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Nafisa Pre Reg > Endocrine > Flashcards

Endocrine Flashcards

1
Q

//

What are the two types of diabetes insipidus? (2)

A

pituitray

nephrogenic

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2
Q

What causes pituitary diabetes insipidus?

A

insufficient levels of antidiuretic hormone (ADH).

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3
Q

What causes nephrogenic diabetes insipidus?

A

kidney defects.

(The kidneys do not respond to ADH)

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4
Q

What are the treatment options for pituitary diabetes insipidus? (2)

A

Vasopressin (ADH)

and its analog Desmopressin

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5
Q

How are doses of Vasopressin or Desmopressin adjusted in the treatment of pituitary diabetes insipidus?

A

Doses are tailored to produce slight diuresis every 24 hours to avoid water intoxication.

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6
Q

What is the difference between Vasopressin and Desmopressin in terms of potency and duration of action? (2)

A

Desmopressin is more potent

and has a longer duration of action than vasopressin.

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7
Q

How is Desmopressin used in the differential diagnosis of diabetes insipidus?

A

If desmopressin fails to produce a respond (i.e no reduction in urine output), it indicated nephrogenic diabetes insipidus

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8
Q

How do both pituitary and nephrogenic diabetes insipidus patients benefit from thiazide diuretics?

A

Both types of patients can benefit from the paradoxical antidiuretic effect of thiazide diuretics.

(While diuretics typically increase urine output, thiazide diuretics can actually reduce urine volume in individuals with diabetes insipidus)

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9
Q

In what situations is Carbamazepine used in the treatment of diabetes insipidus?

A

Carbamazepine is sometimes useful

in sensitizing renal tubules to the action of remaining vasopressin

(im guessing this is for nephrogenic diabetes insipidus)

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10
Q

What are some other uses of Desmopressin? (2)

A

in haemophilia and Von Willebrand’s disease to boost factor VIII concentration

also in nocturnal enuresis.

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11
Q

How is Desmopressin used in the treatment of haemophilia and Von Willebrand’s disease?

A

it boost factor VIII concentration

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12
Q

What is the recommendation regarding fluid intake when taking Desmopressin? (3)

A

have minimal fluid intake
1 hour before the dose

until 8 hours after

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13
Q

Why should we not administer intranasal desmopressin for nocturnal enuresis?

A

increased risk of hyponatraemic convulsions.

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14
Q

Why can vasopressin be used in the treatment of variceal bleeding in portal hypertension?

A

has vasoconstrictor effects.

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15
Q

What is the role of Oxytocin in medical practice? (2)

A

another pituitary hormone

used in obstetrics: labour stimulation as increased uterine activity

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16
Q

What are some common side effects associated with desmopressin?(6)

A

fluid retention

hyponatremia (especially when fluid intake is not restricted)

stomach pain

headache

nausea

vomiting

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17
Q

what risk is increased when taking desmopressin for nocturnal enuresis?

A

hyponatremic convulsions

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18
Q

How can the risk of hyponatremic convulsions be minimized when using desmopressin for nocturnal enuresis? (4)

A

by avoiding fluid overload

stopping the medication during vomiting or diarrhea episodes

adhering to recommended doses

avoiding concurrent use of drugs that increase vasopressin secretion (such as paracetamol, nicotine, and tricyclic antidepressants).

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19
Q

Why is there an increased risk of hyponatremic convulsions in elderly patients taking desmopressin?

A

due to factors such as age-related changes in physiology

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20
Q

What should we measure and monitor in elderly patient taking desmopressin? (1)

When should we discontinue the desmopressin? (1)

A

measure what their baseline serum sodium is
AND regularly monitor their levels during treatment.

Discontinue treatment if levels fall below baseline.

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21
Q

What is the oxytocic effect of desmopressin during pregnancy?

A

has a small oxytocic effect in the third trimester of pregnancy

(has the ability to stimulate uterine contractions)

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22
Q

What is the potential risk associated with desmopressin use in pregnancy?

A

an increased risk of pre-eclampsia

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23
Q

What is pre- eclampsia? (5)

A

a disorder

characterized by high blood pressure

and significant protein in the urine

can lead to serious comp

can affect both the mother and the unborn baby

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24
Q

What are the normal secretions of the adrenal cortex? (2)

A

hydrocortisone (cortisol): glucocorticoid activity

aldosterone: mineralocorticoid activity

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25
Q

What are the biological effects exerted by glucocorticoid hormones (glucocorticoid activity)? (5)

A

regulating metabolism

suppressing inflammation

modulating the immune response

vasoconstrictive effects

maintaining blood sugar levels

responding to stress

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26
Q

What is mineralocorticoid activity? (4)

A

Mineralocorticoids act on the kidneys

increase the reabsorption of sodium and water

while promoting the excretion of potassium

help regulate blood pressure and maintain proper fluid balance within the body.

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27
Q

What is Addison’s disease?

A

a disorder

adrenal glands not producing enough hormones

primarily cortisol (a glucocorticoid)

and often aldosterone (a mineralocorticoid)

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28
Q

What are common symptoms of Addison’s disease?(5)

A

fatigue

weakness

weight loss

low blood pressure

hyperpigmentation of the skin

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29
Q

How is Addison’s disease treated? (4)

A

lifelong hormone replacement therapy

to replace the deficient hormones

this is a combination of oral hydrocortisone
AND
fludrocortisone acetate

(a glucocorticoid + mineralocorticoid)

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30
Q

Why is a combination of hydrocortisone and fludrocortisone acetate preferred in Addison’s disease?

A

Hydrocortisone alone does not provide sufficient mineralocorticoid activity for complete replacement in Addison’s disease.

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31
Q

How is replacement therapy dosed throughout the day for mimicking the normal diurnal rhythm of cortisol secretion? (3)

A

Replacement therapy is given in two doses

with a larger dose in the morning

and a smaller dose in the evening

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32
Q

What is acute adrenocortical insufficiency?

A

a life-threatening condition

characterized by a sudden and severe deficiency of cortisol and often aldosterone

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33
Q

Who does acute adrenocortical insufficiency typically occur in? (3)

A

individuals with underlying adrenal insufficiency (such as Addison’s disease)

who experience stress, illness, surgery, or trauma

and thus their body has an INCREASED demand for cortisol

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34
Q

What are symptoms of acute adrenocortical insufficiency? (7)

A

sudden onset of severe weakness

fatigue

abdominal pain

nausea

vomiting

low blood pressure

electrolyte imbalances.

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35
Q

How is acute adrenocortical insuffiency treated?

