Endocrine

Question 1

What ‘condition’ would the following results most likely indicate

a) Normal/low TSH, low T4
b) Low TSH, high T4
c) High TSH, low T4

Answer 1

a) Secondary hypothyroidism (eg due to pituitary/hypothalamic disease)
b) Hyperthyroidism
c) Hypothyroidism

Question 2

A customer of yours has recently been diagnosed with Addison’s disease, and has a new script for cortisone (10mg mane, 5mg afternoon), and fludrocortisone (50mcg mane). Explain to the customer -

a) why they need two different medications, and what they do
b) what to do during illness (re: dosing)
c) adverse effects/referral points
d) lifestyle advice

Answer 2

a) Cortisone = glucocorticoid, fludrocortisone = mineralocorticoid. Autoimmune condition which decreases endogenous (natural) levels of steroid hormones (therefore, need to be replaced to maintain metabolic/anti-inflammatory/BP etc)
b) During illness (non-life threatening) may need to double or treble dose of cortisone
c) Only if doses are too high (e.g. sodium, water retention FLUDRO), (weight gain, inc BSLs CORTISONE)
d) Educate patient and family about condition (know when to increase doses e.g. illness, stress), wear a medic alert bracelet, carry a card (with details of dosing and instructions in emergencies), recognise crisis (dehydration, shock)

Question 3

Provide 3 counselling points, and 3 monitoring points, for risedronate 150mg once a month

Answer 3

Counselling
1) have dental procedure before starting (or inform dentist of use before dental surgery)
2) take on the same day/date each month, if you forget and there is more than 7 days till next dose due TAKE ASAP, if there is less than 7 days till next dose due WAIT FOR NEXT DOSE
3) do not lie down for at least 30 mins after taking dose
(others = space antacids/iron/calcium 2 hrs, take on empty stomach etc)
Monitoring
1) BMD, Ca, Vit D, AEs eg oesophagitis, renal)

Question 4

Which sulfonylureas are the most likely to cause hypoglycaemia and why?

Answer 4

glibenclamide and glimepiride (longer acting, esp in renal impairment)

Question 5

What time should exenatide be administered with respect to food, and why?

Answer 5

Within 60 minutes before one (if using OD) or two (if using BD) main meals (ideally = 15-30 minutes before main meals).
One of the MOAs of exenatide is delaying gastric emptying, which slows glucose absorption and decreases appetite (therefore not much point taking after a meal).

Question 6

Define the following as

• ‘ultra short’ acting, ‘short’ acting or ‘long’ acting
  a) insulin detemir
  b) insulin glulisine
  c) neutral (human) insulin
  d) isophane insulin
  e) insulin glargine
  f) insulin lispro

Answer 6

a) long acting
b) ultra short acting
c) short acting
d) long acting
e) long acting
f) ultra short acting

Question 7

• What is lactic acidosis?

- List 5 risk factors that can increase the risk of lactic acidosis in a patient taking metformin for T2D

Answer 7

• build up of lactate in body decreasing pH (nausea, vomiting, rapid breathing, weakness). Can be diagnosed using blood gas samples.
• shock, sepsis, dehydration, excessive exercise, MI, severe heart failure, surgery, ketoacidosis, alcohol poisoning etc