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BNF > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Classes of anti diabetic drugs

A

SGLT2 inhibitors -gliflozolines
DDP4 inhibitors -gliptins
Buguanide -metformin
SU -gliclazide, tolbutamide, glibenclamide
GLP agonist (incretin) -xenitide, glutide
Acarbose
Thiazolidinedions

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2
Q

HMRA warning on carbimazole

A
  • neutropenia, agranulocytosis (report sign of inf eg sore throat, BWC)
  • risk of congenital malformation (1st trimester) use contraception
  • risk of acute pancreatitis NV,fever
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3
Q

carbimazole indication

A

hyperthyroidism

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4
Q

what is blocking-replacement therapy

A

simultaneous use of levothyroxine and carbimazole to block the endogenous synthesis of thyroid hormone, while maintaining a euthyroid state by providing exogenous hormone

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5
Q

how long should block-replace therapy last

A

18m

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6
Q

can you use block-replace therapy in pregnancy

A

NO

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7
Q

iodine can be used as adjunct to antithyroids 2 weeks before partial thyroidectomy, can it be used long term? why

A

no, antithyroid effect reduces with time

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8
Q

what is Diabetes insipidus

A

body produces a large amount of urine and often feel thirsty.

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9
Q

what is Vasopressin

A

antidiuretic hormone

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10
Q

Desmopressin / vasopressin, which is more potent and has a longer duration of action

A

Desmopressin

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11
Q

two types of diabetes insipidus

A
  1. cranial (not enough ADH produced)

2. nephrogenic (kidney doesn’t respond to ADH)

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12
Q

What trt are used in cranial diabetes insipidus

A

vasopressin or desmopressin (more potent)

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13
Q

what trt is used in nephrogenic diabetes insipidus

A

thiazide diuretics to give paradoxical effect

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14
Q

s/e of desmopressin

A

hyponatrameic convulsions (increase H20 absorption, dilute body fluid)

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15
Q

how to correct hypONatraemia if fluid restrction alone is ineffective

A

Demeclocycline- block renal tubular effect of ADH

Tolvaptan - vasopressin antagonist

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16
Q

rapid correction of hypONatraemia should be avoided because…

A

osmotic demyelination of neurones –> serious CNS effects

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17
Q

high mineralocorticoid activity = effect on body fluid level and BP

A

fluid retention = increase BP

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18
Q

which corticorsteroid has the most potent / standard / least potent mineralocorticoid effect

A

fludrocortisone / hydrocortisone / betamethasone, dexamethasone

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19
Q

glucocorticoid effect of hydrocortisone allows it to be used on short term basis via IV for..

A

surgeries or emergency e.g. asthma

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20
Q

effect of minerlocorticoid on K+ and Ca++ level

A

K+, Ca++ LOSS

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21
Q

which corticorsteroid has the most potent / standard / least potent glucocorticoid effect

A

betamethasone, dexamethasone / prednisolone, prednisone, deflazcort, hydrocortisone / fludrocortisone

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22
Q

what is the main use of glucocorticoid effect

A

anti-inflammatory (e.g. asthma, COPD)

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23
Q

what are the s/e of corticosteroid?

A 
ACHING BOSOM
A- adrenal supression (fatigue, hyPOtension, hyPOglycaemia, hypERK), appetite increase, abrupt w.d rxns (hypotension, death)
Cushing's syndrome, Cataracts
HypERglycaemia, hyperlipidaemia
Infections (IM suppression)
Nervous system, psychiatric rxn (mood, depression)
Glaucoma, GI ulcer (with food)
BP increase
Skin thinning
Osteoporosis (>3m, bisphosphonates), child growth
Obesity
Muscle wasting (caution w statin)
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24
Q

mhra warning on methylprednisolone injectable

A

contains lactose, avoid use in cow milk allergic pts

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25
Q

how to reduce adrenal suppression caused by corticosteroid

A
  1. take dose OM (least suppressive action)
  2. take two days worth dose on alternate day
  3. intermittent short courses
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26
Q

avoid abrupt w.d of steroid if used prednisolone > x mg OD for more than 1 week

A

pred>40mg for over 1 week

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27
Q

what is addison’s disease

A

lack of hydrocortisone and aldosterone, normally followed by adrenalectomy

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28
Q

trt for adrenalectomy / addisons disease

A

hydrocortisone and fludrocortisone (for both gluco-, mineralo effect)