A

IV hydrocortisone every 6 to 8 hours.

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36
Q

What is hypopituitarism?

A

a deficiency in one or more of the hormones produced by the pituitary gland

(note: the pituitary gland regulates cortisol and other hormones however, it has nothing to do directly with mineralocorticoids. That’s the job of the adrenal gland)

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37
Q

How is hypopituitarism treated? (2)

A

oral hydrocortisone

AND

Additional replacement therapy with levothyroxine sodium and sex hormones should be given (as indicated by the pattern of hormone deficiency)

(a mineralocorticoid is not usually required as adrenal glands produce them and they should be functioning as normal)

(in hypopituitarism, where the pituitary gland fails to produce adequate levels of various hormones, there can be deficiencies in other hormones beyond just cortisol and mineralocorticoids. Additional treatment with levothyroxine sodium (to replace thyroid hormone) and sex hormones may be needed based on the specific hormone deficiencies. Levothyroxine helps with metabolism, while sex hormones address issues like reproductive dysfunction. This therapy aims to balance hormones and relieve symptoms caused by hormone deficiencies.

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38
Q

Why is high glucocorticoid activity alone not advantageous in corticosteroid therapy? (2)

A

High glucocorticoid activity is only beneficial if accompanied by relatively low mineralocorticoid activity.

Without this balance, the therapeutic effects may not be clinically relevant.

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39
Q

Why is fludrocortisone’s anti-inflammatory activity considered clinically irrelevant? (3)

A

has such high mineralocorticoid activity

that its anti-inflammatory effects are overshadowed

rendering them clinically insignificant.

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40
Q

Which corticosteroids are particularly suitable for high-dose therapy in conditions where fluid retention is a concern? (4)

A

Betamethasone and dexamethasone are suitable

as have long duration of very high glucocorticoid activity

and have insignificant mineralocorticoid activity

minimizing the risk of fluid retention.

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41
Q

Which corticosteroid is most commonly used by mouth for long- term disease suppression?

A

Prednisolone

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42
Q

What activities do prednisolone and prednisone predominately have?

A

glucocorticoid activity

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43
Q

How does deflazacort compare to prednisolone in terms of glucocorticoid activity? (2)

A

Deflazacort is derived from prednisolone

so demonstrates high glucocorticoid activity, making it effective for therapeutic use.

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44
Q

Why is hydrocortisone considered unsuitable for long-term disease suppression? (4)

A

Has significant mineralocorticoid activity

this leads to fluid retention

making it unsuitable for long-term disease suppression

due to associated side effects.

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45
Q

What can hydrocortisone be used to treat? (2)

A

can be utilized for adrenal replacement therapy

where its mineralocorticoid activity may be beneficial.

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46
Q

What are corticosteroids?

A

Steroid hormones

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47
Q

Where are corticosteroids produced?

A

In the adrenal cortex?

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48
Q

What are the two main classes of corticosteroids? (2)

A

Glucocorticoids

Mineralocorticoids

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49
Q

Which corticosteroid has the MOST mineralocorticoid side effects?

A

fludrocortisone

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50
Q

Which corticosteroids have significant mineralocorticoid side effects? (3)

A

hydrocortisone

corticotropin

tetracosactide

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51
Q

Which corticosteroids have negligible mineralocorticoid actions?

A

high potency glucocorticoids such as betamethasone and dexamethasone

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52
Q

Which corticosteroids have slight mineralocorticoid side effects? (3)

A

methylprednisolone

prednisolone

and triamcinolone

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53
Q

What are some mineralocorticoid side effects associated with corticosteroid use? (5)

A

hypertension

sodium retention

water retention

potassium loss

calcium loss.

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54
Q

What are some glucocorticoid side effects associated with corticosteroid use? (9)

A

diabetes

osteoporosis (particularly in the elderly),

avascular necrosis of the femoral head at high doses

proximal myopathy

weakly linked peptic ulceration

psychiatric reactions

Cushing’s syndrome (with moon face, striae, and acne at high doses)

increased appetite

weight gain

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55
Q

What is the significance of high doses of glucocorticoids in terms of side effects? (3)

A

High doses of glucocorticoids can lead to severe side effects

such as Cushing’s syndrome

but these side effects are usually reversible upon withdrawal of treatment

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56
Q

What is Cushing’s syndrome?

A

Disorder resulting from prolonged exposure to high levels of cortisol

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57
Q

What can cause Cushing’s syndrome? (2)

A

Can be endogenous (excessive natural cortisol production)

or exogenous (due to corticosteroid medication)

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58
Q

What are symptoms of Cushing’s syndrome? (8)

A

Weight gain (especially in face and upper body)

thinning skin

easy bruising

stretch marks (striae)

high blood pressure

fatigue

muscle weakness

mood changes.

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59
Q

What are patients advised to do if they notice warning signs while undergoing prolonged steroid treatment?

A

Patients are advised to report all warning signs to their doctor immediately

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60
Q

What should patients undergoing prolonged steroid treatment (>3 weeks) have?

A

A steroid card

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61
Q

What is paradoxical bronchospasm?

A

constriction of the airways

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62
Q

What are the symptoms of uncontrolled asthma? (3)

A

cough

wheezing

tight chest

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63
Q

What is adrenal suppression?

A

occurs when the adrenal glands do not produce enough cortisol

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64
Q

What are the symptoms of adrenal suppresion? (7)

A

fever

nausea

vomiting

weight loss

fatigue

headache

muscular weakness

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65
Q

How should prolonged corticosteroid therapy be withdrawn to prevent acute adrenal insufficiency?

A

must be withdrawn gradually

( as adrenal atrophy can develop and persist for years after stopping treatment)

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66
Q

What are some signs indicating the need for gradual withdrawal of corticosteroid therapy? (3)

A

a) Receiving more than 40mg prednisolone (or equivalent) daily for more than one week.
b) Being given repeat evening doses.
c) Receiving treatment for more than three weeks.

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67
Q

How does prolonged corticosteroid treatment affect infection risk, and what precautions should patients take? (4)

A

Prolonged corticosteroid treatment increases the risk of infection

especially severe infections like chickenpox or measles (if the patient is not already immune)

Patients should avoid exposure to chickenpox, shingles, or measles, and more serious infections such as TB and septicaemia

infections may reach an advanced stage before being recognized.

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68
Q

What psychiatric reactions are associated with corticosteroid treatment? (5)

A

euphoria

suicidal thoughts

nightmares

depression

insomnia

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69
Q

When do psychiatric reactions associated with corticosteroid treatment, and when do they usually subside? (2)

A

These reactions are usually associated with high doses or treatment withdrawal

they typically subside on reducing the dose.

