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Pre reg pharmacy > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Where is ADH produced

A

Hypothalamus

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2
Q

Where is ADH stored

A

Pituitary gland

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3
Q

When is ADH released and its role

A

When water in body to low, retains water in the body by reducing water loss in the kidneys

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4
Q

Affects on ADH in diabetes insipidus

A

Reduced production - kidneys don’t retain water - water loss

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5
Q

Signs and symptoms of Iapetus insipidus

A

Extreme thirst
Polyuria
Dilute urine

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6
Q

2 types of diabetes insipidus

A
  1. Pituitary (cranial) - lack of vasopressin production
  2. Nephrogenic (partial) - kidneys don’t respond to ADH
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7
Q

Treatment of partial diabetes insipidus

A

Vasopressin / desmopressin

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8
Q

Treatment of nephrogenic diabetes insipidus

A

Thiazide diuretic

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9
Q

Affects of desmopressin vs vasopressin

A

More potent
Longer duration
No vasoconstrictor effects

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10
Q

Desmopressin side effects

A

Hyponatraemia
Nausea

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11
Q

Result of inappropriate increase in ADH secretion

A

Body stores more water, diluting blood salt concentration causeing hyponatraemia

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12
Q

Treatment of increased ADH (3)

A
  1. Fluid restriction
  2. Demeclocycline - blocks renal tubular effect of ADH
  3. Tolvaptan - vasopressin antagonist (avoid rapid correction - osmotic demyelination - serious neurological effects)
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13
Q

Action of mineralcorticosteroids

A

High fluid retention - low anti inflammatory effect

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14
Q

2 mineralcorticosteroid

A

Fludrocortisone
Hydrocortisone

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15
Q

Side effects of mineral corticosteroids

A

Sodium + water retention - hypertension
Potassium loss - hypokalaemia
Calcium loss - hypocalcaemia

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16
Q

Action of Flucocorticosteroid

A

Low fluid retention - high ant inflammatory effect

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17
Q

5 glucocorticosteroids

A

Dexamethasone
Betmethasone
Prednisone
Prednisolone
Deflazacort

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18
Q

Glucocorticosteroid side effects

A

Diabetes
Osteoporosis - osteoporotic fractures
Avascular necrosis of femoral head and muscle wasting
Gastric ulceration and perforation

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19
Q

General side effects of corticosteroids

A

MHRA - chorioretinopathy - report vision disturbance
Psychiatric reactions - insomnia, irritability, behaviour
Adrenal suppression - can last years after treatment
Infections - immunosuppressive
Chicken pox - risk of severe
Measles
Insomnia
Cushing syndrome - moon face, hirsutism

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20
Q

Treatment for Managing Cushing syndrome

A

Metyrapone
Ketaconazole

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21
Q

Effects of corticosteroid use (CORTICOStEROIDUSE)

A

Cushing syndrome, osteoporosis, Retard growth, Thin skin, Immunosuppression + Insomnia, Chorioretinopathy, Oedema, Striae, Emotional disturbance, Rise in BP, Obesity, Increased hair growth, Diabetes mellitus, Ulcers, Suppression, Electrolyte imbalance

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22
Q

Managing steroid side effects 5

A

Lowest effective dose minimum period
Single dose in morning,
Total dose for 2 days can be single dose on alternative days
Intermittent therapy with short course
Local treatment rather than systemic

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23
Q

When to gradually withdraw steroid use 6

A

> 40mg prednisolone/equivalent daily for >1 week
Repeat evening doses
3 week treatment
Recently received repeated courses
Taken short course within 1 year of stopping long term therapy
Other causes of adrenal suppression

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24
Q

Mild topical corticosteroid

A

Hydrocortisone

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25
Q

Moderate potency topical steroid

A

Clobetasone

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26
Q

Potent topical corticosteroid

A

Betamethasone

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27
Q

Very potent topical corticosteroid

A

Clobetasol

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28
Q

Treatment of adrenal insufficiency - Addison’s disease / congenital hyperplasia

A

Hydrocortisone
Primary adrenal insufficiency - Fludrocortisone as well

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29
Q

Symptoms of adrenal crisis

A

Severe dehydration, hypovolemic shock, altered conscious, seizures, stroke, cardiac arrest

