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AKT > Endocrine > Flashcards

Endocrine Flashcards

1
Q

1st line treatment for diabetes (hbA1c aim)
- some benefits
- caution
- what if rapid response is needed

What if CI

A

Metformin, aiming 48- if rises to 58 on 3 months, add
- sick day rules, reduces certain cancer risks
- avoid if egfr <30, caution if <45
- glicazide if rapid response needed

Hypo drug or dual agent = 53

Consider SGLT2 in HF
Other patients is either a DDP4, SU or pioglitazone

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2
Q

What are Sitagliptin, Linagliptin examples of
- some benefits + risks

What are exenatide + linaglitide

A

DPP4 inhibitors
- no hypos + weight neutral
- avoid in pancreatitis
- Linagliptin good in renal impairment and pregnancy

GLP-1 inhibiors
- np hypos, reduce appetite, weight loss advantage in BMI >30
- pancreatitis risk, spenny injection

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3
Q

Glicazide. + Pioglitazone

A

SU
- rapid improvement, cheap
- HYPO RISK, weight gain

Thiazolidnones
- no hypos
- weight gain, avoid HF, # risk
- risk of getting bladder ca

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4
Q

Dapaglifozine, Empaglifozin

A

SGLT2 inhibitor
- no hypo, weight loss
- Diuretic gives CV benefit
Good in CKD + HF (add in as soon at metformin tolerated)

Rex : Sick day rules, avoid ever <60, UTIs, thrush, distal limb ischaemia, Fournier gangrene, DKA

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5
Q

When would you consider stepping up to insulin
What are the requirements
How should you change dose for low BMs, or high

Do you give a long side metformin

A

If no response on 2 or more drugs (targets <53) every 3 months
0.5 - 1 units/kg - if really low requirement ?MODY 3
Honeymoon period at T1DM often have low requirements initially
10% up if raise
20 % down if hypos

Yes e.g long acting insulin with metformin
Or in T1 basal-bolus of insulin but with metformin if bmi >25

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6
Q

What are the HBA1c targets in
- lifestyle/ single drug
- in 2 drugs

A
  • 48 (6.5%)
  • 53 (7%)
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7
Q

What primary prevention who you consider in diabetics

A

Atrovstatin 20mg in those disease >10years or QRISK >10%
ACE i if hypertensive or ACR >3

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8
Q

Pregnancy advice for those with diabetes

A

5mg folic acid till 12 weeks
Only drugs allowed are metformin and insulin
STOP ACe i and statins
Aspirin from 12 weeks to reduce pre-eclampsia
Additional hearts an at 20weeks

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9
Q

What is risk factors and then the work up for gestational diabetes
Is glibenclamide an option

When tested if hx of gestatsional diabetes

follow up

A

BMI >30, previous big baby, family history, high risk ethnicity
OGTT is offered at booking appointment for 24-28 weeks ( positive is FG >5.6, 2hour GT >7.8)
If really high (FG >7 or macrosomia) start insulin +/- metformin
Advised monitoring

Yes, only if can’t tolerate metformin

Tested straight away

Fasting plasma glucose check at 6–13w post-delivery

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10
Q

ABPI where caludication might be present
diabetes

A

<0.5
>1.4 - calcification

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11
Q

What further Ix should you do at a Na of 129

A

d/w medics
serum osmo - >275 ?hyperglycaemia
urine osmo <100 - primary polydipisa, high water and toast intake
urine na

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12
Q

results indicating SIADH
some drug causes

A

low serum osmo + Na
high urine osmo + na

Anti - Ds = SSRIs,, amitriptyline,
anti - E = lamotrigine, valproate, carbamaazpine
cardio - amiordarone, fibrates
others = desmopressin, PPI, ectasy,

Diuretics - more hypovolemic

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13
Q

diabetes inspidus
- different between cranial and renal
- causes of both

another ddx cause of hypernatremia

A
  • cranial (works with desmopressin) - tumour, wolfrans, sheehans
  • renal needs thiazide or amiloride - congeneital, hypercalacemia, hypokalaemia, chronic renal disease, lithium, demoolocyline

Dehydration

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14
Q

Differences between a neuropathic and vascular ulcer
- diabetics often have coexisting peripheral neuropathy and peripheral vascular disease

A

N = warm foot, pressure points, pulses good, normal ABPI, painless, punched out

V = cool foot, absent pulses, reduced or high ABPI, at extremities (between toes), painful

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15
Q

Classification of retinopathy
- treatment

Other bits of diabetic eye
- x 4

A

Non - proliferative
- aneurysm (blocked swollen vessels), exudate (leaky vessles)