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70
Q

What are warning signs of corticosteroids? (6)

A

paradoxical bronchospasm

uncontrolled asthma

adrenal suppression

frequent courses of antibiotics and/ or corticosteroids

immunosuppression

psychiatric reactions

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71
Q

What parameters should be monitored regularly during corticosteroid treatment? (8)

A

Blood pressure

blood lipids

serum potassium

body weight and height - in children and adolescents

bone mineral density

blood glucose

eye exams (for intraocular pressure and cataracts)

signs of adrenal suppression

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72
Q

What is the recommendation regarding corticosteroid treatment during pregnancy and breastfeeding? (2)

A

Benefit of treatment during pregnancy and breastfeeding outweighs the risk.

Pregnant women with fluid retention should be closely monitored, and treatment is required during labor.

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73
Q

What are some drug interactions associated with corticosteroids? (6)

A

Accelerated metabolism of corticosteroids by carbamazepine, phenobarbital, phenytoin, and rifamycins.

Induction or enhancement of the anticoagulant effect of coumarins by corticosteroids

Impairment of the immune response to vaccines by high-dose corticosteroids, necessitating avoidance of concomitant use with live vaccines.

Masking of gastrointestinal effects of NSAIDs (including aspirin) by corticosteroids, with avoidance of concomitant use if possible and consideration of gastroprotection.

Potential for severe hypokalemia when given with other drugs that lower serum potassium, such as loop and thiazide diuretics.

Antagonism of the effects of antihypertensive and oral hypoglycemic drugs by glucocorticoids.

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74
Q

Why is it important to monitor blood pressure during corticosteroid treatment?

A

because corticosteroids can cause hypertension as a side effect.

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75
Q

What is the significance of monitoring bone mineral density during corticosteroid treatment?

A

because corticosteroids can lead to osteoporosis and bone loss

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76
Q

How can corticosteroids affect the immune response to vaccines? (2)

A

High-dose corticosteroids can impair the immune response to vaccines

necessitating avoidance of concomitant use with live vaccines.

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77
Q

What effect can corticosteroids have on the gastrointestinal effects of NSAIDs? (2)

A

Corticosteroids can mask the gastrointestinal effects of NSAIDs, including aspirin

carefully consider use
avoid use
if do use, use along with gastroprotection.

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78
Q

Which drugs accelerate the metabolism of corticosteroids? (4)

A

Carbamazepine

phenobarbital

phenytoin

rifamycins

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79
Q

What effect can corticosteroids have on the anticoagulant effect of coumarins?

A

Corticosteroids may induce or enhance the anticoagulant effect of coumarins

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80
Q

What risk is associated with combining corticosteroids with loop and thiazide diuretics?

A

can lead to severe hypokalemia

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81
Q

How do glucocorticoids affect the effects of antihypertensive and oral hypoglycemic drugs?

A

Glucocorticoids antagonize the effects of antihypertensive and oral hypoglycemic drugs.

when glucocorticoids are taken concurrently with antihypertensive or oral hypoglycemic medications, they can reduce the effectiveness of these drugs, potentially leading to less control over blood pressure or blood sugar levels

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82
Q

What is the treatment approach for patients with type 1 diabetes?

A

Patients with type 1 diabetes require administration of insulin

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83
Q

How can patients with type 2 diabetes be controlled? (2)

A

Patients with type 2 diabetes may be controlled on diet alone

but may also require oral antidiabetics and/or insulin

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84
Q

What is the main aim of diabetes treatment? (2)

A

alleviate symptoms

minimize the risk of long-term complications, particularly cardiovascular disease.

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85
Q

How can the risk of cardiovascular disease in diabetic patients be reduced? (2)

A

risk of cardiovascular disease can be reduced by using an ACE inhibitor (which also provides kidney protection to diabetics)

and a lipid-regulating drug.

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86
Q

What are the long-term complications associated with diabetes? (3)

A

neuropathy

retinopathy

nephropathy.

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87
Q

How often should HbA1c levels be measured?

A

HbA1c (glycosylated hemoglobin) should be measured every 3-6 months

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88
Q

What are HbA1c levels a good indication?

A

glycemic control over the previous 2-3 months.

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89
Q

What is the ideal target for HbA1c concentration, and why may it not always be achievable? (3)

A

The ideal target for HbA1c concentration is 59mmol/mol or less.

However, the reference range is 20-42mmol/mol, which may not always be achievable

Moreover, aiming for very low HbA1c levels increases the risk of severe hypoglycemic episodes in diabetics.

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90
Q

How is diabetic nephropathy tested for? (3)

A

urinary microalbuminuria

annual tests for urinary protein

serum creatinine

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91
Q

What risk is associated with the presence of nephropathy in diabetic patients?

A

increases the risk of hyperkalemia.

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92
Q

What is the recommended treatment for diabetic patients with nephropathy, regardless of blood pressure?

A

All diabetic patients with nephropathy should be treated with ACE inhibitors or ARBs, regardless of blood pressure.

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93
Q

How can ACE inhibitors affect the hypoglycemic effect of anti-diabetic drugs and insulin? When is this especially true? (2)

A

ACE inhibitors can potentiate the hypoglycemic effect of anti-diabetic drugs and insulin

especially during initial treatment and if renal impairment is present.

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94
Q

How is mild to moderate pain associated with diabetic neuropathy treated? (2)

A

Paracetamol

Ibuprofen.

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95
Q

What medication is effective for PAINFUL neuropathy in diabetic patients?

A

Duloxetine

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96
Q

What alternatives can be considered if Duloxetine is ineffective for painful neuropathy? (3)

A

Amitriptyline

Nortriptyline (unlicensed)

Gabapentin

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97
Q

What other medications are supported by evidence for the treatment of neuropathic pain in diabetic patients? (5)

A

Tramadol

morphine

oxycodone (under specialist supervision)

Carbamazepine

Capsaicin cream

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98
Q

What are the symptoms of hypoglycemia (blood sugar level < 3.5mmol/L)? (8)

A

pale skin

feeling sweaty

tremor

rapid heart rate

confusion

aggression

fits

impaired consciousness

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99
Q

How should blood glucose be restored in a conscious individual experiencing hypoglycemia?

A

oral glucose should be administered

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100
Q

How should blood glucose be restored in an UNconscious individual experiencing hypoglycemia? (2)

A

IV dextrose should be given.

If this is not available, Glucagon can be administered via an intramuscular injection.