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30
Q

Treatment of adrenal crisis

A

Hydrocortisone Rapidly

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31
Q

Diabetes type where deficient insulin secretion

A

Type 1

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32
Q

Diabetes type where resisistance to action of insulin

A

Type 2

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33
Q

Diabetic driving requirements in group 1 (2)

A

Adequate hypo awareness
No more than 1 severe hypo whilst awake in 12 months

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34
Q

Diabetic driving requirements for group 2 (5)

A

Report all severe hypos including during sleep
Full hypo awareness
NO severe hypos in 12 months
Use blood glucose meter with 3 months memory
Notify DVLA of visual complications

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35
Q

DVLA advise for diabetics

A

If treated with insulin - always carry monitor and strips
Check levels max 2hrs before driving then every 2hrs while driving
Blood glucose should be above 5mmol/L
Keep supply of fast acting carbs

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36
Q

Features of type 1 diabetes

A

Hyper >11mmol/L
Kenos is
Rapid weight loss
BMI <25kg/m2
<50yrs
Family history of autoimmune

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37
Q

Frequency of blood glucose monitoring in type 1

A

4 times a day - before each meal and before bed

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38
Q

Type 1 diabetes blood glucose targets

A

Waking and fasting - 5-7mmol/L
Fasting BG before meals at other times of day - 4-7mmol/L
90 mins after eating - 5-9mmol/L
When driving - >5mmol/L

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39
Q

First line insulin regimen for type 1 diabetes

A

Basal- bolus multiple daily injection

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40
Q

How basal bolus insulin regimen works

A

Basal - long/intermediate acting insulin - OD/BD
Bolus - short/rapid acting insulin - before meals

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41
Q

First line basal bolus regimen

A

Basal - Detemir BD
Bolus - glargine OD

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42
Q

What is biphasic insulin regimen

A

Short acting mixed with intermediate - 1-3x daily

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43
Q

When to increase insulin (3)

A

Infection
Stress
Trauma

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44
Q

When to decrease insulin (5)

A

Physical activity
Inter current illness
Reduced food intake
Impaired renal function
Endocrine disorders

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45
Q

Insulin injection technique (3)

A

Subcutaneous - inactivated orally
Inject into body area with plenty of sc fat
Rotate injection site

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46
Q

How does lipohypertrophy occur

A

Repeatedly injecting at same sight - erratic absorption

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47
Q

4 insulin types

A

Short acting
Rapid acting
Intermediate acting
Long acting

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48
Q

Particulars of short acting insulin (4)

A
  1. Human, bovine, porcine
  2. Injected 15-30 mins before meals
  3. Onset of 30-60mins - peak at 1-4hrs
  4. Duration up to 9 hrs
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49
Q

Particulars of rapid acting insulin

A
  1. Lispro, aspart, glulisine
  2. Inject immediately before meals
  3. Onset <15 mins
  4. Duration 2-5hrs
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50
Q

Particulars of intermediate acting insulin

A
  1. Biphasic isophane, biphasic aspart/lispro (isophane mixed with short acting)
  2. Onset 1-2hrs - peak at 3-12hrs
  3. Duration 11-24hrs
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51
Q

Particulars of long acting insulin

A
  1. Detemir, degludec, glargine
  2. InjectOD (BD detemir)
  3. Onset2-4 days to reach steady state
  4. Duration 36hrs
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52
Q

Features of prediabetic

A

HbA1c 42-47 mol/mol
Lifestyle advise to prevent

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53
Q

Diabetic diagnostic HbA1c level

A

48mmol/mol

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54
Q

Type 2 diabetes treatment in low CVD risk

A
  1. Metformin
  2. If above target - ADD DPP4i (gliptin), piogitazone, sulfonylurea, SGLT-2I (flozin)
  3. If still above target - triple therapy ADD/SWAP
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55
Q

Treatment of Type 2 diabetes in high CVD ris

A
  1. Metformin, once tolerated ADD SGLT-2I (Metformin not tolerated, flozin monotherapy)
  2. Above target - follow dual and triple therapy guideline
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56
Q

