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Random Pre Reg Questions > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Treatment of cranial diabetes insipidus

A

Vasopressin
Desmopressin

ADH drugs

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2
Q

Treatment of nephrogenic diabetes insipidus

A

Carbamazapine
Thiazide diuretics - paradoxical effects
Oxytocin

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3
Q

Side effect of desmopressin

A

HypONatraemic convulsions

due to extreme dilution of water

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4
Q

When to inform DVLA of diabetes

A
  • All drivers treated with insulin must inform DVLA
  • Drivers to notify DVLA if the have episodes of hypoglycaemia
  • Drugs with greatest risk of hypoglycaemias: insulin, sulphonylurea, meglitinides
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5
Q

DVLA advice with diabetes

Target blood glucose while driving

A
  • Avoid hypoglycaemia and know warning signs & actions to take
  • Carry glucose meter & test strips when driving
  • Check blood glucose at least 2 hours before driving and every 2 hours while driving
  • Blood glucose should always be >5 mmol/L while driving
  • Take snack if blood glucose falls to or below 5 mmol/L
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6
Q

What to do if blood glucose goes below 5 mmol/L while driving

A
  • STOP vehicle in safe place
  • Switch off engine
  • Eat or drink suitable source of sugar
  • Wait until 45 minutes after blood glucose is normal
  • Continue journey
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7
Q

Advice on alcohol consumption with diabetes

A
  • Alcohol can mask the signs of hypoglycaemia
  • Drink in moderation and with food
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8
Q

Symptoms of hypoglycaemia

A
  • Confusion, unconsciousness, change of behaviour
  • Difficulty concentrating
  • Slurring speech & convulsions
  • Hunger
  • Palpitations (tachycardia)
  • Shaking and trembling
  • Sweating
  • Double vision
  • Headache
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9
Q

What is the oral glucose tolerance test used to test for?

How is it carried out?

A
  • Establish gestational diabetes
  • Diagnose impaired glucose tolerance
  • Involves measuring blood glucose conc after fasting for 8 hours and then 2 hours after drinking a standard anhydrous glucose drink

Not for testing diabetes

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10
Q

What is HbA1c?

What’s it used for?
when is it performed?

A
  • Test for red blood cells with glucose linked
  • Used to diagnose Type 2 diabetes ONLY
  • How well you’ve been controlling blood sugar in the past 2-3 months in type 1 and type 2
  • Predict microvascular and macro vascular complications and mortality

Performed at anytime of the day and doesn’t require any special preparation

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11
Q

When won’t you use HbA1c in diagnosing diabetes

A
  • Type 1 diabetes
  • In children
  • During pregnancy
  • Women up to 2 months postpartum
  • Symptoms < 2 months
  • Treatment with meds that can cause hyperglycaemia, pancreatic damage, CKD, HIV
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12
Q

How often should you monitor HbA1c in diabetics

A
  • Type 1: every 3-6 months (more frequently if blood glucose changing rapidly)
  • Type 2: every 3-6 months until stable then monitor every 6 months
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13
Q

What tests are used in diagnosing type 2 diabetes

A

HbA1c
Fasting blood glucose test

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14
Q

What test is used in diagnosing gestational diabetes

A

Oral glucose tolerance test (OGTT)

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15
Q

What test is used in diagnosing type 1 diabetes

A

Random blood glucose test

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16
Q

Examples of diabetic complications

A

Retinopathy
Nephropathy
Neuropathy (pain, numbness & weakness)
Premature CVD
Peripheral arterial disease

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17
Q

Symptoms of Type 1 Diabetes

A
  • Polydipsia: excessive thirst
  • Polyphagia: excessive hunger
  • Pulyuria: excessive urination (especially at night)
  • Weight loss
  • Irritability and other mood changes
  • Fatigue and weakness
  • Blurred vision
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18
Q

What is the glucose level in random hyperglycaemia

A

> 11 mmol/L

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19
Q

Target HbA1c

A

>/= 48mmol/mol (6.5%)

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20
Q

What BMI indicates rapid weight loss

A

<25kg/m

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21
Q

What is the fasting plasma glucose level on waking

A

5-7 mmol/L

I wake at 5 to 7

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22
Q

What is glucose target before meals

A

4-7 mmol/L

Be4 meals

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23
Q

What is glucose target after meals

A

5-9 mmol/L

I dine at nine

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24
Q

Random plasma glucose concentration target

A

< 11 mmol/L

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25
Q

How many times should blood glucose be measured each day

A

4 times

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26
Q

What is the body’s normal insulin regimen?