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101
Q

What are the symptoms of Diabetic Ketoacidosis (DKA) or HyperOsmolar Non-Ketosis (HONK)? (9)

A

dehydration

acute hunger

thirst

abdominal pain

fruity smelling breath and urine if ketotic

rapid breathing

confusion

decreased consciousness

and arrhythmias due to hyper/hypokalemia.

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102
Q

How do DKA and HHS differ, and which type is usually associated with Type 1 diabetes?

A

DKA is usually associated with Type 1 diabetes and is characterized by hyperglycemia (>20mM) with ketones present.

HHS mainly occurs in Type 2 diabetes and is characterized by severe dehydration due to hyperglycemia (>50mM) with minimal ketones present.

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103
Q

How are DKA and HHS managed? (9)

A

nasogastric tube to remove stomach contents

IV insulin and fluids

LMWH to prevent clotting

urinary catheter for fluid monitoring

sliding scale insulin for tight glucose control

fluid, potassium

phosphate replacement for rehydration and electrolyte balance maintenance

consideration of antibiotics if infection caused hyperglycemia.

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104
Q

What are the characteristics of rapid-acting insulins? (3)

A

they are used as needed (PRN)

have a faster onset and shorter duration of action compared to “short” insulins

should be injected immediately before or after eating.

105
Q

Can you provide examples of rapid-acting insulins? (3)

A

Insulin Aspart (Novorapid)

Insulin Glulisine (Apidra)

Insulin Lispro (Humalog)

106
Q

How should short (neutral or soluble) insulins be administered? (2)

A

used PRN

should be injected 30 minutes before eating

107
Q

Can you name some examples of short (neutral or soluble) insulins? (3)

A

Actrapid
Humulin S
Insuman Rapid

108
Q

What is the administration frequency and duration of action for intermediate insulins? (2)

A

usually administered twice daily (BD)

have a duration of action of up to 16 hours

109
Q

What precaution should be taken before injecting intermediate insulins? (2)

A

Before injecting intermediate insulins, it’s necessary to resuspend zinc-insulin particulate.

also important to never use these insulins intravenously (as the particulate may block a capillary)

110
Q

Can you give examples of intermediate insulins?

A

Humulin I
Detemir (Levemir)
Deglubec (Tresiba).

111
Q

What is the purpose of long acting insulins and how often are they used in a day? (2)

A

They provide 24-hour coverage

used OD at the same time each day

112
Q

Name some examples of long-acting insulins

A

Glargine (Absaglar, Lantus)

113
Q

What are biphasic insulins, and what is their composition?

A

They are a combination of shorter- and longer-acting insulins

They offer more convenience but less control

They need to be re- suspended before giving

114
Q

Can you provide examples of biphasic insulins? (3)

A

Novomix 30

Humalog Mix 25

Humulin M3.

115
Q

What are some warning signs associated with insulin therapy? (6)

A

recurring episodes of hypoglycemia (e.g., sweating, palpitations, confusion, drowsiness)

signs of diabetic ketoacidosis (e.g., nausea, vomiting, drowsiness)

symptoms of liver toxicity

heart failure

pancreatitis (e.g., jaundice, abdominal pain)

ulceration of foot tissue.

116
Q

What interactions should be considered with insulin therapy? (2)

A

Interactions may include substances that INCREASE blood-glucose-lowering activity (reducing insulin requirements) and INCREASE RISK OF HYPOGLYCAEMIA
such as:

oral antidiabetics, ACE inhibitors, MAOIs, salicylates, and sulphonamide antibiotics.

Additionally, substances that REDUCE blood-glucose-lowering activity (increasing insulin requirements) include:

corticosteroids, diuretics, sympathomimetics (e.g., epinephrine, salbutamol, terbutaline), thyroid hormones, and oral contraceptives (oestrogens, progestogens)

Beta-blockers or alcohol may also potentiate and/or weaken the blood-glucose-lowering activity of insulin.

117
Q

How can we resuspend the zinc- insulin particulate in intermediate insulin?

A

need to gently roll or invert the insulin vial between your palms until the solution appears uniformly cloudy or milky

helps ensure that the insulin is properly mixed before administration

It’s important not to shake the vial vigorously, as this can cause foaming or denaturation of the insulin.

118
Q

What substances INCREASE blood-glucose-lowering activity and increase the risk of hypoglycemia when interacting with insulin? (5)

A

Oral antidiabetics

ACE inhibitors

MAOIs

salicylates

sulphonamide antibiotics

119
Q

Which substances may REDUCE blood-glucose-lowering activity and increase insulin requirements when interacting with insulin? (5)

A

Corticosteroids

diuretics

sympathomimetics (e.g., epinephrine, salbutamol, terbutaline)

thyroid hormones

oral contraceptives (oestrogens, progestogens)

beta- blockers and alcohol MAY also reduce blood- glucose lowering activity

120
Q

What is the brand- name of the long- acting Insulin Detemir? (1)

A

Levemir

121
Q

What are two brand names of Insulin Glargine? (2)

A

Absaglar

Lantus

122
Q

What is the brand- name of the long- acting Insulin Degludec? (1)

A

Tresiba

123
Q

What is the brand- name of the rapid- acting Insulin Aspart?

A

Novorapid

124
Q

What is the brand- name of the rapid- acting Insulin Glulisine?

A

Apidra

125
Q

What is the brand- name of the rapid- acting Insulin Lispro?

A

Humalog

126
Q

What is the mechanism of action of Alpha glucosidase inhibitor (Acarbose)? (2)

A

inhibits the breakdown of starch and sucrose to glucose

thus delaying the absorption of sugar.

127
Q

What is a common side effect associated with Acarbose, and how does it typically change over time? (2)

A

Flatulence

but it tends to decrease with time, potentially improving adherence

128
Q

How should acarbose be taken?

A

With food

129
Q

What is the primary mechanism of action of Biguanide (Metformin)? (2)

A

decreases gluconeogenesis

and increases the peripheral utilization of glucose.

130
Q

What is the current recommendation regarding the use of Metformin in diabetes treatment?

A

Metformin is now considered first-line treatment for all patients with type 2 diabetes.

131
Q

What precaution should be taken regarding Metformin use in patients undergoing surgery with general anesthesia? (3)

A

Metformin should be suspended on the morning of surgery if general anesthesia is used

as it can cause ketoacidosis

It should be restarted when renal function returns to baseline.

132
Q

How should Metformin use be managed in patients undergoing procedures involving iodinated contrast agents such as in X- rays? (3)

A

Metformin should be suspended prior to such procedures

and restarted after 48 hours IF renal function returns to baseline

to prevent renal failure and lactic acidosis.

133
Q

What are some common side effects of Metformin, particularly when initiating treatment? (3)

A

GI disturbances are initially common with Metformin use

Especially at high doses.

Dose titration may improve tolerability and MR

E.G. DIARRHOEA

134
Q

What are examples of sulphonylureas? (5)

A

Gliclazide

Glipizide

Glibenclamide

Glimepiride

Tolbutamide

135
Q

What is the primary mechanism of action of Sulphonylureas?

A

increase insulin secretion from the pancreas

136
Q

How should sulphonylureas be taken?

A

With food

137
Q

What are potential side effects associated with Sulphonylureas?

A

may cause hypoglycemia and weight gain

hypersensitivity (common within the first 6-8 weeks of therapy)

138
Q

What is the primary mechanism of action of Thiazolidinedione (Pioglitazone)?

A

Pioglitazone reduces peripheral insulin resistance

139
Q

What are some common side effects of Pioglitazone? (11)

A

GI upset

weight gain

edema

hypoglycemia

anaemia

headache

visual disturbances

arthralgia (joint pain)

hematuria (blood in urine)

impotence

liver toxicity

140
Q

What action should be taken if symptoms of liver dysfunction occur in a patient taking Pioglitazone? (2)

A

If symptoms such as severe GI upset, fatigue, jaundice, or dark urine occur

discontinue pioglitazone treatment

141
Q

What risk increases when pioglitazone is combined with insulin? How should patients be monitored? (2)

A

risk of heart failure increases

monitor and if signs such as shortness of breath, fatigue, irregular heartbeat, edema occur; DISCONTINUE treatment

142
Q

What risk is associated with the use of Pioglitazone regarding bladder health? (5)

A

a small increased risk of bladder cancer

However, the benefits of Pioglitazone outweigh the risks.

Patients should be assessed for risk factors before treatment

Treatment should be reviewed after
3–6 month

If patient develops urinary symptoms during treatment should be reported promptly for review (such as haematuria, dysuria, or urinary urgency)

143
Q

What are risk factors that would put patients on pioglitazone at a higher risk of bladder cancer? (4)

A

un-investigated macroscopic haematuria

age

smoking status

exposure to chemotherapy agents

144
Q

What is the mechanism of action of Meglitinides, including Nateglinide and Repaglinide?

A

stimulate insulin secretion

145
Q

When should Meglitinides be taken in relation to main meals?

A

30 minutes before main meals

146
Q

What are potential side effects associated with Meglitinides? (3)

A

may cause hypoglycemia

hypersensitivity

GI upset.

147
Q

What is the mechanism of action of DPP 4 inhibitors, including Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, and Vidagliptin?
(3)

A

DPP 4 inhibitors inhibit DPP4 enzymes that break down incretins,

which are produced by the gut in response to food

Incretins trigger insulin secretion and lower glucagon secretion

Therefore;increase in incretion= increased insulin secretion and decreased glucagon secretion

148
Q

What are some common side effects of DPP 4 inhibitors? (5

A

hypoglycemia

upper respiratory tract infections (URTI)

GI upset

peripheral edema,

pancreatitis.

(Vildagliptin has rare reports of liver dysfunction)

149
Q

When should treatment with DPP 4 inhibitors be discontinued in the case of pancreatitis? (2)

A

if severe abdominal pain, nausea, and vomiting persist

as these indicate pancreatitis.

150
Q

What action should be taken if symptoms of liver dysfunction occur in a patient taking DPP 4 inhibitors?

A

discontinue treatment

151
Q

What is the mechanism of action of SGLT2 inhibitors, including Canagliflozin, Empagliflozin, and Dapagliflozin? (3)

A

SGLT2 inhibitors inhibit SGLT2 in the renal tubules

to reduce glucose reabsorption

and increase glucose excretion.

152
Q

What precaution should be taken regarding volume depletion before starting treatment with SGLT2 inhibitors? (2)

A

Any hypovolemia needs to be corrected before starting treatment with SGLT2 inhibitors

due to their associated risk of volume depletion.

153
Q

When should treatment with SGLT2 inhibitors be considered for interruption?

A

if symptoms of hypovolemia occur

(such as postural hypotension and dizziness)

154
Q

What factors may increase the risk associated with SGLT2 inhibitor use? (5)

A

being elderly

concomitant use of antihypertensive medications

cardiovascular disease

gastrointestinal illness

complicated urinary tract infections (UTI)

155
Q

What are some common side effects of SGLT2 inhibitors? (6)

A

constipation

thirst
nausea
lower UTIs
hypoglycemia
polyuria.

156
Q

What serious complication has been associated with the use of SGLT2 inhibitors, and what action should be taken if suspected? (3)

A

Serious and potentially life-threatening cases of diabetic ketoacidosis (DKA)s.

Treatment should be discontinued if DKA is suspected

and prompt medical attention must be sought.

157
Q

What specific risk has been associated with Canagliflozin use regarding lower limbs, and what preventive measures are advised?

A

Canagliflozin may increase the risk of lower-limb amputation, mainly affecting toes.

Preventive foot care is important for all patients with diabetes.

Patients are advised to stay well hydrated, carry out routine preventive foot care

They should seek medical advice promptly if they develop skin ulceration, discoloration, or new pain or tenderness.

158
Q

What are examples of GLP-1 like agonists? (5)

A

Exenatide
Albiglutide
Dulaglutide
Liraglutide
Lixisenatide

159
Q

What is the mechanism of action of GLP-1 like receptor agonists? (3)

A

bind to and activate the GLP-1 receptor
mimicking the activity of normal incretins.
They increase insulin secretion and slow gastric emptying.

160
Q

What are some common side effects associated with Glucagon-like peptide receptor agonists? (4)

A

gastrointestinal (GI) upset
headaches
weight loss
pancreatitis.

161
Q

What action should be taken if severe abdominal pain, nausea, and vomiting persist in a patient taking Exenatide?

A

Treatment should be discontinued permanently

as these symptoms could indicate pancreatitis.

162
Q

How should missed doses be managed of the Glucagon-like peptide receptor agonists: Abliglutide, Liraglutide and Dulaglutide

A

Administer the missed dose only if there are at least three days until the next scheduled dose.

163
Q

How should missed doses be managed of the Glucagon-like peptide receptor agonist: Exenatide

A

Leave the missed dose and continue with the next scheduled dose.

164
Q

How should missed doses be managed of the Glucagon-like peptide receptor agonist: Lixisenatide?

A

Administer the missed dose 1 hour before the next meal

165
Q

According to the NICE 2017 guidelines for treating type 2 diabetes, what is the recommended initial treatment if metformin monotherapy is contraindicated or not tolerated? (3)

A

DPP4 inhibitor (gliptin)
Pioglitazone
sulfonylurea.

166
Q

What are the dual therapy options recommended by NICE 2017 for people in whom metformin is contraindicated or not tolerated? (3)

A

DDP4 inhibitor plus pioglitazone
DDP4 inhibitor plus a sulfonylurea
Pioglitazone plus a sulfonylurea.

167
Q

Who does osteoporosis commonly occur in? (2)

A

postmenopausal women
individuals taking long-term oral corticosteroids

168
Q

What are other risk factors for osteoporosis? (6)

A

low body weight
cigarette smoking
excess alcohol intake
lack of physical activity
family history of osteoporosis
early menopause.

169
Q

How can individuals at risk for osteoporosis reduce their risk? (2)

A

should maintain an adequate intake of calcium and vitamin D

doses of oral corticosteroids should be kept as low as possible, and courses as short as possible

170
Q

What is the role of calcitonin in the regulation of bone turnover and calcium balance? (2)

A

Calcitonin decreases blood calcium concentrations

and is involved with parathyroid hormone (PTH) in the regulation of bone turnover and the maintenance of calcium balance.

171
Q

What is the mechanism of action of Teriparatide in treating osteoporosis? (3)

A

Teriparatide is a recombinant form of PTH
Intermittent use activates osteoblasts
which leads to an overall increase in bone.

172
Q

How does Cinacalcet reduce the risk of osteoporosis? (2)

A

Cinacalcet sensitizes Ca2+ receptors of the parathyroid gland to reduce PTH levels
thereby indirectly reducing the risk of osteoporosis.

173
Q

What is the mechanism of action of Denosumab in treating osteoporosis? (2)

A

Denosumab is a human monoclonal antibody that inhibits osteoclast formation, function, and survival

thereby decreasing bone resorption.

174
Q

What are examples of bisphosphonates commonly used in clinical practice? (2)

A

alendronate
risedronate

175
Q

What is the mechanism of action of bisphosphonates?

A

Bisphosphonates are absorbed onto bone crystals and slow down the rate of bone turnover.

176
Q

What precautionary measures should be taken regarding osteonecrosis of the jaw in patients receiving bisphosphonates? (5)

A

Patients receiving bisphosphonates, especially intravenous ones, should have a:

dental check-up before treatment
receive routine dental check-ups
maintain good oral hygiene
report any oral symptoms such as dental mobility, pain, swelling, non-healing sores, or discharge to both a doctor and dentist during treatment.

177
Q

What is the risk associated with atypical femoral fractures in patients receiving bisphosphonates (3)

A

Atypical femoral fractures are a rare risk

mainly occurring in patients receiving long-term treatment with bisphosphonates.

Patients should be advised to report any thigh, hip, or groin pain during treatment with a bisphosphonate.

178
Q

What is the very rare risk associated with the external auditory canal in patients receiving bisphosphonates?

A

There is a very rare risk of benign idiopathic osteonecrosis of the external auditory canal

mainly in patients receiving long-term therapy with bisphosphonates

Patients should be advised to report any ear pain, discharge from the ear, or ear infection

(a condition where the bone tissue in the external ear canal has died)

179
Q

What is the mechanism of action of Strontium ranelate? (2)

A

stimulates bone formation

reduces bone resorption.

180
Q

What risk is increaed with strontium ranelate?

A

serious cardiovascular disease, including myocardial infarction

This risk should be assessed before treatment and monitored regularly during treatment.

181
Q

What severe allergic reaction has been reported with the use of Strontium ranelate, and what are its symptoms? (2)

A

eosinophilia

systemic symptoms (such as DRESS syndrome)

182
Q

What is DRESS syndrome?

A

a delayed hypersensitivity reaction

it can be fatal

183
Q

What are the symptoms of DRESS syndrome? (4)

A

rash
fever
swollen glands
increased white cell count

it can affect the liver, kidneys, and lungs.

184
Q

What action should be taken if a patient experiences severe allergic reactions such as DRESS while taking Strontium ranelate?

A

Treatment should be discontinued immediately, and the patient should consult their GP immediately.

185
Q

What advice should be given regarding food intake when taking Strontium ranelate granules? (3)

A

Patients should avoid food for 2 hours before and after taking Strontium ranelate granules

particularly calcium-containing products like milk

and antacids containing aluminium and magnesium hydroxide.

186
Q

What is hormone replacement therapy (HRT) and when is it appropriate? (4)

A

HRT involves small doses of estrogen

sometimes combined with a progestogen in women with a uterus.

It is suitable for alleviating menopausal symptoms like vaginal atrophy or vasomotor instability

It can also help reduce postmenopausal osteoporosis.

Vaginal atrophy= thinning, drying and inflammation of the vaginal walls

187
Q

How can vasomotor symptoms be managed in women who cannot take estrogen?

A

Clonidine can be used to reduce vasomotor symptoms (hot flashes and night sweats)

in women who are unable to take estrogen.

188
Q

What are the risks associated with hormone replacement therapy (HRT)? (5)

A

increased risk of venous thromboembolism
stroke
endometrial cancer (although reduced by progestogen use)
breast cancer
ovarian cancer

189
Q

What is the timeframe for increased risk of breast cancer with HRT? (3)

A

The risk of breast cancer increases within 1-2 years of starting HRT

but it is related to the duration of use

and disappears within 5 years of stopping.

190
Q

Which HRT has a risk of endometrial cancer?

A

estrogen-only HRT

191
Q

How does the risk of endometrial cancer relate to HRT? (2)

A

The risk of endometrial cancer depends on the dose and duration of estrogen-only HRT

however, this risk is eliminated if a progestogen is given continuously.

192
Q

What is the association between long-term HRT use and ovarian cancer risk? (2)

A

Long-term HRT use is associated with an increased risk of ovarian cancer

but this excess risk disappears within a few years of stopping treatment.

193
Q

What is the increased risk of venous thromboembolism with HRT? (2)

A

HRT is associated with an increased risk of deep vein thrombosis (DVT) and pulmonary embolism

especially in the first year of use.

194
Q

Which pre- disposing factors increase the risk of venous thromboembolism with HRT?

A

a family history of DVT or obesity may further increase this risk.

195
Q

How can the risk of deep vein thrombosis during travel be managed for women on HRT? (3)

A

Travel involving prolonged immobility increases the risk of DVT.

This risk can be reduced with exercise or compression hosiery.

It’s also recommended to review the need for HRT in women with predisposing factors.

196
Q

What factors contribute to the risk of stroke in women on hormone replacement therapy (HRT)?

A

The risk of stroke increases with age

meaning older women have a greater absolute risk of stroke.

197
Q

Does hormone replacement therapy (HRT) prevent coronary heart disease?

A

No, HRT does not prevent coronary heart disease. In fact, there is an increased risk of coronary heart disease in women who start combined HRT more than 10 years after menopause.

198
Q

What are the immediate reasons to stop combined hormonal contraceptives or HRT? (8)

A

Sudden severe chest pain

Sudden breathlessness (or cough with blood)

Unexplained swelling or severe pain in one leg

Severe stomach pain

Serious neurological effects including severe, prolonged headache, sudden partial or complete loss of vision, sudden disturbance of hearing, bad fainting attack, unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of the body

Hepatitis, jaundice, liver enlargement

Blood pressure above systolic 160 mmHg or diastolic 95 mmHg

Prolonged immobility after surgery or leg injury

Detection of a risk factor which contraindicates treatment

199
Q

What is the purpose of using Clomifene (anti-oestrogen) in medical treatment? (2)

A

Clomifene is used to stimulate ovulation

used in the treatment of female infertility.

200
Q

Why should Clomifene not typically be used for longer than 6 cycles?

A

due to an increased risk of ovarian cancer

201
Q

How do androgens (testosterone) affect the body?

A

Androgens, such as testosterone, cause masculinization.

They may be used as replacement therapy in castrated adults and in individuals who are hypogonadal due to either pituitary or testicular disease.

202
Q

What is the function of anti-androgens?

A

inhibit the effects of testosterone in the body.

203
Q

In what circumstances is cyproterone acetate used?

A

Cyproterone acetate is used in the treatment of severe hypersexuality and sexual deviation in men.

204
Q

How are dutasteride and finasteride utilized in medical treatment? (2)

A

Dutasteride and finasteride are used in benign prostatic hyperplasia

to reduce prostate size.

205
Q

What are the primary antithyroid drugs used in the treatment of thyroid disorders? (2)

A

Carbimazole is the most commonly used drug

while propylthiouracil is reserved for patients intolerant/ sensitive of carbimazole

206
Q

How do Carbimazole and Propylthiouracil primarily act in the body?

A

interfere with the synthesis of thyroid hormones.

207
Q

What precautionary measures should be taken regarding neutropenia and agranulocytosis in patients taking Carbimazole (3)

A

should report symptoms and signs suggestive of infection, especially sore throat.

A white blood cell count should be performed if there is any clinical evidence of infection.

Carbimazole should be stopped promptly if there is clinical or laboratory evidence of neutropenia.

208
Q

Is radioactive iodine contraindicated in pregnancy?

A

Yes

209
Q

What considerations are important for the initial dosing of Levothyroxine and Liothyronine? (3)

A

a baseline ECG is valuable

can assess the electrical activity of the heart

to ensure that symptoms related to hypothyroidism are not being mistaken for symptoms of heart ischemia

210
Q

What symptoms may indicate a need for dose adjustment or temporary withholding of Levothyroxine or Liothyronine? (6)

A

diarrhea
nervousness
rapid pulse
insomnia
tremors
and sometimes anginal pain

THESE may ALL indicate a need to reduce the dose or withhold it for 1-2 days.

211
Q

How does liothyronine compare to levothyroxine? (2)

A

Liothyronine is used in severe hypothyroid states where a rapid response is required

it is faster acting but has a shorter duration compared to levothyroxine

212
Q

Why should steroids be used with cuation in children?

A

possible growth restrictions

213
Q

What is the target HbA1C concentration for patients with type 1 diabetes?

A

48mmol/ mol (6.5%)

214
Q

How often should type 1 diabetes monitor their blood- glucose concentration?

A

atleast 4 times a day: including before each meal and before bed

215
Q

What should the blood-glucose concentration of a type 1 diabetic be: on waking

A

5-7mmol/L

216
Q

What should the blood-glucose concentration of a type 1 diabetic be: before meals and throughout the day

A

4-7mmol/L

217
Q

What should the blood-glucose concentration of a type 1 diabetic be: after eating?

A

5-9mmol/L atleast 90 minutes after eating

218
Q

What should the blood-glucose concentration of a type 1 diabetic be: when driving?

A

atleast 5mmol/L

219
Q

How does an insulin pump work? (4)

A

contains short-acting or rapid acting insulin

The pump infuses the insulin into the patient s/c slowly

this provides basal control

When patient is about to eat, they will press the button and get a bolus dose of soluble insulin as well

220
Q

Who are insulin pumps given to? (2)

A

only used in adults who suffer disabling hypoglycaemia

or have high HbA1C concentrations.

221
Q

Where should insulin be injected? (3)

A

into a body area with plenty of SC fat

usually the abdomen (fastest absorption rate)

or outer thighs/buttocks (slower absorption rate).

222
Q

What is lipohypertrophy? (3)

A

lump of fatty tissue

it can occur due to repeatedly injecting the insulin into the same area

can cause erratic absorption of insulin resulting in poor glycaemic control.

Lipohypertrophy can be minimised by using different injection sites in rotation.

223
Q

What is an alternative to gliclizide whent here is a risk of hypoglycaemia?

A

sitagliptin

224
Q

why is metformin a good choice for overweight patients?

A

it does not cause weight gain

225
Q

How often is metformin taken?

A

TDS
with meals

226
Q

if metformin alone, was not adequately controlled diabetes, what canw e add on?

A

add a Sulphonylurea/DPP4i/Pioglitazone

227
Q

Why can we not give sulphonylureas e.g. gliclizide to overweight patients?

A

cause weight gain

228
Q

can we give sulphonylureas in pregnancy?

A

no, avoid

229
Q

can pioglitazone cause weight gain?

A

yes

230
Q

what are two advantages of DPP4 inhibitors compared to sulphonylureas?

A

do not cause weight gain

have less incidence of hypoglycaemia

231
Q

what must diabetic patients do to reduce their risk of hypoglycaemia when driving?

A

Drivers treated with insulin must carry a glucose meter with blood-glucose strips and fast- acting snacks

must check their blood-glucose concentration 2 hours BEFORE driving and every 2 hours WHILE driving.

Blood-glucose levels should always be above 5mmol/litre while driving.

But if blood-glucose falls to 5mmol/litre or below, a snack should be taken (fast-acting carbohydrate).

232
Q

What should diabetic drivers do if blood glucose is less than 4mmol/L or symptoms of hypoglycaemia appear? (3)

A

the driver should not drive.

If the driver is driving then stop driving, eat/drink some sugar

and wait until 45 minutes after blood-glucose has returned to normal.

233
Q

What is the earliest sign of nephropathy? (2)

A

Microalbuminuria

so patients should have an annual test for urinary protein

234
Q

Why should patients with diabetic nephropathy not be given BOTH an ACEi and ARB?

A

they are susceptible to developing hyperkalaemia

235
Q

How is diabetic ketoacidosis treated?

A

have to rehydrate the patient without giving glucose

Initial management involves rehydrating the patient with 0.9% saline via IV infusion

To replenish potassium levels, potassium chloride fluid is administered

IV insulin infusion is then given to reduce blood glucose and ketone production

(the Insulin should be mixed with 0.9 % saline and titrated to lower glucose by at least 3 mmol/l/hr)

When blood glucose drops below 14 mmol/l, IV glucose 10% is added to prevent hypoglycemia.

Insulin infusion continues until blood ketone concentration is <0.3 mmol/l and the patient can eat

then shifted to SC fast-acting insulin with a meal, discontinuing the infusion after 1 hour.

236
Q

What should be done for patients on insulin before surgery?

A

On the day BEFORE surgery, continue usual insulin regimen except for once-daily long-acting analogues, which are reduced by 20%.

On the day OF surgery and THROUGHOUT the intra-operative period, once-daily long-acting analogues are also reduced by 20%, while all other insulin is halted until the patient resumes eating and drinking post-surgery.

237
Q

What medications should be stopped once insulin infusion is initiated during surgery? (6)

A

Acarbose

meglitinides

sulfonylureas

pioglitazone

DPP4i

SGLT2i

238
Q

Which medications can be taken as normal during the entire peri-operative period? (2)

A

Pioglitazone
DPP4i

239
Q

What should be done with SGLT2 inhibitors on the day of surgery? (2)

A

SGLT2 inhibitors should be omitted on the day of surgery and not restarted until the patient is stable

due to the increased risk of ketoacidosis during periods of dehydration and acute illness.

240
Q

Why should sulfonylureas be omitted on the day of surgery? (3)

A

Sulfonylureas are associated with hypoglycemia in the fasted state

so they should be omitted on the day of surgery

and not restarted until the patient is eating and drinking again.

241
Q

What risks are associated with diabetes in pregnancy? (2)

A

increases risks to both the woman and the developing fetus

such as pre-eclampsia and adverse outcomes like stillbirth, miscarriage, and neonatal death.

242
Q

What HbA1c level should women with pre-existing diabetes aim for before conception?

A

HbA1c level below 6.5%

to reduce the risk of congenital malformations in the newborn

243
Q

What should women with pre-existing diabetes take before pregnancy to reduce the risk of neural tube defects in the newborn?

A

should take folic acid

at the dose recommended for women at high risk of conceiving a child with a neural tube defect.

244
Q

Which antidiabetic drug should be continued during pregnancy? (2)

A

Metformin should be continued during pregnancy

while all other oral antidiabetic drugs should be discontinued and SUBSTITUTED with INSULIN therapy.

245
Q

Which antidiabetic drug can be used during breastfeeding?

A

Metformin can be used

while all OTHER antidiabetic drugs should be AVOIDED

246
Q

What is the treatment approach for gestational diabetes if fasting blood glucose is >7mmol/L? (3)

A

Initially, diet and exercise are recommended.

If blood glucose targets are not met after 1-2 weeks, Metformin can be started.

If fasting blood glucose is over 7mmol/L, immediate treatment with insulin is advised, with or without Metformin.

247
Q

How is hypoglycemia initially treated? (3)

A

Initially, 10-20g of oral glucose is given, such as cola, sugar, or Lucozade.

This may be repeated if necessary after 10-15 minutes.

After initial treatment, consuming carbohydrates like a sandwich, fruit, milk, or biscuits can prevent blood glucose from falling again.

248
Q

What emergency measures are taken for hypoglycemia causing unconsciousness?

A

Glucagon is administered to increase plasma glucose concentration by releasing glycogen from the liver.

If not effective after 10 minutes, , intravenous glucose 20% can be administered.

Diazoxide administered orally is useful for managing chronic hypoglycemia only.

249
Q

What should be done if a patient taking liothyronine develops diarrhoea?

A

its a sign metabolism occurs too rapidly

reduce dose or whithold for 1-2 days and start again at a lower dose

(same is true if pt is experiencing any of these symtoms: nervousness, insomnia, tremors etc)

250
Q

What fractures have both alendronic acid and risedronate sodium been shown to reduce?

A

have been shown to reduce the occurrence of vertebral, non-vertebral, and hip fractures

251
Q

What is an additional option for osteoporosis treatment, particularly for younger postmenopausal women at high risk of fractures?

A

Hormone replacement therapy (HRT)

252
Q

Why is hormone replacement therapy generally restricted for older postmenopausal women?

A

due to the risk of adverse effects such as cardiovascular disease and cancer.

253
Q

What are the second-line options for those who are intolerant of or contraindicated to oral bisphosphonates?

A

Intravenous bisphosphonates, such as denosumab and zoledronic acid

254
Q

How should alendronic acid be taken? (4)

A

Alendronic acid should be taken once weekly in women and once daily in men

with a full glass of water while sitting or standing.

It should be taken at least 30 minutes before breakfast and other medicines

and the patient should remain upright for a further 30 minutes after taking it

255
Q

Can alendronic acid be given in pregnancy?

A

No, avoid

256
Q

What is tetracosactide used for, and how does its administration help diagnose adrenocortical function? (4)

A

Tetracosactide

an analogue of corticotropin (ACTH)

is used to test adrenocortical function

FAILURE of the plasma cortisol concentration to RISE after ADMINISTRATION of tetracosactide INDICATED adrenocortical insufficiency.

257
Q

What are gonadotropins used for in the treatment of infertility in women? (4)

A

Gonadotropins

are used in the treatment of infertility in women with hypopituitarism

or those who have not responded to clomifene citrate

or for assisted conception such as in-vitro fertilisation (IVF).

Gonadotrophins include: follicle-stimulating hormone (FSH), luteinising hormone (LH), FSH alone (as in follitropin), or chorionic gonadotrophin

258
Q

What is an example of growth hormone used for treating deficiency in children and adults?

A

Somatotropin (which has been replaced by somatropin)

259
Q

What is hypoglycaemia?

A

a clinical state

where the blood glucose levels fall below 3.5mmol/L.

Nafisa Pre Reg (11 decks)

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