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Inori Pre Reg > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What’s the target HBA1C for type 1 dm?

A

Below 48mmol/mol

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2
Q

Whats the target HBA1C for type 2 diabetes?

A

Below 48 if on diet, life style treatment or only on 1 non hypo antidiabetic med

Below 53 if on hype med or more than 2 antidiabetic drug

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3
Q

What should the blood glucose level be if driving?

A

Higher that 5mmol/l
If less than 4mmol/l, do not drive
Should check every 2hrs and before driving

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4
Q

What group of people’s HBA1C may be misleading measure of glycaemic control?

A

Pregnancy - reliable 1st trial but not after
Haemoglobinopathirs e. G. Sickle cell - produces false positive
Chronic renal failure - can cause anaemia and thus produce false positive
Anaemia
Increased red cell turnover
Alcoholism - can reduce HBA1C

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5
Q

Common adr of metformin?

A

GI side effect

Potential for b12 deficiency

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6
Q

What antidiabetic med is safe for breastfeeding?

A

Insulin
Metformin
Glibenclamide

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7
Q

What should you give if a preg lady cannot tolerate metformin and insulin is not enough?

A

If after 11wks (2nd and 3rd trimester) can give glibenclamide

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8
Q

Sick day rules on diabetes?

A

Keep taking insulin and diabetic meds (apart from SGLT2 bc it can increase risk of DKA)
May need more insulin cas illness can cause hyperglycaemia
Keep monitoring more often than usual (at least every 4hrs)
Monitor for ketones (esp type 1)
Drink plenty of fluids
Try to eat

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9
Q

What’s the insulin safety warning?

A

Overdose of insulin due to abbreviations or incorrect device

  • the words unit or international units should not be abbreviated
  • specific insulin administration devices should always be used to measure insulin like insulin syringes and pens
  • never give IV syringe for SC injection as IV are in ml not units

Risk of severe harm and death due to withdrawing insulin from pen devices

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10
Q

What could increase insulin requirements?

A 
Infection
Stress
Trauma - accidental, surgery
Pregnancy (2nd and 3rd trimester)
Puberty
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11
Q

What could decrease insulin requirements?

A 
Physical activity
Illness
Reduced food
Renal
Organic causes
Endocrine disorder e g. Addison disease, hypopituitarism
Coeliac disease e. G. Gluten intolerance
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12
Q

How do you use insulin injection?

A

Hold it with a fist and push slowly and when it gets to 0, wait 10secs to allow insulin to spread

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13
Q

What is diabetes insipidus?

A

Where large amounts of dilute urine are produced which causes thirst

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14
Q

What’s the 2 types of diabetes insipidus?

A

Cranial where the hypothalamus does not make enough ADH

Nephrogenic where the kidneys do not respond to ADH

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15
Q

How do you treat diabetes insipidus?

A

Cranial = vasopressin or desmopressin
Desmopressin is more potent analogue than vaso with a longer duration and no vasoconstriction effects

Nephrogenic = thiazide diuretics

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16
Q

What is desmopressin and vasopressin used for?

A

Diabetes insipidu

Nocturnal enuresis

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17
Q

What’s the side effect of desmopressin and vasopressin?

A

Hyponareaemia

Hyppnatraemic convulsions

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18
Q

What does polyphagia, polydipsia mean?

A

Excessive hunger

Excessive thirst

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19
Q

Interaction between Ace inhibitors and antidiabetic meds Inc insulin?

A

Ace inhibitor potentiate hypoglycemic effects and antidiabetic drugs and insulin, esp in renal imapirment

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20
Q

Interaction between ACE inhibitor and insulin?

A

Hyperkalaemia

Hypoglycemic

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21
Q

Which drugs antagonise hypoglycemic effect of insulin?

A

Corricosteroids
Oral contraceptives
Loop/thiazide diuretics

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22
Q

When do you need to stop taking metformin?

A

If dehydrated e. G. From fever, vomiting, diarrhoea as increase risk of lactic acidosis

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23
Q

When should you consider stopping gliflozins?

A

If dehydrated as they can cause volume depletion

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24
Q

How do you store insulin?

A

Store in fridge between 2 to 8 degrees
Once opened, store at room temperature and use by 28 days
If left outside the fridge at 15 to 30 degrees more than 48brs, discard
If frozen, discard

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25
Q

How do you convert dose of beef insulin to human insulin?