Treatment of type 2 diabetes in Metformin resistance

A
  1. DPP-4I (gliptin), pioglitazone, sulfonylurea, SGLT-2I
  2. If above target DPP-4I + Pioglitazone OR DPP-4I + Sulfonylurea OR pioglitazone + Sulfonylurea
  3. If above target still - insulin
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57
Q

Mechanism of action of Metformin

A

Decrease glucose genesis and increase peripheral utilisation of glucose

58
Q

Side effects of Metformin

A

Lactic acidosis - avoid if eGFR <30
GI side effects
Reduce Vitamin B12

59
Q

Sulphonylurea mechanism of action

A

Augments insulin secretion

60
Q

Long acting sulfonylurea

A

Gilbenclamide
Glimepiride

61
Q

Short acting sulfonylurea

A

Gliclazide
Tolbutamide

62
Q

Side effects of sulfonylurea

A

High risk of hypo
Avoid prescribing in acute porphyria
Avoid in hepatic and renal failure

63
Q

Pioglitazone mechanism of reaction

A

Reduces peripheral insulin resistance

64
Q

Risks associated wit pioglitazone

A

Increased risk of bladder cancer - review safety and efficacy after 3-6 months - stop treatment if inadequate response - report haematuria, dysuria, urinary urgency
Increased risk of bone fractures
Increased risk of liver toxicity - report nausea vomiting, abdominal pain, fatigue, dark urine

65
Q

DPP- 4I mechanism of action

A

Inhibits DPP 4 to increase insulin secretion and lower glucagon secretion

66
Q

Risks associated with DPP4I

A

Pancreatitis - discontinue if persistent severe abdominal pain
Villa gliptin - hepatotoxic

67
Q

Mechanism of action of SGLT-2I

A

Inhibits SGLT2 in renal proximal convulated tube

68
Q

SGLT2I MHRA warning

A

Life threatening , fatal cases of dka- monitor ketones if treatment interrupted
Farniers gangrene - necrotising fascitis of genitalia/perineum

69
Q

GLP1 agonist moa

A

Increase insulin secretion, suppress glucagon secretion, slows gastric emptying

70
Q

GLP1 risks

A

MHRA - dka when concomitant insulin rapidly reduced
Cute pancreatitis
Dehydration

71
Q

Acarbose mechanism of action

A

Delays digestion and absorption of starch and sucrose

72
Q

Side effects of Acarbose

A

High risk of GI side effects - reduce dose

73
Q

Meglitides mechanism of action

A

Stimulates insulin secretion

74
Q

Antidiabetics that cause weight gain

A

Pioglitazone, sulphonylureas

75
Q

Antidiabetics that have no effect of weight

A

DPP4i

76
Q

Antidiabetics that cause weight loss

A

Metformin, GLP1, SGLT2I

77
Q

Treatment of diabetic neuropathy causing proteinuria

A

Ace I / arb

78
Q

Treatment of neuropathic postural hypotension

A

Increase salt intake
Fludrocortisone

79
Q

Treatment of painful peripheral neuropathy

A

Antidepressant, gabapentin, pregabalin

80
Q

Treatment of diabetic foot neuropathy

A

Treat pain and manage infection

81
Q

Treatment of autonomic neuropathy

A

Treat diarrhoea with codeine / tetracyclines

82
Q

Treatment of gustatory sweating

A

Antimuscarinic - propantheline bromide

83
Q

Symptoms of DKA

A

Polyurea
Thirsty
Pear drop breath
Deep/fast breathing
Lethargy/unconsciousness
Confusion

84
Q

Diagnosing dka

A
  1. Check blood sugar
  2. Blood sugar >11mmol/L - check ketone levels
85
Q

Ketone level management

A

0.6-1.5mmol - slight risk - retest in 2 hrs
1.6-2.9mmol - increased risk - contact GP
3mmol + - medical emergency

86
Q

Treatment of DKA (7)

A
  1. BP <90 - restore volume with 500ml IV NaCl 0.9%
  2. Once BP >90 - Maintenance IV NaCl 0.9%
  3. Start IV insulin mixed with NaCl at a rate;
    - ketone conc falls at 0.5mmol/L/hr
    - BG conc falls at 3mmol/L/hr
  4. When BG <14mmol/L - IV Glucose 10%
  5. Continue insulin till Keaton <0.3mmol/L +pH >7.3
  6. When pt stable to eat - give fast acting insulin with meal
  7. Stop treatment 1hr after food
87
Q

