanon (longer duration of action) can be used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the benefit of using Sustanon, which is a mixture of different testosterone esters, in treatment?

A

Longer duration of action.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is cyproterone acetate?

A

Anti-androgen used in the treatment of severe hypersexuality and sexual deviation in the male. It inhibits spermatogenesis and produces reversible infertility (but is not a male contraceptive) ; abnormal sperm forms are produced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who can cyproterone acetate be used in and to treat what? (2)

A

Males for severe hypersexuality and sexual deviation.NOT a male contraceptive - despite inhibiting spermatogenesis and reversible infertility. Also licensed for use alone in patient with metastatic prostate cancer refractory to gonadorelin analogue therapy and has been used as an adjunct in prostatic cancer and in the treatment of acne and hirsutism in women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the risks with using cyproterone acetate?

A

It has caused hepatic tumours in animal studies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can cyproterone acetate be used to treat in women?

A

Acne and hirsutism (excessive hair growth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dustateride and finasteride are alternatives to alpha-blockers in what group of men?

A

Those with a significantly enlarged prostate. Finasteride is also licensed for use with doxazosin in the management of benign prostatic hyperplasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Finasteride is also licensed for use in the management of benigen prostatic hyperplasia in conjunction with what?

A

Doxazosin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Low-strength finasteride can be used to treat what?

A

male-pattern baldness in men.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anabolic steroids have some androgenic activity but cause less _______ than androgens in women.

A

Virilisation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anabolic have some therapeutic use in the treatment of what?

A

Aplastic anaemias.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Anabolic steroids are no longer recommended for the treatment of what in women?

A

Osteoporosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most commonly used anti-thyroid drug?

A

Carbimazole - propylthiouracil should be reserved for patients who are intolerant of carbimazole or for those who experience sensitivity reactions to carbimazole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Over-treatment with antithyroid drugs can result in the rapid development of hypothyroidism and should be avoided particularly during pregnancy because it can cause what?

A

Fetal goitre.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is ‘bocking-replacement’ therapy? How long is it given for usually?

A

Combination of carbimazole with levothyroxine sodium daily, may be used in a blocking-replacement regimen for usually 18 months. NOT SUITABLE DURING PREGNANCY.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When is blocking-replacement therapy not suitable?

A

During pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When would iodine be prescribed to a patient with hyperactive thyroid?

A

10-14 days before partial thyroidectomy: however, there is little evidence of a beneficial effect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When would radioactive sodium iodide (131)I used?

A

Increasingly for the treatment of thyrotoxicosis at all ages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What beta blocker can be used for rapid relief of thyrotoxic symptoms?

A

Propranolol (hydrochloride) [Nadolol is also used]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What impact do beta blockers have on TFT results?

A

None.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is thyroid storm treated? [5]

A

Emergency treatment consisting of:IV fluids, Propranolol hydrochloride Hydrocortisone (as sodium succinate)Oral iodine solutionCarbimazole or propylthiouracil (via NG tube if needed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the anti-thyroid drug of choice during the first trimester, why?

A

Propylthiouracil because carbimazole has been associated (rarely) with congenital defects, including aplasia cutis of the neonate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the anti-thyroid drug of choice in the second trimester, why?

A

Consider switching from propylthiouracil to carbimazole due to the risk of hepatotoxicity. Both antithryoid drugs can cross the placenta in high doses so the lowest effective dose should be used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Osteoporosis occurs most commonly in who?

A

Post menopausal women.Those taking lon-term oral corticosteroids. Other risk factors include:low BWSmokingAlcoholismSedentary lifestyleFHEarly menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How is osteoporosis treated?

A

Calcium and Vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What needs to be excluded before treatment for osteoporosis should begin?

A

Reversible causes of osteoporosis such as:HyperthyroidismHyperparathryoidismOsteomalacia or hypogonadism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What can be used for the prevention of postmenopausal osteoporosis?

A

Bisphosphonates such as alendronic acid and risedronate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When would HRT be used for preventing osteoporosis?

A

if other treatments are contraindicated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

When is HRT of most benefit for the prophylaxis of postmenopausal osteoporosis?

A

if started early in menopause and continued for up to 5 years, but bone loss resumes on stopping HRT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

If bisphosphonates are unsuitable for treatment of osteoporosis what can be used instead?

A

Calcitriol or strontium ranelate. Calcitonin is no longer recommended for the treatment of postmenopausal osteoporosis as risk of malignancy outweighs benefit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is teriparatide?

A

recombinant form of parathyroid hormone consisting of the first (N-terminus) 34 amino acids, which is the bioactive portion of the hormone.Newly introduced for treatment of postmenopausal osteoporosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is raloxifene hydrochloride licensed for?

A

Prophylaxis and treatment of vertebral fractures in postmenopausal women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

The greatest rate of bone loss occurs during what period of oral corticosteroid use?

A

6-12 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When should parents prescribed an oral corticosteroid be assessed and when needed given a prophylactic osteoporosis treatment?

A

When likely to be on them for 3 months or longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Calcitonin (Salmon) is used for what?

A

To lower the plasma-calcium concentration in patients with hypercalcaemia associated with malignancy. Also for the treatment of Pagets disease (Paget’s disease of bone disrupts the normal cycle of bone renewal, causing bones to become weakened and possibly deformed) when other treatments have failed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is Cinacalcet licensed to treat?