A

Reduce dose by 10%

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26
Q

How do you covert dose from pork insulin to human insulin?

A

No dose change

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27
Q

How to manage pts on insulin treatment undergoing surgery?

A

Night before - usual insulin

Day of surgery - IV glucose with potassium (if not Hyperkalaemia) according to fluid requirements (lower in elderly, volume depleted pts and CV disease)
Or IV soluble insulin with NACL

Once pt start eating and drinking - SC before breakfast and stop IV 30mins later

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28
Q

When do you consider dual antidiabetic therapy in type 2 dm?

A

When HBA1C rises to 58mmol

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29
Q

When will you consider triple therapy or insulin therapy in type 2 dm?

A

If on dual therapy but still the HBA1C rises to 58mmol

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30
Q

What’s the short acting sulponylurea and its advantage?

A

Gliclazide
Tolbutamide
Lower risk of hypo so use in elderly and renal impairment

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31
Q

What’s the long acting sulponylurea?

A

Glibenclamide

Glimepiride

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32
Q

Which sulponylurea causes electrolyte imbalance and what electrolyte?

A

Glipizide and glimepiride causes hyponareaemia

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33
Q

What side effects does sulponylurea cause?

A 
Hyponareaemia
Hypoglycaemia
Weight gain
Jaundice
Hypersensitivity reaction the first 6 to 8wks
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34
Q

Interaction between warfarin and sulponylurea?

A

Increased risk of Hypoglycaemia

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35
Q

Interaction between ACE inhibitor and sulponylurea?

A

Increased risk of Hypoglycaemia

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36
Q

Interaction between sulponylurea and NSAIDS?

A

Reduced renal excretion

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37
Q

What’s the NICE advise on treatment plan with pioglitazone (thiazolinedione)?

A

Continue if HBA1C is reduced by 0.5% within 6 months

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38
Q

Side effects of pioglitazone?

A

Heart failure - increased incidence when combined with insulin
C/I in history of hf

Bladder cancer - report haematuria, dysuria and urgency

Hepatotoxicity - stop if jaundice occurs

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39
Q

What’s the drug group of gliflozins? Canagliflozin, dapagliflozin, empagliflozin

A

SGLT2 inhibitors

Sodium glucose co-transporter 2

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40
Q

Side effects of SGLT2 inhibitors

A

Life threatening atypical DKA with only moderately raised blood glucose level

Volume depletion - report postural hypotension, dizziness

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41
Q

What’s the safety info regarding canagliflozin?

A

Increased risk of lower limb amputation - report skin ulceration, discolouration, new pain
- stay hydrated, foot care

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42
Q

Drug names of DPP4 inhibitors?

A 
Linagliptim
Saxagliptin
Sitagliptin
Alogliptin
Vilagliptin
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43
Q

Side effects of DPP4 inhibitors?

A

Pancreatitis - report persistent, severe abdominal paim

Liver toxicity with vildagliptim - stop and report N and V, jaundice, dark urine

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44
Q

Drug names of meglitinides?

A

Nateglinide

Repaglinide

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45
Q

Side effects of metaglinide?

A

Hypersensitivity reaction

Nateglinide - abdominal pain, constipation, diarrhoea, n and v

Raoaglinide - visual disturbances

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46
Q

Patient advise on metaglinide

A

Particular care to avoid Hypoglycaemia as metaglinide stimulate insulin secretion

Take 30mins before main meal

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47
Q

When do you use acarbose?

A

Reserved for when other oral hypoglycemics cannot be taken

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48
Q

Side effects of acarbose?

A

Flatulence - improves with time and antacids do not help

Diarrhoea - withdraw or reduce dose

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49
Q

Pt counselling on acarbose?

A

Chew with fisrt mouthful of food or Swallow whole with little liquid immediately before food

Carry glucose to counteract hypo if happens

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50
Q

Drugs of GLP 1 agonist?

A 
Glucacon like peptide 1
Exenatide
Albiglutide
Dulaglutide
Liraglutide
Lixisenatide
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51
Q

Advantages of using GLP1 agonists?

A

Prevents weight gain

SC injection available

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52
Q

Side effects of GLP1 agnosit?