Proliferative
- new vessels

Maculopathy
- invloves the macula

Laser treatment haunts progression but doesn’t restore vision

Cataract
Glaucoma (not increase risk compared to general pop)
Retinal detachment
Ocular nerve palsies

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16
Q

How many diabetics are effected by polyneuropathy

A

40-50%
Optimise blood glucose in key

Can’t be reverse but amyotrophy (muscle wasting) is reversible with better blood sugar control

17
Q

Rules for driving on insulin

A

Have to inform the DVLA (not if only short term e.g. 3months or pregnancy)
1 severe (ie need help) hypo - tell DVLA, 3months off
Should take a blood sugar 2 hour before and 2hour into drive

18
Q

What BMI is overweight
What BMI is obese

A

> 25
30

19
Q

Drug causes of obesity

A

Steroids, antipyschotics, contraceptives esp depot, SUs, insulin

20
Q

Obesity aims of treatment

A

Aim to loose 0.5-1kg/week - target BMI 25

Orlistat - BM >30 or BM >28 with co-morb (BP, DM)
- 3months review, aim 5% weight loss

Surgery - >BMI 40 or 34 with condition that could be improved with weight loss

21
Q

Meningitis
- tx
- prophylaxis

A

Benpen 1.2g IM, 600mg <9year, 300mg <1yr (ceftriaxon is alternative for pen)

Prophylaxis is oral ciprofloxacin 500mg single dose or rifampicin 600mg BD or may be used

22
Q

What levels of hyponatremia would you do emergency admission
Or discuss with medics

A

<125
125-129

23
Q

What drugs cause hyponatremia

A

Diuretics - thiazides mostly, indapamide + hydrochlothiaizide
- loops not as bad, but if given along ACE or spur
SSRI and carbamazepine

Less so - PPI, antipsychotics, TCAs, opiates, NSAIDs, ACEi

24
Q

What are some causes of spurious hyperNa

A

Hyperglycaemia (serum osmo high)
High proteins e.g. paraproteinuria in myeloma
Lipids e.g. triglycerides

25
Q

If suspects SIADH - what biochemistry are you expecting

Causes

A

Low serum Na
Serum osmo <275
High urine Na
High urine osmo

Malignancy - lung (SCLC), gastric, urinary, lymphoma, sarcoma
Resp - Pneumonia, TB, asthma
Neuro - stork, tumour, meningitis
Endo - hypothyroid

26
Q

Mild hypo (130-135)
- reviews meds, when repeating

A

2 weeks with osmolalities

27
Q

Differentials for hypovolaemic hyponatraemia

A

GI loses, sweating, renal losses (dieurtics)
Primary adrenal insufficiency (raised K, raised urinary excretion of Na)
Third space los - sepsis, pancreatitis, GI obstruction

28
Q

Hypernatraemia numbers - commoners cause

A

> 160 = emergency admission
150-159 = specialist advice
145 = managed primary care

Dehydration
- serum osmo high too is gold standard

29
Q

What other causes of hypernatreamia

A

Dehydration, diarrhoea - ask in history. Stop dieurtics, encourage fluids
Euvoleic - diabetes insidious? (Cranial +ve suppression test, or renal = thiazide)
Hypervolaemic = conns/hyperaldosteormi, too much fluid

30
Q

What are some of the drugs causes of hyperkalaemia

A

NSAIDs
ACE/ARB
Heparin
Trimethoprim, co-trimazole
Laxatives - macrogel
Spironolactone, Eplerenone

(BB + dig tox can potentate risk too)

31
Q

If mod k (numbers)
- what are you doing
- what in mild

A

6 - 6.4 = rpt in 24hours, admit if unwell
5.5 - 5.9 = rpt in 2 weeks if well, if AKI or unexpected, r/v and rpt in 3 days

32
Q

In hypokalaemia - what levels are you thinking admission for IV

What is treatment plan in mild

A

<2.5 = admit!, 2.5-3 = r/v + most likely admit as will need IV

3.1 - 3.5 = rpt in 3 days, review meds
Only really giving supplements in stable causes such as stoma output

33
Q

Main causes of hypokalaemia

A

Fluid loss

Loop, thiazide, insulin, salbutamol, ripserdone, quetiapine, theophylline, corticosteroids, excessive laxative use

Hypomagnesioa ! In 40% - alcoholics, chronic diarrhoea, PPI

34
Q

Some food sources of K

A

Mackerel, crisps, liquorice, honey dew melon, banana, mild chocolate

35
Q

Most appropriate screening test for primary hyperaldosteron

  • hypokalaemia, hypertension
A

Spot renin and aldosterone level

Salin surpression is confirmatory
CT for ?adenoma or hyperplasia

36
Q

test for ?cushing syndrom
- what is ?cushing disease

A

high dose dex for disease

AKT (14 decks)

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