A

Basal-bolus

  • Basal - slow and steady secretion of insulin
  • Bolus - insulin excreted when you eat
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27
Q

Three types of insulin

A
  • Human insulin
  • Human analogue insulin (modified)
  • Animal insulin (cows and pigs)
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28
Q

How is insulin administered?

A

SC route most ideal - inactivated by GI enzymes so not orally

  • Inject in area with most fat - (Abdomen fastest absorption rate) or outer thigh / buttocks*
  • Injecting same area repeatedly can cause lipohypertrophy - (Rotate injection sites)
  • Check injection sites for signs of infection, swelling, bruising & lipohypertrophy before administration**
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29
Q

Examples of soluble insulin

A

Soluble are not rapid but act-rapid and all have ‘S’ and similar to human insulin

  • Actrapid
  • Humulin S
  • Insuman
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30
Q

Examples of rapid acting insulin and their brand names

A

’LAG’

  • Lispro (Humalog)
  • Aspart (Novorapid)
  • Glulisine (apidra)
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31
Q

Examples of intermediate insulin

A
  • Isophane/NPH (Humulin I)
  • Novimix
  • Humalogmix
  • Humulin M3
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32
Q

Examples of long acting insulin and frequency

A
  • Detemir (levemir) OD-BD
  • Glargine (lantus, toujeo) OD
  • Degludec (tresiba) OD
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33
Q

Which long acting insulin can be given twice a day

A

Determir (levemir)

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34
Q

When should rapid acting insulin be taken?

  • onset of action
  • duration
A

Inject immediately before meals

  • 15 minutes
  • 2-5 hours
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35
Q

When should soluble insulin be taken?

  • onset of action
  • duration
A

IV best for diabetic emergencies (eg. Ketoacidosis & pre-operatively)

  • 30-60 mins (SC admin)
  • 9 hours
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36
Q

When should intermediate insulin be taken?

  • onset of action
  • duration
A

Inject before meals

  • 1-2 hours
  • 11-25 hours
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37
Q

When should long acting insulin be taken?

  • onset of action
  • duration
A

Once a day except Determir that can be twice a day

  • 2-4 hours
  • 36 hours
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38
Q

Three types of insulin regimens

A
  • Basal-bolus
  • Once daily regimen
  • Mixed/ Biphasic regimen
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39
Q

What is basal-bolus regimen

When is it used?

A

Multiple daily injection regimen at each meal

  • Long acting / intermediate + Short acting
  • Basal: OD/BD (Given at bedtime)
  • Bolus: Taken specifically at meal time
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40
Q

Who is basal-bolus regimen good for

A
  • First line for NEWLY diagnosed TYPE 1 pts
  • Busy work life who need to be flexible
  • People who have less regular routine
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41
Q

Basal-bolus regimen for type 1 vs type 2

A

Type 1: SA at meal times + LA at bed time

Type 2: SA + IM

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42
Q

Who is the once daily regimen for?

A

Type 2 diabetes + oral tablets

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43
Q

Choice of OD insulin regimen

A

LA: pts who experience hyperglycaemia through the day & night

IM: hyperglycaemia at night or morning but fine during the day (take before bed)

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44
Q

How is mixed/biphasic regimen taken

A

Works on assumption that you have 3 meals each day

  • Inject OD, BD or TDS before meals
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45
Q

What does biphasic contain

A

SA + IM

  • Premixed or manually mix with syringe
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46
Q

