Endocrine Flashcards
Classes of anti diabetic drugs
SGLT2 inhibitors -gliflozolines
DDP4 inhibitors -gliptins
Buguanide -metformin
SU -gliclazide, tolbutamide, glibenclamide
GLP agonist (incretin) -xenitide, glutide
Acarbose
Thiazolidinedions
HMRA warning on carbimazole
- neutropenia, agranulocytosis (report sign of inf eg sore throat, BWC)
- risk of congenital malformation (1st trimester) use contraception
- risk of acute pancreatitis NV,fever
carbimazole indication
hyperthyroidism
what is blocking-replacement therapy
simultaneous use of levothyroxine and carbimazole to block the endogenous synthesis of thyroid hormone, while maintaining a euthyroid state by providing exogenous hormone
how long should block-replace therapy last
18m
can you use block-replace therapy in pregnancy
NO
iodine can be used as adjunct to antithyroids 2 weeks before partial thyroidectomy, can it be used long term? why
no, antithyroid effect reduces with time
what is Diabetes insipidus
body produces a large amount of urine and often feel thirsty.
what is Vasopressin
antidiuretic hormone
Desmopressin / vasopressin, which is more potent and has a longer duration of action
Desmopressin
two types of diabetes insipidus
- cranial (not enough ADH produced)
2. nephrogenic (kidney doesn’t respond to ADH)
What trt are used in cranial diabetes insipidus
vasopressin or desmopressin (more potent)
what trt is used in nephrogenic diabetes insipidus
thiazide diuretics to give paradoxical effect
s/e of desmopressin
hyponatrameic convulsions (increase H20 absorption, dilute body fluid)
how to correct hypONatraemia if fluid restrction alone is ineffective
Demeclocycline- block renal tubular effect of ADH
Tolvaptan - vasopressin antagonist
rapid correction of hypONatraemia should be avoided because…
osmotic demyelination of neurones –> serious CNS effects
high mineralocorticoid activity = effect on body fluid level and BP
fluid retention = increase BP
which corticorsteroid has the most potent / standard / least potent mineralocorticoid effect
fludrocortisone / hydrocortisone / betamethasone, dexamethasone
glucocorticoid effect of hydrocortisone allows it to be used on short term basis via IV for..
surgeries or emergency e.g. asthma
effect of minerlocorticoid on K+ and Ca++ level
K+, Ca++ LOSS
which corticorsteroid has the most potent / standard / least potent glucocorticoid effect
betamethasone, dexamethasone / prednisolone, prednisone, deflazcort, hydrocortisone / fludrocortisone
what is the main use of glucocorticoid effect
anti-inflammatory (e.g. asthma, COPD)
what are the s/e of corticosteroid?
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)
mhra warning on methylprednisolone injectable
contains lactose, avoid use in cow milk allergic pts
how to reduce adrenal suppression caused by corticosteroid
- take dose OM (least suppressive action)
- take two days worth dose on alternate day
- intermittent short courses
avoid abrupt w.d of steroid if used prednisolone > x mg OD for more than 1 week
pred>40mg for over 1 week
what is addison’s disease
lack of hydrocortisone and aldosterone, normally followed by adrenalectomy
trt for adrenalectomy / addisons disease
hydrocortisone and fludrocortisone (for both gluco-, mineralo effect)
trt for hypopituitarism
hydrocortisone, NOT fludrocortisone (aldosterone is regulated by a different system) and other hormones (sex, thryoid)
what is cushing syndrome
hyPERcortisolism
symptoms of cushing syndrome
SKIN THIINING- easy bruise, red strech marks, striae, red cheeks, fat deposits in face = moon face, acne, hirsutism, amenorrhea
causes of cushing syndrome
corticosteroids - reduce dose or w.d
tumour - surgery or cortisol-inhibting drugs: Metyrapone (competitive) or Ketoconazole (potent)
risks with ketoconazole in treating cushing syndrome MHRA
LIFE THREATENING HEPATOTOXICITY - report sign of liver impair eg dark urine, ab pain, jaundice, piritus, NV
risks with METYRAPONE cortisol-inhibiting drugs in treating cushing syndrome
adrenal insufficientcy - report fatigue, NV, hyPOtension, anorexia. hyPONataemia, hyPERKalaemia, hyPOGlycaemia
what are the complications of diabetes and the trts
- retinopathy - treat hypertension
- nephropathy - ACEi/ARB (ACEi potentiates hyPOglycaemic effect of anti-diabetic drug esp in renal impair)
- 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 - gustatory (taste) neuropathy: sweating head, face, neck: antimus
- neuropathic postural hypotension: fludrocortisone, increase salt intake
HbA1C target for diabetic pregnant women
below 48mmol/L 6.5%
how much of the folic acid should diabetic preg women take and why
5mg folic acid as diabetes is high risk gp for neural tube defects
what is the preferred form of insulin used in pregnancy, example
longer acting insulin e.g. isophane insulin