A

Pancreatitis

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53
Q

Pt advise on GLP1 agonist?

A

Do not administer after a meal

If missed dose
Injecti within 1hr of next meal = lixisenatide
Continue with next schedule dose = Exenatide
Inject within 3 days of next weekly dose = Dulaglutide and albiglutide

Use contraception for Mr Exenatide continue 12wks after stopping, lixisenatide, Albiglutide

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54
Q

What’s the HBA1C target for diabetic pt at high risk of arterial disease?

A

Below 48mmol

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55
Q

What medications should an African diabetic pt receive?

A

Both an ACE inhibitor and a diuretic/CCB

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56
Q

What’s the normal cholesterol target and the target for high risk pt such as diabetic pt?

A

Normal below 5mmol

Diabetic below 4 mmol

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57
Q

How do you treat emergency Hypoglycaemia?

A 
10 to 20g glucose/sucrose if necessary repeat after 10 to 15 mins
Coke 100-200ml
Lucozade original 55-100ml
Sugar lumps 3-6
Sugar 2-4 tsp
Ribena 19ml to be diluted
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58
Q

Whats advised against for treatment of Hypoglycaemia?

A

Avoid chocolate or biscuits as fats delay glucose absorption

Sulponylurea induced hypo is always treated in hospital bc it can persist for hours

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59
Q

If Hypoglycaemia unresponsive or unconscious, what should you do?

A

Give sc/IM glucagon

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60
Q

What to do if unresponsive to glucagon after 10mins or hypo prolonged?

A

IV glucose

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61
Q

Symptom of DKA?

A 
Severe hyperglycaemia
High blood ketones and ketonuria, keto breath (metallic taste in mouth) 
Pear drop breath
Dehydration/excessive thirst = polyuria
N&V
anorexia
Abdominal pain
Difficulty breathing
Electrolyte imbalance
Mental confusion
Drowsiness
Diabetic coma
Convulsions
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62
Q

What’s the safe info regarding SGLT2 inhibitors?

A

Risk of DKA
monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) Patients should be advised to seek urgent medical attention if they experience severe pain, tenderness, erythema, or swelling in the genital

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63
Q

Side effects of SGLT2 inhibitors?

A 
Balantis
Back pain
Dyslipidaemia
Hyooglycaemia
Polyuria
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64
Q

What’s the advantage of desmopressin over vasopressin?

A

More potent and has a longer duration of action than vasopressin
Unlike vasoprew, desmopressin has no vasoconstriction effect

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65
Q

How is desmopressin and vasopressin administered?

A

Given by mouth or intranasally

Injection if unconscious

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66
Q

How is desmopressin used for diagnosis of diabetes insipidus?

A

After administration, if the body is able to produce concectrate urine despite water deprivation, confirmation of cranial diabetes insipidus
If failure to respond, Nephrogenic diabetes insipidus

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67
Q

Unlicensed but what can be used for partial pituitary diabetes insipidus?

A

Carbamazepine

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68
Q

Vasopressin can also be used in.?

A

Nocturnal enuresis

Control variceal bleeding in portal hypertention

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69
Q

What can be used for the treatment of Hyponatraemia resulting from inappropriate secretion of antidiuretic hormone?

A

1st line is demeclocycline
Or
Tolvaptan

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70
Q

What happens if you correct Hyponatraemia rapidly?

A

Osmotic demyelination leading to serious neurological eventa

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71
Q

What’s the side effect of vasopressin?

A

Hyponatraemia esp for elderly and renal impairment

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72
Q

Drugs to avoid when using vasopressin?

A

Tricyclic antidepressants as they increase secretion of vasopressin

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73
Q

Intranasal desmopressin cannot be given for what indication?

A

Nocturnal enuresis as increased side effects

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74
Q

Desmopressin are contra indicated in preg bc?

A

Small oxytocic effect in third trimester

Increased risk of pre eclampsia

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75
Q

How can steroids be beneficial in sepsis?

A

High dose corticosteroid should be avoided in sepsis. However, low dose of hydrocortisone and fludrocortisone can help adrenocortical insufficiency resulting from septic shock

76
Q

Which corticosteroid is used to suppress corticotropin secretion in congenital adrenal hyperplasia?