A

Hypercalcaemia in parathyroid carcinoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When should a discussion with patients regarding the cessation of their bisphosphonate treatment for osteoporosis?

A

After 3 years’ treatment as their is no evidence for benefit after this time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Strontium ranelate use has been associated with what?

A

Increased risk of serious cardiovascular disease, including myocardial infarction, and the risk should be assess before treatment and regularly during treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Can corticosteroids be used to treat psoriasis?

A

Should avoid the use of them or use them only under specialist supervision.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Corticosteroids are used both topically, via the rectum, and systemically, via the mouth or IV, in the management of [2]

A

ulcerative colitis and Crohns disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

In what form can corticosteroids be used for haemorrhoids?

A

Topically.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When would the mineralcorticoid activity of fludrocortisone acetate be used to treat postural hypotension?

A

autonomic neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Lower doses of what [2] corticosteroids is of benefit in adrenocortical insufficiency resulting from septic shock?

A

HydrocortisoneFludrocortisone acetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Dexamethasone and betamethasone have little if any action of what type? Why is this, along with their long duration of action, useful?

A

Dexamethasone and betamethasone have little if any mineralocorticoid action and their long duration of action makes them particularly suitable for suppressing corticotropin secretion in congenital adrenal hyperplasia where the dose should be tailored to clinical response and by measurement of adrenal androgens and 17-hydroxyprogesterone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What two corticosteroids are particularly suitable for suppressing corticotropin secretion in congenital adrenal hyperplasia?Why?

A

Dexamethasone and betamethasone have little if any mineralcorticoid action and their long duration of action makes them suitable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

In the treatment of congenital adrenal hyperplasia how should the dose of either dexamethasone and betamethasone be tailored?

A

To clinical response and by measurement of adrenal androgens and 17-hydroxyprogesterone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

In common with all glucocorticoids, the suppressive action of both dexamethasone and betamethasone on the hypothalmic-pituitary - adrenal axis is greatest and most prolonged when?

A

Given at night.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the basis of the overnight dexamethasone test? What is used to help diagnose?

A

In most individuals, a single dose of dexamethasone at night is sufficient to inhibit corticosteroid secretion for 24 hours. The overnight dexamethasone suppression test is used for diagnosing Cushing’s syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What other conditions are betamethasone and dexamethasone appropriate for, apart from the treatment of congenital adrenal hyperplasia?

A

Those where water retention would be a disadvantage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

In what circumstances would it be appropriate to prescibe a corticosteroid for ailments of the brain?

A

In the management of raised intracranial pressure or cerebral oedema that occurs as a result of malignancy (pallative care): high doses of betamethasone or dexamethasone are usually used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How are corticosteroids usually commenced in the treatment of serious conditions such as systemic lupus erythematosus, temporal arteritis, and polyarteritis nodosa?

A

It is usual to begin therapy at a high dose and then to reduce the dose to the lowest commensurate with disease control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the 5 most common mineralocorticoid side effects seen with overdosage or prolonged usage of corticosteroids?

A

Hypertension Sodium retention Water retention Potassium lossCalcium loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Mineralcorticoid side effects are seen most frequently with which corticosteroids?

A
  1. Fludrocortisone 2. Significant with hydrocortisone, corticotropin and tetracosactide.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Mineralcorticoid actions are neglible with the high potency glucocorticoids such as

A

BetamethasoneDexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Minercorticoid side effects appear only slightly with what corticosteroids? [3]

A

MethylprednisolonePrednisoloneTriamcinolone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the glucocorticoid related side effects? [6]

A

DiabetesOsteoporosisHigh doses associated with avascular necrosis of the femoral head.Muscle wastingWeak link to peptic ulceration and perforationPsychiatic reactions also known to occur.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

The suppressive action of a corticosteroid on cortisol secretion is least when it is given when and as what?

A

in the morning as a single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

The adrenal cortex normally secretes hydrocortisone (cortisol) which has glucocorticoid activity and weak ___________ activity. It also secretes the ___________________ aldosterone.

A

Weak mineralcorticoid Mineralcorticoid aldosterone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

In an adrenal deficiency disorder, why is a combination of hydrocortisone and the mineral corticosteroid fludrocortisone acetate needed?

A

Hydrocortisone alone does not provide sufficient mineralcorticoid activity for complete replacement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

In the treatment of Addison’s disease or following adrenalectomy, hydrocortisone is given by what route?

A

Normally oral - as two doses, the larger in the morning and the smaller in the evening, mimicking the normal diurnal rhythm of cortisol secretion. This is normally supplemented by fludrocortisone acetate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Why, in the treatment of Addison’s disease or following adrenalectomy, is hydrocortisone given as two split daily doses, the larger of which is in the morning and the smaller of which in the evening?

A

To mimic the normal diurnal rhythm of cortisol secretion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

In the treatment of acute adrenocortical insufficiency, how is hydrocortisone given? What form is preferred?

A

IV as sodium succinate every 6-8 hours in NaCl IV infusion 0.9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How should glucocorticoids be given in the treatment of hypopituitarism?

A

The same as in treating adrenocortical insufficiency, but since production of aldosterone is also regulated by the renin-angiotensin system a mineralocorticoid is not usually required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How is cushings treated?

A

Mostly surgery.Metyrapone has been found to be helpful in controlling the symptoms of the disease, it is also used to prepare patients for surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What kind of dose of metyrapone is used to either control the symptoms of Cushings or prepare a patient for surgery?

