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GPhC Exam Revision > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is diabetes insipidus and what are the two causes?

A
  • DI is where large amounts of dilute urine are produced, causing extreme thirst.
  • Happens when hypothalamus does not make enough ADH (Cranial).
  • Or when kidneys do not respond to ADH (Nephrogenic)
  • Cranial treated with desmopressin or vasopressin
  • Nephrogenic treated with paradoxical effect of TLDs
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2
Q

What is the main side effect of desmopressin?

A

-Hyponatraemia

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3
Q

Describe syndrome of inappropriate ADH secretion

A
  • Opposite of DI: Too much ADH is produced causing hyponatraemia
  • Treated with fluid restriction, demeclocycline or vasopressin antagonist (tolvaptan)
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4
Q

What are the main side effects of mineralocorticoids?

A
  • Water and sodium retention = hypertension
  • Hypokalaemia
  • Hypocalcaemia
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5
Q

Which steroids have the most glucocorticoid and mineralocorticoid effect?

A
  • Fludrocortisone has most mineral
  • Dexamethasone and betamethasone have most gluco
  • Hydrocortisone has useful amount of both
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6
Q

Outline the main CCS side effects

A
  • Diabetes and hyperglycaemia
  • Osteoporosis
  • Muscle wasting
  • GI issues
  • Psychiatric reactions
  • Immunosuppression
  • Adrenal suppression (Adrenal gland stops making its own steroids)
  • Ophthalmic issues
  • Skin thinning
  • Growth restriction
  • Cushings syndrome
  • Increased appetite and weight gain
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7
Q

In what circumstances should CCS be gradually withdrawn?

A
  • More than 3 weeks use
  • More than 40mg daily for 1 week
  • Repeat evening doses
  • Recent repeated courses
  • Short course within 1 year of stopping long term therapy
  • If adrenal suppression occurs
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8
Q

Describe Addison’s disease

A
  • Low cortisol and aldosterone levels
  • Replacement with hydrocortisone and fludrocortisone necessary
  • Hydrocortisone given BD: higher in morning and lower in evening
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9
Q

Describe Cushing’s syndrome

A
  • Opposite of Addison’s: Hypercortisol

- Treatment is with ketoconazole or metyrapone (cortisol inhibitor)

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10
Q

Outline DKA and symptoms

A
  • When blood glucose and blood ketones are very high
  • Symptoms are: Pear-drop breath, ketonuria, thirst, polyuria, confusion, drowsiness, etc.
  • Treated with soluble insulin and fluids
  • Potassium given unless anuria
  • Established long acting insulins are continued
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11
Q

Outline the rules for driving and blood glucose

A
  • Check BG less than 2 hours before journey and every 2 hours during journey
  • If over 5 then safe to drive. If less than 5 then eat carb before driving. If less than 4 then do not drive.
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12
Q

Which insulins are rapid acting?

A
  • Aspart (Novorapid)
  • Lispro (Humalog)
  • Glulisine (Apidra)
  • Take just before or after a meal*
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13
Q

Which insulins are short acting?

A
  • Insulin
  • Actrapid, Humulin S, Insuman rapid, HPN, HBN
  • Take 30 minutes before food
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14
Q

Which insulins are intermediate acting?

A
  • Isophane insulin
  • Insulatard, Humulin I, HBI, HPI, Insuman basal
  • Usually given 30-60 minutes before food
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15
Q

Which insulins are long acting?

A
  • Glargine (Lantus)
  • Detemir (Levemir)
  • Degludec (Tresiba)
  • Used once daily, except Levemir which is once or twice daily*
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16
Q

Outline a basal-bolus insulin regimen

A

-Short/rapid acting insulin before meals (Bolus) and intermediate/long acting once or twice daily (Basal)

17
Q

Outline a biphasic insulin regimen

A
  • Short/rapid insulin pre-mixed with intermediate/long insulin
  • Given once or twice daily before meals
  • Not suitable if changing requirements
18
Q

Outline long/intermediate insulin regimen

A
  • Long/intermediate given once or twice daily
  • Used with or without rapid/short acting insulins before meals
  • Not routinely used in type 1
19
Q

What insulin regimens are preferred in Type 1 and 2 diabetes?