A

Dexamethasone and betamethasone

77
Q

Why is D and B used for suppressing corticotropin secretion? And when are they best given?

A

None or little mineralcorticoid action and have a long duration of action.
Give at night

78
Q

High mineralcorticoid activity means?

A

Fluid retention

79
Q

Which steroid has the highest mineralcorticoid activity?

A

Fludrocortisone is most potent
= hasn’t got clinical relevant anti inflammation effect

Hydrocortisone has significant
= useful glucocorticoid on short tent basis via IV
= not for long term disease suppression as fluid retention

80
Q

Side effects of mineralcorticoid?

A

Sodium and water retention leading to hypertention

Potassium and calcium loss

81
Q

What’s the effect of glucocorticoid activity?

A

Anti inflammation

82
Q

What steroid has the most potent glucocorticoid activity?

A

Dexamethasone
Betamethasone

Used if fluid retention is a disadvantage so HF

83
Q

What steroid has significant glucocorticoid activity?

A

Prednisolone
Most common steroid used by mouth

Deflazcort

84
Q

Side effects of glucocorticoid?

A

Diabetes = hyperglycaemia
Osteoporosis
= high corticosteroid doses causes a vascular necrosis of femoral head
Muscle wasting
= proximal myopathy = caution with statins

Peptic ulcers
GI irritatiom
Dyspepsia

Psychiatric reactions
= a serious paranoid state or depression with suicide risk even after withdrawal
= mood and behavioural changes
Report immediately

Infections

Adrenal suppression
= even after 1yr of stopping

Glaucoma. Cataract
Skin thinning, bruising, striae
Aggravated epilepsy and schizophrenia
Growth restrictions in children
High doses lead to cushings syndrome
85
Q

How to avoid osteoporosis in steroid use?

A

If more than 3 months of steroid use, prophylaxis with bisphosphonates required

86
Q

How to minimise GI side effects of steroid?

A

Take with or after food

87
Q

Symptoms of adrenal suppression?

How to minimise it happening

A

Can occur ever after stopping up to 1yr
Avoid abrupt withdrawal if using more that 3wks as leads to acute adrenal insufficiency, hypotention and deatn

Anaesthesia can lead to dangerous fall in BP = need adrenal replacement with IV hydrocortisone

88
Q

MHRA safety info methylprednisolone?

A

Methylprednisolone injectable meds containing lactulose = solu-medrone cannot be used in pts with cow’s milk allergy
Serious allergic reaction including bronchospasm and anaphylaxis

89
Q

Counselling points on corticosteroids?

A

Risk of infecriom
Adrenal suppression
Psychiatric reactions
How to withdraw if needed

90
Q

When to withdraw corticosteroid?

A

Longe term use of more than 3wks

More than 40mg prednisolone daily or equivalent for more than 1wk

Repeat doses are taken in the evening

Recent repeated courses

Short course within 1yr of stopping long term steroids

Have other causes of adrenal suppression

91
Q

When are steroid cards issued?

A

Taking long term corticosteroid for more than 3wks

92
Q

Are steroids safe to use in pregnancy and BF?

A

Generally safe

Monitor fluid retention in pregnancy

93
Q

What steroid is used in adjunct to adrenaline to teary anaphylaxis?

A

Hydrocortisone IV injection

94
Q

MHRA warning on corticosteroids?

A

Rare risk of central serous chorioretinopathy with local as well as systemic administration
= a retinal disorder
= pts should be advised to report any blurred vision or other visual disturbances

95
Q

How do you withdraw steroids?

A

Can reduce rapidly down to pred 7.5mg OM or equivalent and the more slowly from there

96
Q

What is cortisol?

A

Natural glucocorticoid secereted in the adrenal cortex

97
Q

What is aldosterone?

A

Natural mineralcorticoid secretes in the adrenal cortex

98
Q

Hwo does adrenal insufficiency occur?

A

Addisons disease or adrenalectomy

99
Q

How do you treat adrenal insufficiency?

A

Adrenal replacement therapy with a combination of hydrocortisone and fludrocortisone

100
Q

How do you give steroids in adrenal replacement therapy?

A

Give hydrocortisone in 2 doses
=20mg OM and 10mg PM
Larger dose in the morning and smaller in the evening

101
Q

How to treat acute adrenocortical insufficiency?