Who can use biphasic regimen

A

Can be used by type 1 & 2 pts

NOT for acutely ill pts or newly diagnosed type 1 pts

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47
Q

What type of pts use insulin pump

A

Adults with disabling hypoglycaemia or high HbA1c >69 mmol/mol

  • Specialist
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48
Q

What factors affect insulin requirements

A
  • Adherence
  • Injection technique / site problems
  • Blood glucose monitoring skills
  • Lifestyle (diet, alcohol, exercise)
  • Renal disease
  • Thyroid disorders
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49
Q

What factors increase insulin requirements

A
  • Infection
  • Stress
  • Accidental or surgical trauma
  • Pregnancy (2nd & 3rd trimester)
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50
Q

What factors decrease insulin requirements

A
  • Physical activity
  • Vomiting
  • Reduced food intake
  • Impaired renal function
  • Addisons - endocrine disease

Things that use up energy or sugar

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51
Q

Where do you dispose needles, lancets

A

Yellow bin

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52
Q

Sick day rules

Diabetic pts on sick days

A

’SICK’

  • Sugar; Monitor blood glucose (blood glucose rise when sick). Increase insulin or sulfonylureas
  • Insulin; NEVER stop insulin or oral diabetes medications. May increase dose of insulin
  • Carbohydrate; Maintain hydration and carbs intake. Replace meals with sugary fluid if pt can’t eat
  • Ketones; Check for ketones every 2-4 hours in type 1. Give extra rapid-insulin if ketones present.
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53
Q

Drugs to stop on sick days until better and able to eat and drink for 24-48 hours

A

’SADMAN’

  • SGLT2 inh : lead to dehydration, risk of DKA
  • ACEi: dehydration, AKI
  • Diuretics: dehydration, AKI
  • Metformin: dehydration, lactic acidosis
  • ARBs: dehydration, AKI
  • NSAIDs: dehydration, AKI
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54
Q

Most common insulin errors reported

A
  • Failure to manage insulin resulting in death
  • Dosing error
  • Wrong frequency
  • Omitted or delayed insulin
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55
Q

Guidance to prevent errors with insulin

A
  • Confirm insulin pen with pt
  • Confirm frequency
  • Intermediate usually cloudy
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56
Q

What drug can increase risk of DKA when given with insulin

A

GLP-1 (Byetta- exenatide & Victoza- liraglutide)

Reports of DKA with people with type 2 on GLP + insulin whose insulin dose was rapidly reduced or discontinued

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57
Q

Pt advice on insulin

A
  • DO NOT withdraw insulin from insulin pen / cartridge devices, use as it is
  • Units must not be abbreviated on prescription or label
  • Insulin syringes and pens should always be used to measure dose
  • Amyloid protein under skin which interferes with insulin absorption and administration (rotate injection site)
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58
Q

Patient and carer advice on insulin

A
  • How to avoid hypoglycaemia
  • Insulin passport
  • Driving and skilled tasks
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59
Q

Conversion to human insulin

A
  • Bovine (cow) to human = reduce by 10%
  • Porcine (pig) to human = maintain
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60
Q

What are the different drug classes of anti diabetics

A
  • Sulphonylureas
  • SGLT-2
  • Biguanides (Metformin)
  • DPP4 inh (gliptins)
  • GLP-1
  • Alpha glucosidase inh (Acrobase)
  • Thiazolidinediones (pioglitazone)
  • Meglitinides (nateglinide)
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61
Q

Examples of sulphonylureas

A
  • Gliclazide
  • Tolbutamide
  • Glipizide
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62
Q

Examples of GLP-1 agonists

A
  • Albiglutide
  • Liraglutide
  • Exenatide
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63
Q

Examples of DPP-4 inhibitors

A

(Dipeptidylpeptidase-4 inhibitors)
Dip your liptin in hot water

  • Alogliptin
  • Linagliptin
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64
Q

Examples of SGLT-2 inhibitors

A
  • Canagliflozin
  • Dapagliflozin
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65
Q

Risk factors of Type 2 diabetes

A
  • Obesity
  • Physical inactivity
  • Raised bp
  • Dyslipidaemia and tendency to develop thrombosis
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66
Q