A

Either high or low. If high, corticosteroid replacement therapy is also needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Why would ketoconazole be used in patients with Cushing’s disease?

A

It may have an effect on corticotropic tumour cells. It is also used under specialist supervision for the treatment of endogenous Cushing’s syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the impact of alcohol on diabetes?

A

Make the signs of hypoglycaemia less clear and can cause delayed hypoglycaemia. Specialist sources recommend that patients with diabetes should drink alcohol only in moderation, and when accompanied by food.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

When are oral glucose tolerance tests used?

A

Mainly for the diagnosis of impaired glucose tolerance; not recommended or necessary for routine diagnostic use when severe symptoms of hyperglycaemia are present.OGTT may be required in patients who have less severe symptoms and a blood-glucose concentration that does not establish or exclude diabetes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the basis of the HbA1c test?

A

Glycated haemoglobin (HbA1c) forms when red blood cells are exposed to glucose in the plasma. The HbA1c test reflects average plasma glucose over the previous 2 to 3 months and provides a good indicator of glycaemic control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What can the HbA1c test not be used for?

A

The diagnosis of suspected diabetes type 1 in children, during pregnancy or in women who are up to two months postpartum. Should also not be used for those who have:<2 months diabetic symptomsHigh diabetes risk and acutely illMedication that could cause hyperglycaemiaAcute pancreatic damageEnd-stage chronic kidney diseaseHIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

How often should the HbA1c be measured in patients with type 1 diabetes?

A

every 3-6 months, more frequently if blood glucose control is thought to be changing rapidly..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How often should the HbA1c be measured in patients with type 2 diabetes?

A

Every 3-6 months until levels and medicatio are stable then can be reduced to every 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Self-monitoring of blood glucose is appropriate for what patients?

A

Those with type 2 diabetes who:-are treated with insulin;- are treated with oral hypoglycaemic drugs e.g. sulfonylureas, to provide information on hypoglycaemia; - to monitor changes in blood-glucose concentration resulting from changes in lifestyle or medication, and during inter current illness. - to ensure safe blood-glucose concentration during activities, including driving.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

How can pregnant women with pre-existing diabetes be treated? [2]

A

Women with pre-existing diabetes can be treated with metformin hydrochloride, either alone or in combination with insulin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What can women with gestational diabetes be treated with?

A

Women with gestational diabetes may be treated, with or without concomitant insulin, with glibenclamide from 11 weeks gestation (after organogenesis) [unlicensed use] or with metformin [unlicensed use].

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are the three main complications?

A

CVDNephropathyNeuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

A regular review of diabetic patients should include an annual test for what, using Albustix?

A

Urinary protein - should also include serum creatinine measurement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

In the regular review of a diabetic patient, what should occur following a negative urinary protein test?

A

A test for microalbuminuria (the earliest sign of nephropathy).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Provided there are no CIs, all diabetic patients with nephropathy causing proteinurea or with established microalbuminuria (at least 3 positive tests) should be treated with what?

A

An ACE inhibitor or an ATRA even if the blood pressure is normal; in any case, to minimise the risk of renal deterioration, blood pressure should be carefully controlled.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Do diabetic patients with nephropathy causing proteinurea or with established microalbuminuria need to have elevated BP before treatment with an ACEI or ATRA can begin?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Patients with diabetic nephropathy are particularly susceptible to developing what?

A

Hyperkalaemia - do not treat with both ACEI and ATRA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

ACEi can have what impact on the hypoglycaemic effect of insulin and oral antidiabetic drugs?When is this effect more likely?

A

Can potentiate it. More likely in first weeks of combined treatment and in patients with renal impairment.

88
Q

What may relieve mild-to-moderate pain due to neuropathy in patients with T1 diabetes?

A

Paracetamol or NSAID like ibuprofen.

89
Q

Duloxetine is an effective treatment of painful diabetic neuropathy, what can be used if duloxetine is ineffective or unsuitable?

A

Amitriptyline [unlicensed use]or Nortriptyline [again unlicensed].

90
Q

If treatment of painful diabetic neuropathy is not effectively achieved using amitriptyline or duloxetine, what is the next stage of treatment?

A

Pregabalin should be trialed.

91
Q

If treatment with one agent is ineffective in managing painful diabetic neuropathy, what can be trialed?

A

Combination therapy of duloxetine or amitriptyline with pregabalin if monotherapy at the maximum tolerated dose does not control symptoms.

92
Q

There is evidence that neuropathic pain may respond to treatment with opioid analgesics. What agents can be used for this?

A

Tramadol, morphine, oxycodone.

93
Q

Of the three opioid analgesics used for neuropathic pain, which can only be initiated under specialist supervision?

A

Morphine and oxycodone. Tramadol can be prescribed while the patient is waiting for assessment by a specialist if other treatments have been unsuccessful.

94
Q

Gabapentin and carbamazepine are sometimes used for the treatment of neuropathic pain. What other agent, used topically, can be used for neuropathic pain?What are the problems surrounding its use?

A

Capsaicin cream 0.075% - however it causes intense burning sensations during the initial treatment period.

95
Q

In autonomic neuropathy, diabetic diarrhoea can often be managed by what antibiotic in an unlicensed use?

A

tetracycline - but codeine phosphate is the best drug. Erthyromycin (esp IV) may be beneficial for gastroparesis [unlicensed use] but this needs confirmation.