Insulin management during elective surgery (minor procedure with good glycemic control)

A

Reduce OD long acting insulin dose by 20% the day before

88
Q

Insulin management during surgery (Major or poor glycaemic control)

A
  1. Reduce OD long acting insulin dose by 20% the day before
  2. On day of surgery - reduce OD long acting insulin dose by 20% - stop other insulin until patient is eating
    IV infusion of KCl + Glucose + NaCl
    Variable rate IV insulin in NaCl 0.9% via pump
    Hourly BG monitoring for first 12 hours
    Give IV glucose 20% if BG <6mmol/L
89
Q

Insulin management post surgery

A

Convert back to SC insulin when patient can eat/drink without vomiting
Basal-Bolus - Restart with first meal
Long acting regimen - Carries on at 20% reduced until pt leaves hospital
Twice daily regimen - restart at breakfast/evening meal (infusion until 30-60min after 1st meal)

90
Q

Diabetes sick day rules (4)

A

Sugar levels - Check BG regularly
Insulin - Carry on taking
Carbs - keep eating, stay hydrated
Ketones - Check regularly q

91
Q

Diabetic medications in pregnancy

A

Stop ALL except Metformin and replace with insulin

92
Q

First line insulin in pregnancy

A

Isophane

93
Q

Treatment of Gestational diabetes - fasting BG <7mmol/L

A
  1. Diet and exercise
  2. Requirement not met 1-2 weeks - Metformin
  3. Metformin not tolerated/effective - insulin
94
Q

Treatment of gestational diabetes - fasting glucose >7mmol/L

A
  1. Diet and Exercise + Insulin +/Metformin
95
Q

Treatment of gestational diabetes - Fasting BG 6-6.9mmol/L with complications

A

Insulin +/ Metformin

96
Q

Symptoms of Hypoglycaemia

A

Sweating, Lethargic, Dizzy, Hunger, Tremor, Tingling lips, Palpitations, Extreme moods, Pale

97
Q

Treatment of Hypoglycaemia - conscious and able to swallow

A

Fast acting Carb repeat every 15 mins for 3 cycles
- 4-5 glucose tabs
- 3-4 heaped teaspoons sugar
- 150-200ml fruit juice

98
Q

Treatment of hypoglycaemia - unconscious/oral not work

A
  1. IM glucagon
  2. Unresponsive after 10mins - IV glucose
99
Q

Risk factors of osteoporosis

A

Post menopausal women
Men over 50
Patient taking long term oral corticosteroids

100
Q

Lifestyle changes in osteoporosis

A

Increase exercise
Smoking cessation
Maintain IBW
Reduce alcohol intake
Increase intake of Vit D + calcium

101
Q

First line treatment of osteoporosis

A

Oral bisphosphonates - Alendronic acid/Risedronate sodium

102
Q

Second line treatment in Postmenopausal women

A

Ibandronic acid, Denosumab, Raloxifene, Strontium

103
Q

Second line osteoporosis treatment in young menopausal

A

HRT, tibolone

104
Q

Second line treatment of severe osteoporosis

A

Teriparatide

105
Q

Second line treatment of osteoporosis in men

A

Zolendronic acid, Densosumab, Teriparatide, Strontium

106
Q

Second line treatment of steroid induced osteoporosis

A

Zolendronic acid, Densosumab, Teriparatide

107
Q

When to give osteoporosis prophylaxis with steroid treatment

A

Women - 70yrs+, previous fragility fracture, large doses
Men - 70yrs+ AND previous fragility/Large doses
Large doses for > 3 months

108
Q

Biphosphonates MHRA warnings

A

Atypical femoral fractures - report thigh, hip, groin pain
Osteonecrosis of jaw - report dental pain, swelling, non-healing sores, discharge
Osteonecrosis of external auditory canal - report ear pain, discharge, ear infection

109
Q

Side effects of biphosphonates

A

Oesophageal reactions - report and stop it irritation, heartburn, dysphagia

110
Q

Alendronic acid administration

A

Take 30mins before breakfast and other oral meds with full glass of water

111
Q

Risedronate sodium administration

A

Take 30 mins before breakfast OR leave 2 hours before food and drink with full glass of water