A

IV hydrocortisone preferably as sodium succinate every 6-8hrs in NACL IV 0.9%

102
Q

Symptoms of addisons disease?

A 
Similar to depression and anorexia
Fatigue
Weakness
Weight loss
Appetite loss
Dizziness
Later can get hyperpigmentation of the skin
103
Q

What level of cortisol will be sus of insufficiency?

A

Below 200mmol/L

104
Q

How to treat addisons crisis?

A

Pt will be shocked and hypotensive so
Fluid reolacement
Glucose as potentially Hypoglycaemic
IV steroids

Monitor K as risk of Hyperkalaemia

105
Q

Symptoms of over replacement in addisons?

A

Hypertention
Thin skin
Easily bruise
Hyprrglycaemia

106
Q

Symptoms of under replacement in addisons disease?

A

Fatigure
Postural hypotention
Weight loss
Appetite loss

107
Q

What is hypopituitarism?

A

Pituitary gland does not stimulate hormone secretion by target glands

108
Q

How to manage hypopituitarism

?

A

Replacement therapy
Hydrocortisone but Not fludrocortisone
Bc renin angiotensin system still working to regulate aldosterone

Replace other hormones if necessary
Sex hormones

109
Q

Although steroids are used in pregnancy, there is still a risk of?

A

When administration is prolonged or repeated during pregnancy, increased risk of Intra uterine growth restriction

Any adrenal suppression in the neonate following prenatal exposure usually resolves spontaneously after birth

110
Q

Children taking steroids should be monitored for?

A

The height and weight of children should beonitored annually

111
Q

Safe practice info on prednisolone?

A

Has been confused with propranolol

112
Q

What is cushings disease/syndrome?

A

Characterised by hypercortisolism

High cortisol

113
Q

What can cause cushings?

A 
Exogenous glucocorticoid administration
= reduce dose or withdraw
Tumour
Obesity
Glucose intolerance
Menstural irregularities
Moon face
114
Q

Symptoms of cushings disease?

A 
Typical facial appearance
= moon face, acne, hirsutism, fat deposits in the face,
Weight gain
Skin changes
= skin thinning, easy bruising, reddish purple striae
Muscle weakness
Mood changes
Menstural disturbances like amenorrhoea
Hypertension
Osteoporosis
115
Q

Treatment of cushings?

A

Surgical like adrenalectomy, transsphenodial

1st line is metyrapone
2nd line under specialist is ketoconazole
Others octreotide, mifepeistone

116
Q

How does ketoconazole work in cushings?

A

Potent inhibitor of cortisol

117
Q

Max dose of ketoconazole?

A

1200mg/day

118
Q

Max dose of ketoconazole when taken with cobicistat?

A

200mg/daily

119
Q

MHRA warning on ketoconazole?

A

Do not use for oral fungal infection as hepatotoxicity, send back prescription
This warning doesn’t apply if ketoconazole is used for cushings but ketoconazole does still cause potentially life threatening hepatotoxicity

120
Q

Pt advice on ketoconazole?

A

Use effective contraception in women bc of teratogenicity

Liver disorder

Affects driving

121
Q

. Monitoring requirements for ketoconazole?

A

ECG (bc cause QT prolongation) before and one week after initiation

Adrenal insufficiency within one week of initiation then 3-6months if established

LFTs before, then weekly for 1 month, then monthly for 6 months

122
Q

What sugar level is considered Hypoglycaemia in diabetic pt?

A

Below 4mmol/L

123
Q

Symptoms of hyperthyroidism?

A 
Weight loss
Diarrhoea
Tachycardia
Heat intolerance
Excitability
Tremors
Angina oain
Sweating
Arrhythmia
Goitre
Bulging eyes
124
Q

What condition is it if the TSH is hight but T4 is low?

A

Primary hypothyroidism

125
Q

What condition is it if the TSH and T4 are both low?

A

Secondary hypothyroidism

126
Q

What condition is it if the TSH is low but T4 is high?

A

Hyperthyroidism

127
Q

What condition is it if the TSH is slightly high but T4 is normal?

A

Subclinical hypothyroidism

128
Q

Normal TSH level?

A

0.4-4.0 mU/L

129
Q

Normal T4 level?

A

9-25pmol/L

130
Q

Normal T3 level?