96
Q

In neuropathic postural hypotension, increased salt intake and the [unlicensed] use of which mineralcorticoid may help?How may it help? What is the most common side effect?

A

Fludrocortisone acetate, increases the plasma volume but uncomfortable oedema is a common side effect.

97
Q

In neuropathic postural hypotension, increased salt intake and the unlicensed use of the mineralcorticoid fludrocortisone acetate can be useful. What else can fludrocortisone be combined with in this use?

A

Fludrocortisone + flurbiprofen and ephedrine hydrochloride [both also unlicensed].

98
Q

Midodrine can be useful in the treatment of which diabetic complication?

A

Postural hypotension but unlicensed. Alpha blocker.

99
Q

How can diabetic gustatory sweating be treated?

A

Antimuscarininc agents such as propantheline bromide.

100
Q

Nueropathic oedema can be relieved with the unlicensed use of what?

A

ephedrine hydrochloride.

101
Q

In DKA, in order to restore circulating fluid volume if the systolic blood pressure is below 90mmHg, what volume of which fluids should be given?Over what duration?

A

500mL sodium chloride 0.9% by IV infusion over 10-15 minutes. Repeated if BP remains below 90mmHg and seek senior medical advice.

102
Q

In DKA, when the blood pressure is >90mmHg, sodium chloride 0.9% should be given by IV infusion at what rate?

A

At a rate that replaces deficit and provides maintenance.

103
Q

In DKA, potassium chloride should be included in the fluids, except when what?

A

When anuria (non-passage of urine) is suspected.

104
Q

In DKA, an intravenous insulin infusion should be started. How is this done?

A

Soluble insulin diluted thoroughly with NaCl 0.9% IV infusion to a concentration of 1 unit/mL; infuse at a fixed rate of 0.1 units/kg/hour.

105
Q

Should established SC therapy with long-acting insulin analogues be continued during the treatment of DKA?

A

Yes. Can miss short acting tho.

106
Q

In DKA management, blood-ketone concentration should fall by at least what value each hour?

A

at least 0.5mmol/litre/hour

107
Q

In DKA management, blood-glucose concentration should fall by at least what value each hour?

A

at least 3 mmol/litre/hour

108
Q

In DKA management, when would 10% glucose be given by IV infusion? and at what rate?

A

When blood-glucose concentration falls below 14mmol/litre, at a rate of 125mL/hour alongside the NaCl 0.9% infusion.

109
Q

What is bromocriptine used for the treatment of? [3]

A

GalactorrhoeaProlactinomas (when it reduces both plasma prolactin concentration and tumour size)Acromegaly - sometimes as it inhibits the release of GH but somatostatin analogues (octreotide) are more effective.

110
Q

What can be used instead of bromocriptine?

A

Cabergoline or quinagolide (a non ergot-derived dopamine agonist)

111
Q

How does quinagolide differ to bromocriptine and cabergoline?

A

It is non-ergot derived so has different side effects.

112
Q

When is high glucocorticoid activity in itself of no advantage?

A

When it is NOT accompanied by low mineralcorticoid activity. For example, the mineralcorticoid activity of fludrocortisone acetate is so high that its anti-inflammatory activity is of no clinical relevance.

113
Q

The relatively high mineralcorticoid activity of hydrocortisone results in what?

A

Fluid retention - making it unsuitable for disease suppression on a long-term basis. IT can however be used for adrenal replacement therapy.

114
Q

Why is prednisolone the corticosteroid most commonly used by mouth for long-term disease suppression?

A

Prednisolone and prednisone have predominatly glucocorticoid activity.

115
Q

What is deflazacort?

A

A derivative of prednisolone with high glucocorticoid activity.

116
Q

What is danazol used to treat? [3]

A
  1. Endometriosis2. Relief of severe pain and tenderness in benign fibrocytic breast disease where other measures have proved unsatisfactory. 3. Long-term management of hereditary angioedema [unlicensed indication].
117
Q

What are cetrorelix and ganirelix?

A

LHRH antagonists, which inhibit the release of the gonadotrophins luteinising hormone and follicle stimulating hormone. They are used in the treatment of infertility by assisted reproductive techniques.

118
Q

What are cetrorelix and ganirelix used to treat?

A

LHRH antagonists, which inhibit the release of the gonadotrophins luteinising hormone and follicle stimulating hormone. They are used in the treatment of infertility by assisted reproductive techniques.

119
Q

Gonadorelin analogues are used in the treatment of [8]

A
  1. Endometriosis2. Precocious puberty 3. Infertility 4. Male hypersexuality with severe sexual deviation 5. Anaemia due to uterine fibroids (together with iron supplementation)6. Breast cancer7. Prostate cancer8. Before intra-uterine surgery: use of leuprorelin acetate and triptorelin for 3-4 months before surgery reduces the uterine volume, fibroid size and associated bleeding.
120
Q

How is mastalgia normally treated?

A

Most women will respond to reassurance and reduction in dietary fat; withdrawal or an oral contraceptive or of HRT. Danazol is licensed for the relief of severe pain and tenderness in benign fibrocystic breast disease which has not responded to other treatment. Tamoxifen may be a useful adjunct in the treatment of mastalgia.

121
Q

What are GlucoGel, Dextrogel, GSF-Syrup and Rapilose gel?

A

Proprietary products of quick-acting carbohydrate available on prescription for patients to keep on hand in case of hypoglycaemia.