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29
Q

trt for hypopituitarism

A

hydrocortisone, NOT fludrocortisone (aldosterone is regulated by a different system) and other hormones (sex, thryoid)

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30
Q

what is cushing syndrome

A

hyPERcortisolism

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31
Q

symptoms of cushing syndrome

A

SKIN THIINING- easy bruise, red strech marks, striae, red cheeks, fat deposits in face = moon face, acne, hirsutism, amenorrhea

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32
Q

causes of cushing syndrome

A

corticosteroids - reduce dose or w.d

tumour - surgery or cortisol-inhibting drugs: Metyrapone (competitive) or Ketoconazole (potent)

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33
Q

risks with ketoconazole in treating cushing syndrome MHRA

A

LIFE THREATENING HEPATOTOXICITY - report sign of liver impair eg dark urine, ab pain, jaundice, piritus, NV

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34
Q

risks with METYRAPONE cortisol-inhibiting drugs in treating cushing syndrome

A

adrenal insufficientcy - report fatigue, NV, hyPOtension, anorexia. hyPONataemia, hyPERKalaemia, hyPOGlycaemia

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35
Q

what are the complications of diabetes and the trts

A
  1. retinopathy - treat hypertension
  2. nephropathy - ACEi/ARB (ACEi potentiates hyPOglycaemic effect of anti-diabetic drug esp in renal impair)
  3. neuropathy - a)diabetic foot - painkillers, duloxetine, TCA:ami,nortriptyline, antiepileptic: gabapentin,pregabalin, carbmazepine
    b) autonomic neuropathy - nerve damage in SM cause uncontrolled involuntary response e.g. diarrhoea, gastroparesis (feel full as stomach emptying slows): erythromycin, c) Erectile dysfunction: sildenafil
  4. gustatory (taste) neuropathy: sweating head, face, neck: antimus
  5. neuropathic postural hypotension: fludrocortisone, increase salt intake
36
Q

HbA1C target for diabetic pregnant women

A

below 48mmol/L 6.5%

37
Q

how much of the folic acid should diabetic preg women take and why

A

5mg folic acid as diabetes is high risk gp for neural tube defects

38
Q

what is the preferred form of insulin used in pregnancy, example

A

longer acting insulin e.g. isophane insulin

39
Q

what are the safe options (antidiabetic medicnes) in pregnancy

A

metformin and insulin (stop all other antidiabetic drug due to risk of hyPOglycaemia esp in 1st trimester)
Glibenclimide in 2nd and 3rd

40
Q

which antidiabetic drug can be used from 11 weeks gestation; after organgenesis

A

glibenclamide

41
Q

what are the symptoms for DKA

A

severe hyPERglycaemia, high ketone level, ketonuria, pear drop breath, dehydration, ex thirst, polyuria, NV, anorexia, ab pain, confusion, drowsiness, coma, convulsion

42
Q

trt for DKA

A

IV infusion

  1. soluble insulin
  2. fluid (saline)
  3. K+ (avoided if anuria)
43
Q

how frequent should you check BGL for long journeys

A

no more than 2h before driving and every 2h thereafter

44
Q

avoid driving if BGL fall below…

A

< 4mmol/l = HYPO

45
Q

2 types of soluble insulin… what are the indications and why (BOLUS)

A

human and beef/pork soluble

used in diabetic emergencies, surgery, due to SHORT acting

46
Q

3 rapid acting analogue insulin (BOLUS) and how it should be taken

A 
1 lispro (Humalog)
2 aspart (novorapid)
3 glulisine (apridra)
take immediately before or after meal
47
Q

name 1 intermediate acting insulin and how it should be taken, which route of adm should be avoided (BASAL)

A

isophane, take BD in connection with soluble insulin

avoid give IV =THROMBOSIS

48
Q

4 long acting analogue and how it should be taken

A 
1 glargine (Lantus)
2 detemir OD/BD )Levemir 
3 degludec (tresiba)
4 protamine zinc 
take OD at same time each day to cover 24h period
49
Q

2 things to avoid when giving protamine zinc

A

never give IV = THROMBOSIS

never MIX with SOLUBLE = binds in syringe

50
Q

under which 4 conditions, insulin requirements will increase

A

pregnancy
puberty
stressful accident, trauma
infections

51
Q

under which 2 conditions, insulin requirements will reduce

A 
endocrine disorders eg Addisons, hypopituitarism 
coeliac disease (gluten)
52
Q