Steps in treatment of type 2 diabetes

A

Step 1: Lifestyle for 3 months

Step 2: Antidiabetic drugs

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67
Q

Properties of metformin

A
  • Only available biguanide
  • 1st choice for ALL type 2 pts
  • Does NOT cause hypoglycaemia
  • Increase dose slowly to prevent GI side effects (OD-BD-TDS)
  • Offer MR if standard not tolerated
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68
Q

Side effects of Metformin

A
  • GI effects : take with or after food
  • Lactic acidosis: discontinue
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69
Q

Contraindications of metformin

A

Acute metabolic acidosis
- Ketoacidosis, renal failure, general anaesthesia (stop morning of surgery)
- Lactic acidosis, avoid if eGFR < 30mL/min
- Renal failure

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70
Q

Can you give metformin to pregnant and breast feeding?

A

Yes

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71
Q

Monitoring requirements for metformin

A

Renal function

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72
Q

Symptoms of lactic acidosis

A
  • Dysponea (difficulty breathing)
  • Muscle cramps
  • Abdominal pain
  • Hypothermia (low temp)
  • Asthenia (weakness/lack of energy)
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73
Q

Properties of solphonylureas

A
  • Hypoglycaemia
  • Weight gain
  • Avoid in pregnancy/ breastfeeding
  • Given when metformin is CI or not overweight
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74
Q

Can sulphonylureas be taken before surgery

A

No,

Change to insulin

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75
Q

Can sulphonylureas be given in pregnancy

A

No, Avoid

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76
Q

What are the long acting sulphonylureas

A

Glimepiride
Chloropropamide

Greatest risk of hypoglycaemia, Avoid in elderly

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77
Q

What are the short acting sulphonylureas

A

Gliclazide
Tolbutamide

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78
Q

Side effects of sulphonylureas

A
  • GI
  • Hepatic impairment (jaundice, hepatitis, hepatic failure)
  • Allergic skin reaction in first 6-8 weeks
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79
Q

Cautions and CI of sulphonylureas

All start with ‘Gli’

A
  • Caution in elderly
  • Acute porphyria and Ketoacidosis
  • Avoid / reduce dose in renal & hepatic impairment
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80
Q

Which anti diabetic affects absorption of sucrose

A

Acarbose

Give glucose
GI side effects

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81
Q

Side effects of Pioglitazone

A
  • Associated with Heart failure - risk increased when giving with insilin
  • Risk of bladder cancer
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82
Q

When to continue tx with Pioglitazone

A

Only when HbA1c decreased by atleast 0.5% within 6 months of starting tx

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83
Q

Side effects of Pioglitazone

A
  • Bone fracture
  • Weight gain
  • Visual impairment
  • Increased risk of infections and numbness
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84
Q

Monitoring requirements for Pioglitazone

A

Liver function

Report signs of liver toxicity

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85
Q

Pt diagnosed with heart failure has also been diagnosed with type 2 diabetes
What drug can worsen pts condition?

A

Pioglitazone

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86
Q

Which anti diabetic drug can increase risk of infection

A

Pioglitazone

87
Q

Signs of liver toxicity

A
  • jaundice
  • nausea and vomiting
  • dark urine
88
Q

When are Dipepridylpeptidase-4 inhibitors contraindicated

A

Diabetic Ketoacidosis

89
Q

Side effect of gliptins

A
  • GI
  • Skin reactions

Discontinue if symptoms of acute pancreatitis

90
Q

Sign of acute pancreatitis

A

Persistent severe abdominal pain

91
Q

MHRA warning with SGLT-2

A

(Flozins)

Risk of Diabetic Ketoacidosis

92
Q

MHRA warning with Canagliflozin

A

Increased risk of lower limb amputation (mainly toes)

93
Q

Which flozin should be stopped when eGFR < 15ml/min

A

Dapagliflozin

94
Q

What drugs require dose adjustments when given with SGLT-2

A

Insulin and Sulphonylureas

95
Q

Side effects of SGLT-2

A
  • Weight loss
  • DKA
  • Increased risk of infection risk
  • Urinary disorders
96
Q

Which anti diabetic drugs require effective contraception

A

Glucagon-like peptide 1 receptor agonist ( GLP1)