122
Q

How is hypoglycaemia which causes unconsciousness treated?

A

If sugar cannot be given by mouth, glucagon (a polypeptide hormone produced by the alpha cells of islets of Langerhans which increases plasma-glucose concentration by mobilising glycogen stored in the liver) can be given by injection.

123
Q

What is diazoxide used for?

A

It is a drug which is useful in the management of patients with chronic hypoglycaemia from excess endogenous insulin secretion, either from an islet cell tumour or islet cell hyperplasia. IT has no place in the management of acute hypoglycaemia.

124
Q

Tetracosactide is an analogue of what? What is it used to test?

A

Tetracocsactide is an analogue of corticotropin (ACTH) and it is used to test adrenocortical function; failure of the plasma cortisol concentration to rise after administration of tetracosactide indicates adrenocortical insufficiency.

125
Q

FSH and LH together, FSH alone (as in follitropin), or chorionic gonadotrophin, are used in the treatment of what? [2]

A

Infertility in women with proven hypopituitarism or who have not responded to clomifene citrate OR in superovulation treatment for assisted conception.

126
Q

What is clomifene citrate?

A

It is an anti-oestrogen which induces gonadotrophin release by occupying oestrogen receptors in the hypothalamus, thereby interfering with feedback mechanisms, chorionic gonadotrophin is sometimes used as an adjunct

127
Q

What is growth hormone used to treat?

A
  1. GH deficiency in children and in adults. 2. Prader-Willi syndrome3. Turner syndrome 4. Chronic renal insufficiency5. Short children considered small for gestational age at birth, and short stature homeobox-containing gene (SHOX) deficiency.
128
Q

How can short stature homeobox-containing gene (SHOX) deficiency be treated?

A

Growth Hormone.

129
Q

Growth hormone of human origin (HGH; somatotrophin) has been replaced by what?

A

Growth hormone of human sequence, somatropin, produced using recombinant DNA technology.

130
Q

What is licensed to treat growth failure in children and adolescents with severe primary insulin-like growth factor-I deficiency?

A

Mecasermin, a human insulin-like growth factor-I (rhIGF-I).

131
Q

Gonadorelin analogues are indicated in what disease states and conditions?

A

EndometriosisInfertilityBreast and Prostate Cancer

132
Q

What is the natural profile of insulin secretion?

A

Basal insulin (low steady secretion of background insulin that controls the glucose continuously released from the liver) and meal-time bolus insulin (secreted in response to glucose absorbed from food and drink).

133
Q

Absorption of insulin is fastest where?

A

Abdomen, the outer thigh/buttocks is slower.

134
Q

How many different (broad) categories of insulin preparations are there? what are they?

A
  1. Short-acting (soluble insulin and long-acting insulins). Intermediate acting insulins. Long-acting insulins.
135
Q

What are some examples of short-acting insulin preparations?

A
  1. Soluble insulin (human, bovine or porcine)2. Rapid-acting insulin analogues such as aspart, glulisine and lispro.
136
Q

When is soluble insulin the most appropriate form of insulin?

A

For treatment of diabetic ketoacidosis and peri-operatively.

137
Q

What are some exampls of intermediate-acting insulins ?

A

Isophane insulin: a suspension of insulin with protamine

138
Q

Aspart, Glulisine and Lispro are what?

A

Rapid acting

139
Q

What are biphasic insulins?

A

They are pre-mixed insulin preperations containing various combinations of short-acting insulin (soluble insulin or rapid-acting analogue insulin) and an intermediate-acting insulin.

140
Q

When should biphasic insulins be administered?

A

Subcut injection immediately before a meal.

141
Q

What are some examples of the long-acting insulins?

A

Protamine zinc insulin Insulin zinc suspensionInsulin determir Insulin glargineinsulin degludec

142
Q

what is the method of action of long-acting insulin?

A

Mimic endogenous basal insulin secretion, but their duration of action may last up to 36 hours.

143
Q

How often is insulin detemir given?

A

once or twice daily.

144
Q

How often is insulin glargine or insulin degludec given?

A

once daily

145
Q

Insulin determir

A

Long acting

146
Q

Insulin glargine

A

Long acting

147
Q

What is vasopressin?

A

ADH, antidiuretic hormone.

148
Q

What is vasopressin used to treat?

A

Diabetes insipidus as is its analogue desmopressin. Dosage is tailored to produce a slight diuresis every 24 hours to avoid water intoxication. Treatment may be required for a limited period only in diabetes insipidus following trauma or pituitary surgery.

149
Q

How does desmopressin differ from vasopressin? [3]

A

Desmopressin is more potent, has a longer duration of action and has no vasoconstrictor effect.

150
Q

How and when is desmopressin given?

A

Desmopressin is given by mouth or intranassally for maintenance therapy, and by injection in the postoperative period or in unconscious patients.

151
Q

How can desmopressin be used in the differential diagnosis of diabetes insipidus?

A

A dose of desmopressin is given intramuscularly or intranasally, restoration of the ability to concentrate urine after water deprivation confirms a diagnosis of cranial diabetes insipidus. Failure to respond occurs in nephrogenic diabetes insipidus.

152
Q

In nephrogenic and partial pituitary diabetes insipidus benefit may be gained from the paradoxical antidiuretic effect of what?

A

Thiazides.

153
Q

The unlicensed use of carbamazepine is sometimes useful in partial pituitary diabetes insipidus, how may it act?

