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Pharmacy > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what is the treatment choice for diabetes insipidus?

A

desmopressin - causes you to pee less but more concentrated

(can cause hyponatraemia, nausea)

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2
Q

what are the treatment options for SIADH?

A

tolvaptan, demeclocycline

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3
Q

what happens when you correct sodium too quickly?

A

osmotic demyelination syndrome

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4
Q

what are the risk factors for osteoporosis?

A

postmenopausal women, men over 50, smoking, excess alcohol, vitamin D deficiency, low calcium intake, low BMI

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5
Q

what treatments are first line for patients with osteoporosis?

A

-alendronic acid
-risedronate

** ibandronic acid may also be appropriate

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6
Q

for patients with osteoporosis who cannot tolerate oral bisphosphonates, what would be a suitable alternative?

A

-parenteral bisphosphonates (zolendronic acid)
-denosumab

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7
Q

when would tibolone be recommended for treatment of osteoporosis?

A

younger postmenopausal women women with menopausal symptoms

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8
Q

how long after treatment with alendronic acid, should it be reviewed to possibly stop?

A

5 years

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9
Q

what are the three MHRA alerts for all bisphosphonates?

A

osteonecrosis of the jaw
osteonecrosis of the auditory canal
atypical femoral fracture

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10
Q

what are the counselling points for alendronic acid?

A

-take with a full glass of water
-swallowed whole
-taken on an empty stomach
-taken while sitting upright or standing - and continue for 30 minutes after
-taken once a week (women) - same day each week

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11
Q

how often is zolendronic acid given for osteoporosis?

A

IV - once yearly

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12
Q

how long is denosumab given for osteoporosis?

A

SC - every 6 months

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13
Q

What are the MHRA alerts for denosumab?

A

-osteonecrosis of the jaw
-osteonecrosis of the auditory canal
-atypical femoral fracture
-rebound hypercalcaemia
-multiple vertebral fractures

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14
Q

which corticosteroid has the highest mineralocorticoid (aldosterone) activity?

A

fludrocortisone

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15
Q

which corticosteroids have the highest glucocorticoid (cortisol) activity?

A

dexamethasone, betamethasone

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16
Q

what effect do mineralocorticoids have on the body?

A

fluid retention, increase BP, hypokalaemia, hypocalcaemia

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17
Q

what effects do glucocorticoids have on the body?

A

anti-inflammatory, osteoporosis, diabetes, muscle wasting, gastric ulceration

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18
Q

what are the side effects of corticosteroids?

A

chorioretinopathy, psychiatric reactions, adrenal suppression, immunosuppression, insomnia, stunted growth, skin thinning, cushingoid symptoms

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19
Q

what are the causes of adrenal insufficiency?

A

addison’s disease, congenital adrenal hyperplasia, secondary causes

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20
Q

list the potency of topical corticosteroids?

A

Mild: hydrocortisone
Moderate: clobetasone
Potent: betamethasone
Very Potent: clobetasol

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21
Q

when should you do a reducing course of steroids?

A

40mg + prednisolone > 1 week
repeat evening doses
> 3 weeks treatment
repeated courses
short course within 1 year of stopping long term therapy
adrenal suppression

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22
Q

patients who are diabetic and driving, should check their blood glucose levels how regularly?

A

2 hourly

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23
Q

for patients with diabetes, blood glucose levels should always be above what to drive?

A

5

if between 4-5, a snack should be taken
if below 4, pull over

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24
Q

what are the sick day rules for type 1 diabetics?

A

monitor sugar levels regularly
continue insulin
eat and keep hydrated
test ketones regularly

SEEK HELP IF:
pregnant
high BG levels
drowsy/ breathless
vomiting/ diarrhoea
abdo pain

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25
Q

What is the advice for managing T1DM patients during surgery?

A

MINOR SURGERY: reduce long acting insulin by 20%

MAJOR SURGERY:
reduce long acting insulin by 20%
and on day of surgery:
stop until pt eating
IV KCl + glucose + NaCl
IV insulin in NaCl (soluble insulin)
hourly BG measurements
IV glucose 20% if > 6mmol/L

POST SURGERY:
SC insulin when eating
restart with first meal
long acting 20% reduced until patient discharged

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26
Q

what are the features of diagnosis in T1DM?

A

hyperglycaemia (>11mmol/L)
ketosis
weight loss
BMI < 25
age < 50
family history

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27
Q

how often should blood glucose be monitored in T1DM?