A
  • Basal/bolus preferred in type 1

- Isophane and short acting preferred in type 2 as biphasic or basal/bolus.

20
Q

What are sick day rules for diabetics

A
  • Monitor BG and blood and urine ketones every 3-4 hours, even at night
  • If blood ketones >3 or urine >2 then contact GP
21
Q

Describe metformin

A 
CV benefit: Yes
Hypo risk: Low
Weight: Decrease 
RI: Avoid if <30, max dose 2g in 45-49
Warnings: Lactic acidosis, anaesthesia, contrast media
22
Q

Describe sulphonylureas

A 
CV benefit: No
Hypo risk: High
Weight: Gain
RI: Caution (Increased hypo risk)
Warnings: Gliben and glimep are longer acting
23
Q

Describe pioglitazone

A

CV benefit: Probable (but fluid retention)
Hypo risk: Low
Weight: Gain
RI: Dose unchanged
Warnings: Heart failure, Bladder Cancer (do not use w/ dapa), Hepatotoxicity, fractures

24
Q

Describe SGLT2Is

A

CV benefit: Yes
Hypo risk: Low
Weight: Decrease
RI: Avoid initiation if <60, stop if often <45
Warnings: Atypical DKA, Volume depletion, lower limb amputation, Fournier’s gangrene, UTI/GUIs

25
Q

Describe DPP4Is

A 
CV benefit: No
Hypo risk: Low
Weight: Neutral 
RI: reduce dose 
Warnings: Pancreatitis, hepatotoxicity
26
Q

Describe GLP1As

A 
CV benefit: Yes
Hypo risk: Low
Weight: Decrease 
RI: avoid if <30
Warnings: DKA if concomitant insulin rapidly withdrawn, Pancreatitis, effective contraception required
27
Q

Describe HbA1c targets in type 2 diabetes?

A
  • Aim for <48(6.5%) if diet controlled or on a single agent
  • Intensify treatment if HbA1c rises to 58 (7.5%)
  • If on multiple meds then aim for 53(7%)
28
Q

Outline daily BG targets

A

Before meals: 4-7
After meals: 5-9
Bedtime: 6-8
Monitor BG: at least 5 times daily

29
Q

What is the HbA1c target in type 1 diabetes?

A

<58 (7.5%)

30
Q

What are the symptoms of hypoglycaemia?

A
  • Tingling lips
  • Pale
  • Sweats and shakes
  • Dizziness
  • Palpitations and tachyC
  • Hunger
  • Anxiety and tremor
  • Drunk behaviour
  • BG<4
31
Q

How is hypoglycaemia treated?

A
  • If conscious: 15-20g rapid acting carbs (100-200ml coke, 50-100ml lucozade, 2-4tsp sugar, 2 tubes glucogel, 4-6 glucose tabs, etc)
  • Retest after 10-15 mins
  • Repeat if BG<4. If >4 then give long acting carb
32
Q

What form of HRT are women who have had a hysterectomy (no womb/uterus) given?

A

-Continuous oestrogen only HRT

33
Q

What form of HRT are women with a uterus given and why?

A
  • Cyclical or continuous combined HRT
  • This is because oestrogen thickens the endometrial lining (Not present if hysterectomy) and progestogens reduce this effect
  • Ci pre-menopause
34
Q

Outline the risks of Cancer with HRT

A
  • All HRT increases risk of breast and Ovarian Cancer
  • Oestrogen only HRT increases risk of endometrial cancer
  • Combined HRT decreases risk of endometrial cancer
35
Q

What blood tests signify hyperthyroidism?

A
  • Increased T3 and T4

- Decreased TSH (Caused by negative feedback)

36
Q

What blood tests signify hypothyroidism?

A
  • Decreased T3 and T4

- Increased TSH

37
Q

How is hyperthyroidism treated in pregnancy?

A
  • Propylthiouracil in first T

- Carbimazole in 2nd T

GPhC Exam Revision (9 decks)

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