Which two drugs can increase hyPOglaemic effect of insulin

A

ACEI (hyPERKalemia and hyPOglycaemia LINKED)

B-blocker - mask sympt of hyPO)

53
Q

Which three types of D antagonise hyPOglycaemic effect of insulin

A

Corticosteroid
CC
loop/thiazide diuretics (low K)

54
Q

storage condition for insulin once opened

A

once opened, room temp and use by 28 days

55
Q

beef insulin to human insulin conversion

A

beef to human = reduce dose by 10%

56
Q

pork insulin to human insulin conversion

A

pork to human = no dose change

57
Q

MOA of metformin (1st line in ALL T2DM)

A

decrease liver gluconeogenesis

increase peripheral use

58
Q

SE of metformin (5)

A
  1. lactic acidosis
  2. GI (N,V,D)
  3. weight loss
  4. taste disturbance
  5. reduce VitB12 absorption
59
Q

metformin should be avoided in which pt gp

A

avoid in pt with renal impairment eGFR<30ml/min

60
Q

MOA of SU

A

increase insulin secretion

61
Q

which two SU can be used in eldery and renal impaired pt and why

A

short acting ones eg gliclazide, tolbutamide as lower risk of hypo

62
Q

which SU is suitable for pregnancy pt in which trimesters

A

glibenclamide in 2 and 3rd trimesters

63
Q

three main SE of SU are…

A
  1. hyPONa
  2. hyPOs (must trt in hospital)
  3. weight gain
64
Q

which drugs can interact with SU and change BGL / excretion

A

ACEi and warfarin can increase hyPO

NSAID can reduce renal excretion of SU

65
Q

Blood glucose target Pre prandial

A

4-7 mmol/L

66
Q

Blood glucose target Post prandial

A

< 9 mmol/L

67
Q

HbA1C target measures every 3/6 months for diabetic Pt

A

6.5-7.5% (< 48-59 mmol/L)

68
Q

HbA1C target measures every 3/6 months for diabetic Pt with high risk of arterial disease

A

< or = 6.5%

69
Q

HTN in DM w/o complications BP target is

A

140/80

70
Q

BP target for DM with compilations

A

130/80

71
Q

How long does insulin last if left outside the fridge at room temp

A

Max 48 hours then discard

72
Q

Recommend insulin regime for T1DM

A

Multiple injection regimen

73
Q

Recommend insulin regime for T2DM

A

Start with isophane insulin OD or BD

Then add short acting (soluble) insulin as a biphasic or multiple injection regimen

74
Q

How does metformin work

A

Decrease gluconeogenesis

Increase peripheral use

75
Q

Se of metformin

A 
Lactic acidosis esp in pt with HF, tissue hypoxia, resp depression, severe infection, dehydration 
GI - N V D use MR 
weight loss
Taste disturbance 
Reduce vit B 12 absorption 
C/I in renal Impairment
76
Q

A deficiency of which vitamin could cause Scurvy (swollen bleeding unhealed wound in gum)

A

Vitamin C

77
Q

Max duration of usage of loperamide

A

5days

78
Q

Dosage of loperamide

A

Take 2 cap (4mg) initially
Take one after each loose stool
Max 16mg daily

79
Q

What’s the criteria for selling tamsulosin?

A

Male
45-75
BPH symp for THREE MONTHS

80
Q

How many tamsulosin can u supply initially then thereafter

A

2 weeks worth to see improvement then another 4 weeks then review for more

81
Q

Which anti diabetic medication need to be stopped prior to Iodine contain in contrast media due to risk of renal failure

A

Metformin

82
Q

License to age for Seretide inhaler

A

12+

83
Q

Which asthmatic drug can cause liver disorder

A

Zafirlukast

84
Q

What is nabilone and what is it indicated for

A

It is a cannabinoid used for nausea and vomiting caused by chemotherapy

85
Q

What class is Apomorphine

A

Non ergot DAR agnost

86
Q

How does stoma in children affect on electrolytes

A

Hypo potassium

87
Q

What formulation of iron supplement should be supplied to a patient with a stoma

A

Iron cause loose stool can complicate stoma
IV IRON indicated
MR AVOID

BNF (13 decks)

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