A

4 times daily

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28
Q

what are the BG targets for T1DM?

A

waking (fasting) 5 -7 mmol/L
before meals 4 - 7 mmol/L
after eating 5 - 9 mmol/L
driving > 5 mmol/L

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29
Q

what are first line options for insulin for a basal-bolus regime in T1DM?

A

1st detemir
2nd glargine

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30
Q

name the short acting insulin?

A

soluble insulin (human OR bovine/porcine)

BRANDS: humulin S, insuman, hypurin soluble, actrapid

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31
Q

when should you administer short acting insulins?

A

15-30 minutes before food

onset: 30-60 minutes
peak: 1-4 hours
duration: up to 9 hours

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32
Q

name the rapid acting insulins?

A

lispro
aspart
glulisine

BRANDS: apidra, novorapid, lispro, aspart, fiasp

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33
Q

when should you administer rapid acting insulins?

A

immediately before meals

onset: <15 mins
duration: 2-5 hours

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34
Q

name the intermediate acting insulins?

A

isophane

BRANDS: insulatard, humulin I, insuman basal, hypurin isophane

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35
Q

when should you administer intermediate acting insuin?

A

onset: 1-2 hours
peak: 3-12 hours
duration: 11-24 hours

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36
Q

name the long acting insulins?

A

detemir
degludec
glargine

BRANDS: tresiba, lantus, toujeo, levemir

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37
Q

when should you administer long acting insulins?

A

once daily
(twice daily for detemir)

onset: 2-4 days for steady state
duration: 36 hours

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38
Q

what are the symptoms of DKA?

A

polyurea
thirst
fruity breathe
deep, fast breathing
lethargy
confusion

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39
Q

how is DKA diagnosed?

A

if BG > 11mmol/L test ketones:
0.6-1.5 retest in 24 hours
1.6-2.9 GP
>3 medical emergency

40
Q

how do you manage DKA?

A

BP < 90 restore volume (500ml NaCl)
BP > 90 maintenance IV NaCl

start IV insulin (soluble) in NaCl at rate so that:
ketones fall at 0.5mmol/L/hr
BG falls at 3mmol/L/hr

when BG <14 start IV glucose 10%

continue insulin until:
ketones < 0.3
pH > 7.3

STOP treatment 1 hour after first meal

41
Q

what are the symptoms of a hypo?

A

sweating
lethargic
dizziness
hunger
tremor
palpitations
pale
extreme moods

42
Q

how do you diagnose a hypo?

A

BG < 4 mmol/L

43
Q

How do you treat a hypo in patients who can swallow?

A

fast-acting carbohydrate:
4-5 glucose tablets
3-4 teaspoons of sugar
200ml fruit juice
glucose 40% gels

Can repeat after 15 minutes up to 3 times

Once BG > 4, give a longer acting carbohydrate

44
Q

How do you manage a patient who has been treated 3 times with short acting carbohydrates and whose BG are still below 4?

A

IM glucagon
IV glucose 10%

45
Q

what are the medications for type 2 diabetes?

A

metformin (biguanides)
sulfonylureas
DPP-4 inhibitors
SGLT 2 inhibitors
GLP 1 agonists
Pioglitazone

46
Q

what is the mechanism of action of metformin?

A

reduced gluconeogenesis and increase the peripheral use of glucose

47
Q

what is the max daily dose of metformin

A

2g

48
Q

what are the side effects of metformin?

A

lactic acidosis
GI
reduced B12

49
Q

what is the renal cut off for metformin?

A

30ml/min

50
Q

what are the benefits of treatment with metformin?

A

weight loss and cardiovascular benefit

51
Q

name the sulfonylureas?

A

glibenclamide, gliclazide, glimepiride, tolbutamide, glipizide

52
Q

which of the sulfonylureas has the longest duration of action and is therefore associated with he greatest hypo risk?

A

glibenclamide

53
Q

what is the mechanism of action of the sulfonylureas?

A

stimulate beta cell insulin secretion in the pancreas

54
Q

what are the side effects of the sulfonylureas?

A

hypos
acute porphryia

55
Q

what are the side effects of the sulfonylureas?

A

hypos
acute porphyria
hepatic and renal failure

56
Q

what effect do sulfonylureas have on weight?

A

weight gain

57
Q

name the DPP-4 inhibitors?

A

alogliptin, linagliptin, sitagliptin, saxagliptin, vildagliptin

58
Q

which of the DPP-4 inhibitors is associated with hepatotoxicity?