A

By sensitising the renal tubules to the action of remaining endogenous vasopressin.

154
Q

Desmopressin can be used to boost factor VIII concentration in mild to moderate haemophillia and in what other disease?

A

von Willebrand’s disease.

155
Q

Vasopressin infusion is used to control what complication of portal hypertension, prior to more definitive treatment?

A

Variceal bleeding.

156
Q

What is demeclocycline hydrochloride used in the treatment of?

A

Hyponatraemia resulting from inappropriate secretion of antidiuretic hormone, if fluid restriction alone does not restore sodium concentration or is not tolerable.

157
Q

What is tolvaptan?

A

A vasopressin V2-receptor antagonist licensed for the treatment of hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion; treatment duration with tolvapatan is determined by the underlying disease and its treatment.

158
Q

Oestrogen therapy is given cyclically or continuously for a number of gynaecological conditions. If long-term therapy is required in women with a uterus, what should normally be added to the regimen and why is this added?

A

A progestogen to reduce the risk of cystic hyperplasia of the endometrium and possible transformation to cancer.

159
Q

Why are oestrogens no longer used to suppress lactation?

A

Because of their association with thromboembolism.

160
Q

Menopausal atrophic vaginitis may respond to what?

A

A short course of a topical vaginal oestrogen preparation used for a few weeks and repeated if necessary.

161
Q

HRT using small doses of an oestrogen, together with a progestogen in women with a uterus, is appropriate for alleviating menopausal symptoms such as what?

A

Vaginal atrophy or vasomotor instability.

162
Q

What is tibolone used for? [2]

A

Used for short-term treatment of symptoms of oestrogen deficiency (including women being treated with gonadotrophin releasing hormone analogues).Also used for osteoporosis prophylaxis in women at high risk of fractures when other prophylaxis contra-indicated or not tolerated. 2.5mg daily. Unsuitable for use within 12 months of last menstrual period (may cause irregular bleeding).

163
Q

What is clonidine hydrochloride used for? [3]

A
  1. Reduction of vasomotor symptoms in women who cannot take an oestrogen but may cause unacceptable side effects.2. Hypertension: 10-100 micrograms 3 times a day, increase dose every second or third day, usual maximum dose 1.2mg daily. 3. Prevention of recurrent migraine: prevention of vascular headache: 50 micrograms twice daily for 2 weeks, then increased if necessary to 75 micrograms twice daily.
164
Q

What are the risks of HRT that patients should be aware of?

A

Increased risk of venous thromboembolism.Stroke. Endometrial cancer (reduced by a progestogen).Breast Cancer.Ovarian Cancer. CHD in women who start HRT more than 10 years after menopause.

165
Q

WRT to HRT, oestrogen alone is suitable for continous use in which patient group?

A

Women without a uterus, however, in endometriosis, endometrial foci may remain despite hysterectomy and the addition of a progestogen should be considered in these circumstances.

166
Q

What is ethinylestradiol licensed for the treatment of? [4]

A
  1. Short-term treatment of the symptoms of oestrogen deficiency.2. Osteoporosis prophylaxis if other drugs cannot be used.3. Treatment of female hypogonadism and menstrual disorders. 4. VERY OCCASSIONALY: under specialist supervision, for the management of hereditary haemorrhagic telangiectasia and the pallative treatment of prostate cancer.
167
Q

What is raloxifene hydrochloride licensed to treat?

A
  1. Treatment AND prevention of postmenopausal oseoporosis; unlike HRT, raloxifene hydrochloride does not reduce menopausal vasomotor symptoms [hot flashes and night sweats] Dose of 60mg once daily.
168
Q

Levonorgestrel is the active isomer of what?

A

Norgestrel (a testosterone analogue), levonorgestrel has twice the potency of norgestrel.

169
Q

Where endometriosis requires drug treatment, it may respond to what?

A

A progestogen such as norethisterone, administered on a continuous basis. Danazol and gonadorelin analogues are also available.

170
Q

What can ethinylestradiol be occasionally used to treat?

A

VERY OCCASSIONALY: under specialist supervision, for the management of hereditary haemorrhagic telangiectasia and the pallative treatment of prostate cancer.

171
Q

Although oral progestogens have been used widely for menorrhagia they are relatively ineffective compared with what?

A

Tranexamic acid or, particularly where dysmenorrhoea is also a factor, mefenamic acid; the levonorgestrel-releasing intrauterine system may be particularly useful for women also requiring contraception.

172
Q

In women with antiphospholipid antibody syndrome who have suffered recurrent miscarriage, administration of low-dose what and a prophylactic dose of what may decrease the risk of fetal loss?

A

low dose aspirin and low dose LMWH under specialist supervision.

173
Q

In women with a uterus why does a progestogen need to be added to long-term oestrogen therapy for HRT?

A

To prevent cystic hyperplasia of the endometrium and possible transformation to cancer; it can be added on a cyclical or a continuous basis. Combined packs incorporating suitable progestogen tablets are available.

174
Q

What is ulipristal acetate?

A

A progesterone receptor modulator with a partial progesterone antagonist effect. Ullipristal acetate is used in the pre-operative treatment of moderate to severe symptoms of uterine fibroids: it is also used as an hormonal emergency contraceptive.

175
Q

What is ulipristal acetate used for?