(Liraglutide, exenatide, lixisenatide)

97
Q

What class of antidiabetic have no effect on weight

A

’Metformin with liptin doesn’t affect weight’

Metformin
Gliptins

98
Q

What class of antidiabetic cause weight gain

A

Sulphonylureas
Pioglitazone

99
Q

What class of antidiabetic cause weight loss

A

’The GirLs like to lose weight’

SGLT2i (flozins)
GLP-1(tide)

100
Q

What antdiabetic causes heart failure

A

Pioglitazone

101
Q

Which SGLT-2 is no longer used in Type 1

A

Dapagliflozin
(Forxiga 5mg)

102
Q

What is a severe side effect associated with GLP-1

which one is excluded

A

Sever GI disease

Semaglutide

103
Q

Mechanism of action of acarbose

A

Delays digestion and absorption of starch and sucrose

104
Q

Mechanism of action of metformin

A

Decreases gluconegenesis
Increases peripheral utilisation of glucose

Acts only in the presence of insulin so only effective when there is some functioning pancreas cells

105
Q

Mechanism of action of dipeptidylpeptidase-4 inhibitor

A

Increase insulin secretion
Lower glucagon secretion

106
Q

Mechanism of Sulphonylureas

A

Increase insulin secretion

107
Q

Mechanism of action of pioglitazone

A

Reduce peripheral resistance
Reduces blood glucose concentration

108
Q

Mechanism of SGLT2 (flozins)

A

Reduce glucose reabsorption
Increase urinary glucose excretion

109
Q

Mechanism of action of GLP-1 receptor agonists (semaglutide)

A

Augments glucose dependent insulin secretion
Slows gastric emptying

110
Q

What does HbA1c have to be before adding a second antidiabetic to Metformin?

A

58 mmol/mol

111
Q

What anti diabetic is not indicated for triple therapy

A

Pioglitazone + Dapagliflozin

112
Q

When is insulin introduced in type 2 diabetes

A

When multiple drugs not effective
HbA1c > 75 mmol/mol

113
Q

What to do if pt has glucose >4 mmol/L but with hypoglycaemia symptoms

A

Small carb snack eg. Bread/ normal meal

114
Q

What to do if pt has blood glucose <4 mmol/L and is conscious and can swallow

A

oral glucose - for 3 cycles with 15 minutes intervals

Eg. Glucogel 40%

115
Q

What to do if pt with glucose < 4mmol/L has been given 3 cycles of oral glucose but still has blood glucose <4

A

IM glucagon or
IV glucose 10% infusion

Give thiamine to alcohol patients

116
Q

What to do if pt has blood glucose <4 mmol/L and is unconscious or in emergency

A

IM glucagon or
IV glucose 10% / 20% infusion

117
Q

When do you give IV glucose in hypoglycaemia

A

When IM glucagon is not effective after 10 minutes

118
Q

When is IV glucose 20% infusion used

A

Only in emergency or if unconscious

119
Q

What to avoid in hypoglycaemia

A
  • Orange juice : high potassium
  • Chocolates and biscuits : low in sugar but high in fat which can delay gastric emptying
120
Q

Examples of long acting carb

A
  • two biscuits
  • one slice of bread
  • 200-300ml of milk (not alternative)
121
Q

When to avoid glucagon

A
  • Prolonged fasting
  • Adrenal insufficiency
  • Chronic hypoglycaemia
  • Alcohol- induced hypoglycaemia
  • Pt taking sulfonylurea (give IV glucose)
122
Q

CVD drugs beneficial in diabetes

A
  • ACEi
  • low dose aspirin
  • lipid regulating drugs eg. Statin
123
Q

What is used in diabetic nephropathy?