what are the safe options (antidiabetic medicnes) in pregnancy
metformin and insulin (stop all other antidiabetic drug due to risk of hyPOglycaemia esp in 1st trimester)
Glibenclimide in 2nd and 3rd
which antidiabetic drug can be used from 11 weeks gestation; after organgenesis
glibenclamide
what are the symptoms for DKA
severe hyPERglycaemia, high ketone level, ketonuria, pear drop breath, dehydration, ex thirst, polyuria, NV, anorexia, ab pain, confusion, drowsiness, coma, convulsion
trt for DKA
IV infusion
- soluble insulin
- fluid (saline)
- K+ (avoided if anuria)
how frequent should you check BGL for long journeys
no more than 2h before driving and every 2h thereafter
avoid driving if BGL fall below…
< 4mmol/l = HYPO
2 types of soluble insulin… what are the indications and why (BOLUS)
human and beef/pork soluble
used in diabetic emergencies, surgery, due to SHORT acting
3 rapid acting analogue insulin (BOLUS) and how it should be taken
1 lispro (Humalog) 2 aspart (novorapid) 3 glulisine (apridra) take immediately before or after meal
name 1 intermediate acting insulin and how it should be taken, which route of adm should be avoided (BASAL)
isophane, take BD in connection with soluble insulin
avoid give IV =THROMBOSIS
4 long acting analogue and how it should be taken
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
2 things to avoid when giving protamine zinc
never give IV = THROMBOSIS
never MIX with SOLUBLE = binds in syringe
under which 4 conditions, insulin requirements will increase
pregnancy
puberty
stressful accident, trauma
infections
under which 2 conditions, insulin requirements will reduce
endocrine disorders eg Addisons, hypopituitarism coeliac disease (gluten)
Which two drugs can increase hyPOglaemic effect of insulin
ACEI (hyPERKalemia and hyPOglycaemia LINKED)
B-blocker - mask sympt of hyPO)
Which three types of D antagonise hyPOglycaemic effect of insulin
Corticosteroid
CC
loop/thiazide diuretics (low K)
storage condition for insulin once opened
once opened, room temp and use by 28 days
beef insulin to human insulin conversion
beef to human = reduce dose by 10%
pork insulin to human insulin conversion
pork to human = no dose change
MOA of metformin (1st line in ALL T2DM)
decrease liver gluconeogenesis
increase peripheral use
SE of metformin (5)
- lactic acidosis
- GI (N,V,D)
- weight loss
- taste disturbance
- reduce VitB12 absorption
metformin should be avoided in which pt gp
avoid in pt with renal impairment eGFR<30ml/min
MOA of SU
increase insulin secretion
which two SU can be used in eldery and renal impaired pt and why
short acting ones eg gliclazide, tolbutamide as lower risk of hypo
which SU is suitable for pregnancy pt in which trimesters
glibenclamide in 2 and 3rd trimesters
three main SE of SU are…
- hyPONa
- hyPOs (must trt in hospital)
- weight gain
which drugs can interact with SU and change BGL / excretion
ACEi and warfarin can increase hyPO
NSAID can reduce renal excretion of SU
Blood glucose target Pre prandial
4-7 mmol/L
Blood glucose target Post prandial
< 9 mmol/L
HbA1C target measures every 3/6 months for diabetic Pt
6.5-7.5% (< 48-59 mmol/L)
HbA1C target measures every 3/6 months for diabetic Pt with high risk of arterial disease
< or = 6.5%
HTN in DM w/o complications BP target is
140/80
BP target for DM with compilations
130/80
How long does insulin last if left outside the fridge at room temp
Max 48 hours then discard
Recommend insulin regime for T1DM
Multiple injection regimen
Recommend insulin regime for T2DM
Start with isophane insulin OD or BD
Then add short acting (soluble) insulin as a biphasic or multiple injection regimen
How does metformin work
Decrease gluconeogenesis
Increase peripheral use
Se of metformin
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
A deficiency of which vitamin could cause Scurvy (swollen bleeding unhealed wound in gum)
Vitamin C
Max duration of usage of loperamide
5days
Dosage of loperamide
Take 2 cap (4mg) initially
Take one after each loose stool
Max 16mg daily
What’s the criteria for selling tamsulosin?
Male
45-75
BPH symp for THREE MONTHS
How many tamsulosin can u supply initially then thereafter
2 weeks worth to see improvement then another 4 weeks then review for more
Which anti diabetic medication need to be stopped prior to Iodine contain in contrast media due to risk of renal failure
Metformin
License to age for Seretide inhaler
12+
Which asthmatic drug can cause liver disorder
Zafirlukast
What is nabilone and what is it indicated for
It is a cannabinoid used for nausea and vomiting caused by chemotherapy
What class is Apomorphine
Non ergot DAR agnost
How does stoma in children affect on electrolytes
Hypo potassium
What formulation of iron supplement should be supplied to a patient with a stoma
Iron cause loose stool can complicate stoma
IV IRON indicated
MR AVOID