A

Pre-operative treatment of moderate to severe symptoms of uterine fibroids;it is also used as an hormonal emergency contraceptive. Short term for heavy menstrual bleeding associated with uterine fibroids of diameter of 3cm or more and a haemoglobin level of 102 g/litre or below; ulipristal acetate may also be considered if the haemoglobin level is greater than 102g/litre.

176
Q

What is the difference between liothyronine sodium and levothyroxine?

A

Liothyroxine has a similar action to levothyroxine but is more rapidly metabolised and has a more rapid effect.

It may be used in severe hypothyroid states when a rapid response is desired.

177
Q

A target HbA1c concentration of what or lower is recommended in patients with type 1 diabetes?

A

48mmol/mol (6.5%)

178
Q

Blood-glucose concetration should be monitored at least how often?

A

Four times a day.

179
Q

Diabetic patients should aim for a fasting blood-glucose concentration of what upon waking?

A

5-7mmol/litre fasting blood-glucose concentration on waking.

180
Q

Diabetic patients should aim for a blood-glucose concetration of what before meals and at other times of the day?

A

4-7mmol/litre before meals and at other times a day.

181
Q

Diabetic patients should aim for a blood-glucose concetration of what at least 90 minutes after eating?

A

5-9mmol/litre at least 90 minutes after eating.

182
Q

Diabetic patients should aim for a blood-glucose concentration of at least what when driving?

A

At least 5mmol/litre when driving.

183
Q

Patients with type 1 diabetes who have a BMI of what? or above who wish to improve their blood-glucose control while minimising their effective insulin dose, may benefit from metformin hydrochloride as an addition..

A

Patients who have a BMI of 25 kg/m2 or above (23 kg/m2 or above for patients of South Asian or related ethnicity) who wish to improve their blood-glucose control while minimising their effective insulin dose, may benefit from metformin hydrochloride [unlicensed indication] as an addition to insulin therapy.

184
Q

An insulin pump (continuous subcutaneous insulin infusion) contains what type of insulin?

A

Normally a rapid-acting insulin analogue or soluble insulin.

185
Q

Patients with type 1 diabetes should be offered what as first-line regimen?

A

Patients with type 1 diabetes should be offered multiple daily injection basal-bolus insulin regimens as the first-line choice.

186
Q

Patients with type 1 diabetes should be offered multiple daily injection basal-bolus insulin regimens as the first-line choice.

What should be offered as the long-acting basal insulin therapy?

A

Twice-daily insulin detemir should be offered as the long-acting insulin therapy.

187
Q

Patients with type 1 diabetes should be offered multiple daily injection basal-bolus insulin regimens as the first-line choice. Twice-daily insulin detemir should be offered as the long-acting basal insulin therapy.

What is an alternative once daily regimen?

A

Once-daily insulin glargine may be prescribed if insulin detemir is not tolerated, or if a twice-daily regimen is not acceptable to the patient. Insulin detemir may also be offered as an alternative once-daily regimen.

188
Q

Patients with type 1 diabetes should be offered multiple daily injection basal-bolus insulin regimens as the first-line choice. What type of insulin is recommended as the bolus or mealtime insulin replacement?

A

A rapid-acting insulin analogue is recommended as the bolus or mealtime insulin replacement, rather than soluble human insulin or animal insulin (rarely used). The rapid-acting insulin analogue should be injected before meals—routine use after meals should be discouraged. Patients who have a strong preference for an alternative mealtime insulin should be offered their preferred insulin.

189
Q

How can the use of beta blockers blunt hypoglycaemic awareness?

A

Reducing warning signs such as tremor.

190
Q

What are the characteristics of Metformin?

A

Metformin does not stimulate insulin increetion and therefore, when given alone, does not cause hypoglycaemia.

The dose of standard-release metformin should be increased gradually to minimise the risk of GI side effects.

191
Q

What are the characteristics of Sulfonylureas?

A

Glibenclamide, gliclazide, glimepiride, glipizide, tolbutamide.

May cause hypoglycaemia - more likely with long-acting sulfonylureas such as glibenclamide.

Associated with modest weight gain, probably due to increased plasma-insulin concentrations.

192
Q

Hypoglycaemia is more likely with long-acting sulfonylureas like what?

A

Glibenclamide.

193
Q

Why are sulfonylureas associated with modest weight gain?

A

Probably due to increased plasma-insulin concentrations.

194
Q

Nateglinide and repaglinide are what type of antidiabetic drug?

A

Meglitinide: rapid onset of action and short duration of activity.

195
Q

Pioglitazone is what yype of antidiabetic drug?

A

Thiazodinedione - associated with several long-term risks and its ongoing benefit to the patient should be reviewed regularly.

196
Q

How do sulfonylureas work?

A

They increase insulin release from beta cells in the pancreas.

They bind to and close ATP-sensitive K+ channels on the cell membrane of pancreatic beta cells.

197
Q

How do thiazolidinediones (also known as glitazones) work?

A

TZDs act by activating PPARs (perioxisome proliferator-activated receptors), a group of nuclear receptors, specific for PPARgamma.

The end result is an increase in the storage of fatty acids in adipocytes, thereby decreasing the amount of fatty acids present in circulation.

198
Q

How do meglitinides work?

A

Meglitinide bind to an ATP-dependent K+ channel on the cell membrane of pancreatic in a similar manner to sulfonylureas but have a weaker effect.

The end result is increased secretion of (pro) insulin.