A

3.5-7.8 pmol/L

131
Q

Hyperthyroidism treatment?

A

1st line: carbimazole
2nd line: propylthiouracil
(if intolerant or c/I of carbimazole)

Thyroidectomy is a treatment choice for younger pts with large Goitre. Then they take levo thyroxine for the rest of their lives

132
Q

Why should hypothyroidism be avoided in pregnancy?

A

Can cause fatal Goitre

133
Q

Dose of carbimazole?

A

15-40mg OD until the pt is euthyroid (usually after 4-8wks after), then reduce to 5-15mg, reduce dose gradually

134
Q

How long is carbimazole treatment?

A

Usually 12-18months

135
Q

The equivalent doses of carbimazole to propylthiouracil?

A

1mg of carbimazole= 10mg of propylthiouracil

136
Q

MHRA warning on carbimazole?

A

Bone marrow suppression so report sore throat, mouth ulcers, fever, malaise

Increased risk of congenital malformations esp in first trimester and at high doses of over 15mg, so try to avoid in pregnancy and use contraceptions

Risk of acute pancreatitis

137
Q

Side effects of propylthiouracil?

A

Severe hepatic reactions Inc fatal cases where liver transplan was required

138
Q

Symptoms of thyrotoxicosis?

A 
Increased HR over 140
Tachycardia, arrhythmia
Heat intolerance
Diarrhoea, N&V, dehydration
Seizures
Delirium, confusion, psychosis
139
Q

What is used for thyrotoxicosis?

A

Radioactive sodium iodide solution

Propranolol for rapid relief of the symptoms

140
Q

Management of thyrotoxic crisis?

A

Emergency treatment with IV administration of fluids, propranolol, and hydrocortisone, oral iodide solution and carbimazolr/propylthiouracil

141
Q

What’s needed before Thyroidectomy?

A

Iodine 10-14 days before partial Thyroidectomy

Adjunct to antithyroid drugs but not long term

142
Q

What treatment if hyperthyroidism is contra indicated in pregnancy?

A

Blocking replacement therapy and radioactive iodine

143
Q

Management of hyperthyroidism in pregnancy?

A

During first trimester use propylthiouracil
Then switch to carbimazole during second trimester bc of risk of hepatotoxicity

Both drugs cross the placenta and in high doses may cause fatal Goitre and hypothyroidism

144
Q

Is hashimoto disease hypo or hyper thyroidism?

A

Hypo

145
Q

Symptoms of hypothyroidism?

A 
Weight gajn
Constipation
Bradycardia
Cold intolerance
Lethargy
Muscle cramps
Slow movemebts
Depression
Thin hair
146
Q

What drugs can cause hypothyroidism?

A

Amiodarone and lithium

147
Q

How to take levo thyroxine?

A

OM at least 39mins before breakfast, caffeine containing liquids or other meds

148
Q

Management of severe hypothyroid emergencies?

A

Liothyronine by IV injection with IV fluids, hydrocortisone

149
Q

Liothyronine advantage over levothyroxine?

A

More rapid effect and more potent

So ideal in severe hypothyroid

150
Q

Initial dose advice on levothyroxine and liothyronine in pts with CV disorders?

A

If metabolism increases too rapidly it causes hyperthyroidism symptoms so reduce dose or with old for 1-2 days and start again at a lower dose

151
Q

Osteoporosis risk factors?

A 
Low body weight
Elderly
Smoking
Lack of exercise
Excess alcohol
Family history
Menopause esp if early
Long term corticosteroid use
152
Q

2nd line option for osteoporosis prophylaxis?

A

IV bisphosphonates (ibandronic acid, zoledronic acid),
denosumab
raloxifene hcl

153
Q

What’s last resort treatment for severe osteoporosis?

A

Teriparatide

154
Q

Other treatment options for osteoporosis?

A

HRT for younger postmenopausal women (restricted to younger bc increased risk of CV disease and cancer)

155
Q

How do bisphosphonates work?

A

Slows the rate of growth and dissolution of the bone by absorbing onto the hydroxyapatite crystals in the bone reducing the rate of bone turnover

156
Q

Drug of choice in prevention and treatment of osteoporosis?

A

Alendronic

Risedronic

157
Q

Alendronic, risedronate, ibandronic acid’s treatment duration?