A

ACEi / ARB

124
Q

Signs of DKA

A
  • Dehydration; polydipsia & polyuria
  • Weight loss
  • Excessive tiredness
  • Nausea & vomiting
  • Abdominal pain
  • Sweet smell to breath
  • Sweet and metallic taste in mouth
125
Q

Symptoms of hyperosmolar hyperglycaemic state (HHS)

A
  • Dehydration; polydipsia & polyuria
  • Weight loss
  • Weakness
  • Poor skin turgor
  • Acute cognitive impairment
126
Q

Which has a faster onset of action between DKA and HHS

A

DKA faster

HHS takes days and more severe

127
Q

Treatment of DKA

A
  • IV fluid replacement
  • Followed by IV soluble insulin (continue LA insulin)
  • Add K & glucose if required
128
Q

Treatment of HHS

A
  • IV fluid replacement
  • Followed by IV insulin
  • K omitted of replaced if required
129
Q

What to monitor in DKA

A

Blood glucose
Blood ketone

Every 1 hour

130
Q

What to do to insulin during surgery

A
  • Have emergency tx of hypoglycaemia on chart
  • Day before : insulin given as normal BUT reduce dose of LA to 80%
  • Day of surgery : Stop all other insulins and continue with 80% LA until pt can eat and drink again
131
Q

What is given throughout surgery with diabetic pts

A

IV Glucose + Soluble insulin

Give until 30-60 min after 1st meal

132
Q

What two drugs can be continued during surgery

A

Metformin
GLP-1

133
Q

What is the anti diabetic drug that can be used in pregnancy?

134
Q

What insulin is preferred in pregnancy/ breastfeeding

A
  • Rapid acting
  • Intermediate acting
  • Long acting
135
Q

What is giving to diabetic women planning to get pregnant

A

Folic acid 5mg until 12 weeks gestation

136
Q

Tx of gestational diabetes

A

Step 1: Diet and exercise
Step 2: Metformin
Step 3: Insulin if metformin ineffective

137
Q

MHRA advice for corticosteroids

A

Chorioretinopathy

  • Blurred vision
  • Refer to ophthalmologist
138
Q

Difference between mineralcorticoid and glucocorticoid

A

Mineralcorticoid - work on electrolytes and water (used in hypotension)

Glucocorticoid - Inflammation/ reduced immunoresponse

139
Q

Examples of Mineralcorticoid

A

Fludrocortisone
Hydrocortisone (cortisol)

140
Q

Examples of glucocorticoid

A

Betamethasone
Dexamethasone
Methyl prednisolone
Prednisolone
Triamcinolone

141
Q

Side effects of glucocorticoid

A

’Diabetic bodybuilders are psychos and get stomach ulcers from eating broken bones’

  • Diabetes
  • Osteoporosis (esp in elderly)
  • Muscle wasting (myopathy)
  • Psychiatric reactions
  • Peptic ulceration & perforation
  • Cushing’s syndrome
142
Q

Side effects of mineralcorticoids

A
  • Hypertension
  • Sodium retention
  • Water retention
  • Potassium loss
  • Calicum loss
143
Q

What steroids have the highest potency for glucocorticoid

A

Betamethasone
Dexamethasone

144
Q

What hormones are secreted by adrenal glands

A

Cortisol- glucocorticoid

Aldosterone- Mineralcorticoid

145
Q

What is adrenal suppression and example

A

Insufficient steroid

80% due to Addisons disease

146
Q

Difference between Addisons disease and Cushing’s disease

A

Addisons- insufficient steroids

Cushing’s- too much steroids

147
Q

Symptoms of adrenal suppression

A
  • HypONatraemia
  • HypOtension
  • HypERKalaemia
  • HypOGlycaemia
  • Salt craving
  • Weight loss / Anorexia
  • Fatigue
  • Nausea & vomiting
148
Q

How to minimise corticosteroid side effects

A
  • Use lowest dose for shortest time
  • Give as single dose in the morning
  • Use local tx over systemic
  • Give short course
  • Use large volume spacer devices of high doses required to increase airway deposition & reduce oropharyngeal deposition
149
Q

What is used in adrenal deficiency state

A

Hydrocortisone & Fludrocortisone

150
Q

General side effects of corticosteroids

A
  • Blurred vision
  • Adrenal suppression (Addisons)
  • Increase risk of infection
  • Psychiatric reactions
  • Chicken pox - varicella zoster immunoglobulin vaccine
  • Measles
151
Q

Is it okay to give steroids in pregnancy

A

Yes

Benefits outweigh risk

152
Q

When to titrate steroid down?