199
Q

Whar side-effects are TZDs (glitazones) associated with?

A

Incidence of heart failure is increased when pioglitazone is combined with insulin.

Small increased risk of bladder cancer associated with pioglitazone use.

Fluid retention.

200
Q

What are the characteristics of dipeptidylpeptidase-4 inhibitors (gliptins)?

A

Do NOT appear to be associated with weight gain and have less incidence of hypoglycamia than sulfonylureas.

Example: alogliptin, linagliptin, sitagliptin, saxagliptin and vildagliptin.

201
Q

How do DPP-4 inhibitors/gliptins work?

A

DPP-4 inhibitors block the breakdown of incretin levels (GLP-1 and GIP), which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying and decreases blood glucose levels.

202
Q

A 2018 meta analysis showed that use of DPP-4 inhibitors was associated with a 58% increased risk of developing what compared with placebo or no treatment?

A

Acute pancreatitis.

203
Q

Canaglifozin, dapaglifozin and empaglifozin are examples of what?

A

Glifozins are doium glucose co-transporter 2 inhibitors - they are associated with a risk of diabetic ketoacidosis.

Increased risk also of UTI, candidal vulvovaginitis and low blood sugar.

Canaglifozin has a risk of lower limb amputation.

SGLT2 is responsible for ~90% of the kidney;s glucose reabsorption.

204
Q

What are examples of glucagon-like peptide-1 receptor agonists?

A 
Dulaglutide
Exenatide
Liraglutide 
Lixisenatide
Albiglutide
205
Q

How do GLP1 receptor agonists work?

A

They work via the same pathway as DPP-4 inhibitors but are generally considered to be more potent.

206
Q

What antidiabetic drug can be used in PCOS?

A

Metformin

207
Q

Target HbA1c in patients taking an antidiabetic drug not associated with hypo

A

48mmol/6.5%

208
Q

Target HbA1c in patients taking an antidiabetic drug associated with hypo

A

53mmol/7.0%

209
Q

Why is metformin first line?

A
  1. Weight loss
  2. Low risk of hypo
  3. long term benefits for cardio with long term treatment
210
Q

What should be the first intensificaton of treatment (already taking metformin) for elderly patients or those with renal impairment if a sulfonylurea is indicated?

A

Elderly patients or those with renal impairment are at particular risk of hypoglycaemia; if a sulfonylurea is indicated, a shorter-acting sulfonylurea, such as gliclazide or tolbutamide should be prescribed.

211
Q

GLP1 agonists should only be used in patients who

A
  1. have a BMI of 35 kg/m2 or above (adjusted for ethnicity) and
  2. who also have specific psychological or medical problems associated with obesity; or for those who have a BMI lower than 35 kg/m2 but for whom insulin therapy would have significant occupational implications or
  3. if the weight loss associated with glucagon-like peptide-1 receptor agonists would benefit other significant obesity-related comorbidities.
212
Q

GLP-1 use should be reviewed after how long?

A

6 months, must be a reduction of atleast 11mmol/mol (1.0%) in HbA1c AND a weight loss of at least 3% of initial body-weight.

213
Q

Men with a waist circumference >__cm (>__cm for Asian men), and women with a waist circumference >__cm are at increased risk of obesity related health problems.

A

Men with a waist circumference ≥ 94 cm (≥ 90 cm for Asian men), and women with a waist circumference of ≥ 80 cm are at increased risk of obesity-related health problems. A waist circumference of ≥ 102 cm in men and ≥ 88 cm in women indicates a very high risk of obesity-related health problems.

214
Q

An anti-obesity drug should be considered only for those with a BMI of ≥ __ kg/m2, in whom diet, exercise and behaviour changes fail to achieve a realistic reduction in weight. In the presence of associated risk factors

A

An anti-obesity drug should be considered only for those with a BMI of ≥ 30 kg/m2, in whom diet, exercise and behaviour changes fail to achieve a realistic reduction in weight. In the presence of associated risk factors

215
Q

Orlistat is licensed for use as an adjunct in the management of obesity in patients with a BMI of ≥ __ kg/m2, or, in individuals with a BMI of ≥ __ kg/m2 in the presence of other risk factors.

A

Orlistat is licensed for use as an adjunct in the management of obesity in patients with a BMI of ≥ 30 kg/m2, or, in individuals with a BMI of ≥ 28 kg/m2 in the presence of other risk factors.

216
Q

What are to drugs which produce a feeling of satiety?

A

Drugs which produce a feeling of satiety (such as methylcellulose and sterculia [unlicensed indications]) have been used in an attempt to control appetite, but there is little evidence for their efficacy

217
Q

Bariatric surgery may be considered for patients who have a BMI of ≥ __ kg/m2 (Obesity III, morbid obesity), or between __–__._ kg/m2 (Obesity II) and a significant disease (such as type 2 diabetes or high blood pressure) which could be improved with weight loss, and if all appropriate non-surgical measures have been tried but clinically beneficial weight loss has not been achieved or maintained.

A

Bariatric surgery may be considered for patients who have a BMI of ≥ 40 kg/m2 (Obesity III, morbid obesity), or between 35–39.9 kg/m2 (Obesity II) and a significant disease (such as type 2 diabetes or high blood pressure) which could be improved with weight loss, and if all appropriate non-surgical measures have been tried but clinically beneficial weight loss has not been achieved or maintained.

BNF/Pre-Reg 2017-2018 U (144 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions