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Endocrine Flashcards

1
Q

Instances to discontinue Metformin

A
  • Use of contrast medium (until 48 hours post)
  • eGFR < 30 mL/min/1.73m2

Stress states:
- Heart failure (esp ADHF)
- Severe liver impairment
- Alcoholism
- Sepsis

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2
Q

Dosage of metformin according to renal clearance

A

eGFR >45: Max 850 mg TDS
eGFR 30-45: Max 500 mg BD. No new initiation
eGFR <30: Avoid

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3
Q

Thiazolidinediones drug interactions

A

Pioglitazone: 3A4 substrate
Rosiglitazone: 2C9 substrate

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4
Q

Cautions for thiazolidinediones

A
  • Edema and HF exacerbation
  • Bladder cancer (pioglitazone)
  • Fracture risk
  • Hepatotoxicity and LFT derangements
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5
Q

Cautions for DPP4 inhibitors

A
  • Pancreatitis (sitagliptin)
  • Arthralgias
  • Heart failure (saxagliptin)
  • SJS/TEN
  • Not to be used with GLP-1 agonists
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6
Q

DPP4 inhibitor that does not require renal dose adjustment

A

Linagliptin (5 mg OD)

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7
Q

SGLT2 inhibitors with FDA approval for ASCVD benefit

A

Canagliflozin (CANVAS)
Empagliflozin (EMPA-REG)

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8
Q

SGLT2 inhibitors with FDA approval for HF benefit

A

Dapagliflozin (DAPA-HF / DELIVER)
Empagliflozin (EMPEROR-Reduced / Preserved)

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9
Q

SGLT2 inhibitors renal dosing adjustment

A

Reduced glucose lowering effect when eGFR <45

Dapagliflozin: <25 not initiated, continue at 10 mg OD
Empagliflozin: <30 10 mg OD; <20 unclear benefit

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10
Q

Dose of evidence-based GLP-1 agonists

A

Dulaglutide: SC 0.75-1.5 mg once weekly, up to 3-4.5 mg once weekly
Liraglutide: SC 0.6 mg OD, up to 1.8 mg OD
Semaglutide: SC 0.25 mg once weekly, up to 1 mg once weekly

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11
Q

Goal for HbA1c

A

Stringent: <6.5% (AACE), <7% (ADA)
Lenient: 8%

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12
Q

Drugs interacting with Metformin

A

Cimetidine
Digoxin
Dolutegravir
Ranolazine (not to exceed 850 mg BD if ranolazine is used at 1000 mg BD)
Iodine contrast medium (hold for at least 48 hours after)

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13
Q

Concerns for SGLT2 inhibitors

A
  • AKI
  • DKA
  • Fournier’s gangrene
  • High stress states
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14
Q

Concerns for GLP-1 agonists

A
  • Pancreatitis
  • Thyroid C cell tumors
  • Gastroparesis
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15
Q

Insulins that should not be mixed together

A
  • Glargine + all other insulins (pH issue)
  • Glulisine + all other insulins except NPH
  • Detemir + all other insulins
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16
Q

Cut-off for over-basalisation of insulin

A

> 0.5 IU/kg/day

17
Q

Administration of levothyroxine

A

On empty stomach 30-60 mins before food. Or 4 hours after last meal at night

18
Q

Monitoring of levothyroxine treatment

A

TSH (IN 4-8 weeks, target 0.4-5 mIU/L)
Free T4 (if central hypothyroidism)

19
Q

ADR of thionamides

A
  • Abnormal tastes
  • Rash
  • Agranulocytosis
  • Carbimazole: pancreatitis, teratogenicity
  • PTU: hepatotoxicity, autoimmune vasculitis
20
Q

Interaction of thionamides

A

RAI with NaI (to be stopped at least 3 days before RAI)

21
Q

Treatment of subclinical hypothyroidism

A
  • TSH >10 or
  • TSH 4.5-10 AND symptomatic/TPO-antibody present/history of CVD
22
Q

Monitoring with thionamide treatment

A

Free T4
Total T3
Monitor at 4-6 weeks interval and titrate doses at monthly intervals

23
Q

Treatment of subclinical hyperthyroidism

A

TSH <0.1
Use BB if AF develops

24
Q

Risks associated with alpha antagonists

A
  • Flu-like symptoms, nasal congestion
  • Orthostasis
  • Intraoperative floppy iris syndrome
  • Retrograde ejaculation
25
Q

DDI with alpha blockers

A

Tamsulosin: 3A4, 2D6
Alfuzosin: 3A4
Doxazosin: 3A4, 2C9

26
Q

Administration of alpha blockers

A

Alfuzosin to be taken after meal

27
Q

Risks associated with PDE5 inhibitors

A
  • Orthostasis
  • Colour indiscrimination (silde)
  • Sudden hearing loss
  • Muscle pain (tada)
  • QTc prolongation (varde)
  • NAION
  • Priapism
28
Q

Drug interactions with PDE5 inhibitors

A

3A4 substrates

29
Q

Administration of PDE5 inhibitors

A

Sildenafil 2 hours before food

30
Q

DDI with 5-ARI

A

3A4 substrates

31
Q

Precautions with 5-ARI

A
  • Impotence
  • Gynecomastia
  • Not be handles by females of reproductive age
  • Practise contraception
32
Q

Medications that can induce thyroid disorders

A

Amiodarone
Lithium
Interferon alpha

33
Q

Max dose of metformin

A

IR: 2550 mg/day
XR: 2000 mg/day

eGFR 30-45: 1 g/day

34
Q

Max doses of sulfonylureas

A

Glipizide: 20-40 mg/day
- eGFR <50: Max 20 mg/day
- eGFR <10: Best avoided

Gliclazide IR: 320 mg/day (3 MR = 8 IR)
Gliclazide MR: 120 mg/day
- eGFR <15: avoided, if needed to use IR max 40 mg/day

Glibenclamide: 20 mg/day

35
Q

Dose adjustment for sitagliptin

A

100 mg OD
CrCl <45: 50 mg OD
eGFR <30: 25 mg OD

36
Q

Diagnosis of DM

A

HbA1c 7% or higher

HbA1c 6.1-6.9% AND
- FPG 7 mmol/L or higher or
- 2h OGTT 11.1 mmol/L or higher

Clinical (9 decks)

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