A
  • Tx more than 3 weeks
  • Disease unlikely to relapse
  • Received > 40mg prednisolone (or equivalent), daily for >1 week
  • Recently received repeat courses
  • Taken short course within 1 year of stopping long term therapy
  • Other causes of adrenal suppression
  • Had repeat doses in the evening
153
Q

What are the clinical markers for hyperthyroidism

A

LOW TSH
HIGH Thyroxine [T4]

154
Q

Symptoms of hypothyroidism

A
  • Weight loss
  • A goitre
  • Disturbed sleep
  • Hyperactivity
  • Heat intolerance
  • Complications
155
Q

Drugs used in hyperthyroidism

A

Carbimazole
Propylthiouracil

156
Q

What is blocking replacement regimen

A

Maintains optimal hormone level

Carbimazole + Levothyroxine

157
Q

When to avoid blocking replacement therapy

158
Q

When to avoid carbimazole

A

Pregnancy 1st trimester

159
Q

Other drugs that can be used In hyperthyroidism

A

Iodine
Radioactive sodium ion
Propanalol

160
Q

What is thyrotoxic crisis

How to tx

A

Too much thyroid hormone

  • IV fluids
  • Propranolol
  • Hydrocortisone
  • Oral iodine solution, carbimazole/ propylthiouracil
161
Q

Which anti thyroid drug is safe in pregnancy

A

Propylthiouracil - 1st trimester
Carbimazole - 2nd and 3rd trimester

162
Q

Side effects of Carbimazole

A
  • Neutropenia
  • Agranulocytosis
  • Susceptible to infection
  • Acute pancreatitis
163
Q

Warning signs of Carbimazole

A
  • Stop if bone marrow suppression
  • Report signs of infection especially sore throat
  • Perform white blood cell count if sign of infection
  • Stop promptly if any clinical or laboratory evidence of neutropenia
164
Q

Patient and carer advice with carbimazole

A

Tell doctor immediately if sore throat, mouth ulcers, bruising, fever, malaise or non specific illness develops

165
Q

Monitoring requirements for Propylthiouracil

A
  • Hepatotoxicity
  • Discontinue if sever liver-enzyme abnormalities develop
166
Q

What biological marker is used in pregnancy

A

TSH levels

167
Q

Symptoms of hypothyroidism

A
  • Fatigue
  • Weight gain
  • Constipation
  • Menstrual irregularities
  • Depression, dry skin
  • Intolerance to the cold
168
Q

Tx of hypothyroidism

A

Levothyroxine
Liothyronine IV - emergency or coma

169
Q

Risk factors of osteoporosis

A
  • Age
  • Low BMI
  • Cigarette smoking
  • Excessive alcohol
  • Lack of physical activity
  • Vit D deficiency
  • Low calcium
  • Early menopause
170
Q

What deficiencies can put you at risk of osteoporosis

A

Calcium
Vitamin D

171
Q

Tx of osteoporosis

A

1st line: Bisphosphonate (Alendronic acid or Risedronate)

2nd line: Ibrandronic acid, denosumab or raloxifene

3rd line: HRT - younger post menopausal women

172
Q

MHRA advice for bisphosphonate

A
  • Osteonecrosis of the jaw (more common in IV)
  • Pain in thigh, hip or groin - report
  • Ear pain

Common in tx >2 years

173
Q

Side effects of alendronic acid

A

Oesophageal reactions

STOP and seek medical advice if; dysphasia, new or worsening heartburn, pain on swallowing or retrosternal pain

174
Q

Dose of alendronic acid in men

A

10mg OD - 7days

175
Q

Dose of alendronic acid in women

A

10mg OD - 7 days
OR
70mg OW

176
Q

Counselling for alendronic acid

A
  • Swallow whole
  • Take doses with plenty of water while sitting or standing
  • Take on an empty stomach at least 30 minutes before breakfast or any oral med
  • Stand or sit upright for atleast 30 minutes after administration
177
Q

At what eGFR is bisphosphonate CI

178
Q

What is used in HRT

A

Oestrogen
Progestogens

179
Q

Symptoms of menopause

A
  • Hot flushes
  • Vaginal atrophy
  • Accelerated skin aging
  • Vaginal dryness
  • Decreased muscle mass
  • Sexual dysfunction
  • Bone loss (osteoporosis)
180
Q

What age is early menopause?
What age is natural menopause?

A

Early - <45
Natural - >50

181
Q

Examples of natural oestrogen

A

Estradiol
Estrone
Estriol

182
Q

What oestrogen has three different activities

A

Tibolone

  • Oestrogenic
  • Progestogenic
  • Weak androgenic
183
Q

What is the dose of denosumab

A

60mg every 6 months

184
Q

Do progesterone cause thromboembolism?

A

No

Only oestrogen

185
Q

What is given to women with uterus on long term therapy of HRT and why?

A

Progesterone

Reduces risk of cancer and cystic hyperplasia

186
Q

What type of pts are progesterone used?

A

Women with uterus

Tibolone

187
Q

Risks of HRT?

A

’OBE’

  • Breast cancer
  • Endometrial cancer
  • Ovarian cancer
  • VTE
  • Stroke
  • Coronary heart disease
188
Q

What type of cancer does progesterone reduce risk of

A

Endometrial cancer

189
Q

How often should HRT be reviewed

190
Q

How long is the progesterone cyclically

A

10 days per 28 day cycle

191
Q

Which HRT drug has highest risk of stroke

192
Q

When to stop HRT before surgery

A

4-6 weeks

Continue after surgery when mobile

193
Q

Symptoms to stop HRT

A
  • Signs of DVT
  • Signs of liver toxicity
  • SOB
  • Severe stomach pain
194
Q

Examples of testosterone analogues

A
  • Norethisterone
  • Norgestrel (Levonorgestrel)
195
Q

Examples of progesterone analogues

A

Dydrogesetrone
Medroxyprogesterone

196
Q

What is used in severe hyper sexuality in men

A

Cyproterone
(Dutasteride & Finasteride)

197
Q

Warning with finasteride

A

Women of childbearing age should not handle crushed or broken tablets

198
Q

If pt can’t take HRT what can they have instead

199
Q

Target HbA1c when two or more anti diabetics are prescribed

A

53 mmol/mol

200
Q

Side effect of ticagrelor

A
  • Haemorrhage
  • Bruising
  • Dyspnoea
  • vertigo
  • abdominal pain
201
Q

Nature of interaction between ferrous sulphate and levothyroxine

A

Decreases absorption of levothyroxine

Separate administration by atleast 4 hours

202
Q

Nature of interaction between beta blockers and levothyroxine

A

BB decrease effect of levothyroxine

203
Q

What to do if bisphosphonate is not tolerated or contraindicated in osteoporosis

A

Refer for specialist treatment with
- Zoledronic acid
- Strontium ranelate
- Raloxifene
- Denosumab
- Teriparatide

204
Q

What electrolyte counteracts blood acidity in DKA

A

Bicarbonate

205
Q

Patient advice with desmopressin

A

Restrict fluid from 1 hour before until 8 hours after taking

206
Q

What class of anti diabetic is most associated with DKA

A

SGLT2 (flozins)

207
Q

Pre diabetic blood glucose target

A

6-7 mmol/L

7.9 to 11 - 2 hours after drink

208
Q

Strongest topical corticosteroids

A
  1. Clobetasol
  2. Beclomethasone
  3. Clobetasone
  4. Hydrocortisone - weakest

All at 1%

209
Q

How to treat adrenal insufficiency (Addisons)

A

Hydrocortisone IV
Fludrocortisone

210
Q

How do we treat adrenal crisis

A

Hydrocortisone IM

211
Q

How to give Levo

A

30-60 mins before food / caffeine
SAME BRAND

212
Q

Main side effects of carbimazole

A
  • Neutropenia
  • Sore throat/ fever/ malaise
  • Congenital malformation
  • pancreatitis
213
Q

What is used for symptoms of hyperthyroidism

A

Propranolol - tachycardia

Random Pre Reg Questions (12 decks)

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