112
Q

Natural oestrogens(3)

A

Estradiol
Estrone
Estriol

113
Q

Synthetic oestrogens (2)

A

Ethinylestradiol
Mestranol

114
Q

Progestogens (3)

A

Norethisterone
Levonorgestrel
Desogestrel

115
Q

HRT regimen women with uterus (3)

A

Oestrogen WITH cyclical progestrogen for last 12-14 days of cycle

Continuous oestrogen WITH progestrogen

Continuous combined and tibolone avoided in perimenopause/ within 12 months of last menstrual period

116
Q

HRT breast cancer risk (3)

A

Increased risk after 1yr - longer use = higher risk
Risk is higher in combined HRT over oestrogen only
Excess risk persists for 10ths

117
Q

HRT endometrial cancer risk (2)

A

Risk lower in combined HRT
Also increased risk with tibolone

118
Q

HRT ovarian cancer risk (2)

A

Small increased risk
Disappears few years after stopping

119
Q

HRT VTE risk

A

Increased risk of DVT with HRT

120
Q

HRT stroke risk (2)

A

Slight increase with oestrogen only and combined
Tibolone increases risk 2.2x in first year of treatment

121
Q

HRT coronary heart disease risk

A

Increased risk in combined when >10yrs after menopause

122
Q

HRT regimen women without uterus

A

Continuous oestrogen use

Consider addition of progesterone in endometriosis

123
Q

HRT in elective surgery

A

STOP 4-6 weeks before surgery

Reinitiate when fully mobile

124
Q

HRT in non elective surgery

A

Prophylactic heparin
Graduated compression stockings

125
Q

Reasons to stop HRT (7)

A

Sudden severe chest pain/breathlessness
Unexplained swelling/ seve pain in calf/leg
Severe stomach pain
Serious neurological effects
Hepatitis/jaundice
BP >160mmHg/95mmHg
Prolonged immobility

126
Q

Reaction of high levels of T3 and T4

A

Suppress function/production of TSH/TRH

127
Q

Hormone levels in hyperthyroidism (2)

A

High T3 +T4
Low TSH

128
Q

Signs/Symptoms of hyperthyroidism (7)

A

Hyperactivity
Insomnia
Heat intolerance
Increased appetite
Weight loss
Diarrhoea
Goitre

129
Q

Hyperthyroidism treatment (3)

A

FIRST line - Carbimazole
Second line - propylthiouracil
Symptomatic relief - beta blockers

130
Q

Carbimazole MHRA guidance (3)

A

Neutropenia / Agranulocytosis - report sore throat, malaise, fever

Congenital malformations - women use contraception during treatment

Acute pancreatitis - report + stop immediately

131
Q

Cautions in propylthiouracil

A

Caution in liver disorder - jaundice, dark urine, nausea

132
Q

Treatment of Graves’ disease (2)

A

FIRST line - radioactive iodine
Second line - Carbimazole if iodine/surgery not suitable

133
Q

Carbimazole regimen in Graves’ disease

A

Block and replace regimen in combo with levothyroxine for 12-18months

134
Q

Treatment of hyperthyroidism in pregnancy (2)

A

FIRST TRIMESTER - Propylthiouracil (Carbimazole congenital defects)
SECOND and THIRD trimester - Carbimazole (propylthiouracil hepatotoxicity)

135
Q

Hormone levels in hypothyroidism

A

T3 + T4 low
TSH high

136
Q

Signs/Symptoms of hypothyroidism (7)

A

Fatigue
Weight gain
Constipation
Depression
Dry skin
Intolerance to cold
Menstrual irregularities

137
Q

Treatment of hypothyroidism (2)

A

FIRST line - Levothyroxine
Second line - Liothyronine

138
Q

Levothyroxine monitoring

A

Every 3 months till stable then annually

139
Q

Levothyroxine administration

A

Take in the morning 30 mins before food/caffeine

140
Q

Levothyroxine MHRA warning

A

Small proportion can feel symptoms alternating brands

141
Q

Levothyroxine Vs Liothyronine

A

Lio = mor rapid and potent output
20-25mg = 100mg levothyroxine

Pre reg pharmacy (4 decks)

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