A

vildagliptin

59
Q

what is the mechanism of action of the DPP-4 inhibitors?

A

increase insulin secretion, and decrease glucagon

60
Q

what effect do DPP-4 inhibitors have on weight?

A

weight neutral

61
Q

which DPP-4 inhibitors do not need dose reductions in renal impairment?

A

linagliptin

62
Q

what are the side effects of he DPP-4 inhibitors?

A

pancreatitis

63
Q

name the SGLT-2 inhibitors?

A

canagliflozin
dapagliflozin
empagliflozin

64
Q

what is the mechanism of action of the SGLT-2 inhibitors?

A

inhibits SGLT-2 in renal proximal convoluted tubule
(excrete more glucose in urine)

65
Q

what is the renal cut off for the SGLT-2 inhibitors?

A

60 (when used for diabetes)

66
Q

what effect does SGLT-2 inhibitors have on weight?

A

weight loss

67
Q

what is the MHRA alert specific to canagliflozin?

A

lower limb amputation

68
Q

what are the MHRA alerts for all SGLT-2 inhibitors?

A

DKA risk
Fourniers gangrene

69
Q

name the GLP-1 agonists?

A

dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide

70
Q

what is the mechanism of action of the GLP-1 agonists?

A

increase insulin secretion and reduced glucagon secretion, slows gastric emptying

71
Q

what effect for the GLP-1 agonists have on weight?

A

weight loss

72
Q

what is the mechanism of action of pioglitazone?

A

reduces peripheral insulin resistance

73
Q

what effect does pioglitazone have on weight?

A

weight gain

74
Q

what are the MHRA alerts for pioglitazone?

A

bladder cancer
heart failure

75
Q

what should pioglitazone not be used alongside in triple therapy?

A

dapagliflozin

76
Q

how do you manage diabetes in pregnancy?

A

stop oral antidiabetics except metformin
replace with insulin
folic acid 5mg daily
aim for HbA1c < 48

77
Q

what is defined as pre-diabetic?

A

HbA1c 42-47 mmol/mol

78
Q

what is defined as diabetic?

A

HbA1c > 48 mmol/mol

79
Q

what is the HbA1c target for a patient who is at risk of a hypo?

A

53mmol/L

80
Q

define a hypo?

A

< 4mmol/L

81
Q

what type of HRT has an increased risk of breast cancer?

A

combined HRT (oestrogen and progesterone)
greater than oestrogen alone

82
Q

why is progesterone given alongside oestrogen in HRT?

A

reduces the risk of endometrial cancer when given cyclically (eg 10 days out of 28 day cycle)

83
Q

which HRT is not suitable for women in the perimenopausal period or up to 1 year after their last period?

A

combined and tibolone

84
Q

what options are available for patients with menorrhagia?

A

levonorgestrel releasing IUD
tranexamic acid
NSAID
cyclical progesterone

85
Q

what are the symptoms oh hyperthyroidism?

A

goitre
hyperactivity
disturbed sleep
fatigue
palpitations
anxiety
heat intolerance
increased appetite
weight loss
diarrhoea

86
Q

what is the main cause of primary hyperthyroidism?

A

graves disease

87
Q

define hyperthyroidism?

A

Low TSH
High T4

Subclinical hyperthyroidism:
Low TSH
Normal T4

88
Q

what is first line for hyperthyroidism?

A

carbimazole

89
Q

what is second line for hyperthyroidism?

A

propylthiouracil

when carbimazole not tolerated

90
Q

what are the three MHRA alerts for carbimazole?

A

neutropenia and agranulocytosis
congenital malformations
acute pancreatitis

91
Q

which anti-thyroid medication is not suitable for the block and replace regime?

A

propylthiouracil

92
Q

what are the symptoms of hypothyroidism?

A

fatigue
weight gain
constipation
menstrual irregularities
depression
dry skin
cold intolerance
reduced body and scalp hair

93
Q

define hypothyroidism?

A

High TSH
Low T4

Subclinical hypothyroidism:
High TSH
Normal T4

94
Q

what is the drug of choice for hypothyroidism?

A

levothyroxine

95
Q

how regularly should TSH levels be monitored in hypothyroidism?

A

3 monthly until stable
annually thereafter

96
Q

what is the MHRA alert for levothyroxine?

A

some patients experience symptoms when switching between levothyroxine products

97
Q

what are the counselling points for administration of levothyroxine?

A

take in the morning
30-60 minutes before food, caffeine containing liquids and other medications

Pharmacy (20 decks)

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