A

5yrs

158
Q

Zoledronic acid’s treatment duration?

A

3yrs

159
Q

How to take risedronate?

A

Take on an empty stomach at least 30mins before first food or drink of the day or if taking any other time of the day, 2hrs gap needed before/after food, drink antacids, calcium containing products

Stand or sit upright for 30mins

Avoid taking at bedtime or before risin

160
Q

Which bisphosphonate has the highest risk of bone metastases in breast cancer and severe Hyoercalcaemia of malignancy?

A

Pamidronate
Zolendronic acid = IV and most potent drugs
Also has the highest risk of osteonecrosis of the jaw

161
Q

Names of natural oestrogen?

A

Estrone
Estradiol
Estriol

162
Q

Names of synthetic oestrogen?

A

Ethinylestradiol

Mestranol

163
Q

How to manage vaso motor symptoms causes by post menopausal syndrome?

A

Synthetic oestrogen tabs or patches

164
Q

How to apply oestrogen patches?

A

Apply below waistline away from waist band or breast

165
Q

If synthetic oestrogen are contraindicated in treating vaso motor symptoms caused by manopausal, what can be given?

A

Clonidine

A vasodilator antihypertensive but has unacceptable side effects like rebound hypertention

166
Q

Choice of HRT for women without a uterine?

A

Oestrogen alone continuously

Oestrogen HRT

167
Q

Choice of HRT for women with a uterus?

A

Combined HRT

Oestrogen and progestogen cyclically or continuously if want to avoid withdrawal bleeding

168
Q

Continuous combined HRT is unsuitable in what kind of pts?

A

Peri menopausal
Or
12 months after last periods as irregular bleeding still going on

169
Q

What to do if irregular bleeding continues after stopping continuous combined HRT?

A

Rule out endometrial cancer

170
Q

HRT and surgery?

A

Stop 4-6wks before elective surgery
As risk of thromboembolism
Restart HRT when fully mobile

For non electi e surgery, use parenteral Anticoagulant like heparin and compression stockings

171
Q

HRT and contraception

A

HRT doesn’t provide contraception

For under 50, they are fertile 2yrs after last period so use a low oestrogen combined contraceptive if free from Venous /arterial disease risk factors

For over 50, fertile 1yr after last period so use condoms

172
Q

Side effects of HRT?

A

Ovarian cancer
Breast cancer
Cervical cancer
Endometrial cancer

Coronary heart disease
If combined HRT started 10yrs after Menopause

173
Q

How to reduce risk of endometrial cancer whne using HRT?

A

Add progestogen

Reduces additional risk if given at least 10days cycle or given continuously

174
Q

Reason to stop HRT immediately?

A

Venous thromboembolism (sudden severe chest pain. Sob, cough with blood)

Stroke? (prolonged headache, loss of vision, hearing disturbance,)

Liver dysfunction (severe stomach pain)

BP over 160/95

175
Q

What an antioetrogen used for secondary amenorrhoea line PCOS and infertility in women due to olihomenorrhoea?

A

Clomifene

A ovulation stimulant

176
Q

Side effects of clomifene?

A

Multiple Preganancies

177
Q

Safety info on clomifene?

A

Use do 6 cycles only as can increase risk of ovarian cancer

178
Q

What’s testosterone used for?

A

Replacement therapy in androgen deficiency

179
Q

Side effects of testosterone?

A 
Masculinisation
Acne
Anxiett
Malte pattern baldness
Sexual development in pre pubescent males
Virilusarion in women
180
Q

Do not apply testosterone gels to where?

A

Genital areas

181
Q

Name of male sex hormone antagonism?

A

Cyproterone = hepatotoxic

182
Q

Target post prandial (food) blood glucose conc for non diabetics?

A

Below 7.8mmol/L

183
Q

Target post prandial (food) blood glucose conc for type 1 Dm?

A

5-9mmol/L

184
Q

Target post prandial (food) blood glucose conc for type 2 Dm?

A

Below 8.5

185
Q

Pre prandial blood sugar levels?

A

Both for type 1 and 2 is 4-7

186
Q

What is tibolone?

A

Combined HRT taken continuously

Contains oestrogen, progestogen and weak androgenic

Inori Pre Reg (22 decks)

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