Endocrine Flashcards
1
Q
What’s the target HBA1C for type 1 dm?
A
Below 48mmol/mol
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
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
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
5
Q
Common adr of metformin?
A
GI side effect
Potential for b12 deficiency
6
Q
What antidiabetic med is safe for breastfeeding?
A
Insulin
Metformin
Glibenclamide
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
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
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
10
Q
What could increase insulin requirements?
A
Infection Stress Trauma - accidental, surgery Pregnancy (2nd and 3rd trimester) Puberty
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
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
13
Q
What is diabetes insipidus?
A
Where large amounts of dilute urine are produced which causes thirst
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
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
16
Q
What is desmopressin and vasopressin used for?
A
Diabetes insipidu
Nocturnal enuresis
17
Q
What’s the side effect of desmopressin and vasopressin?
A
Hyponareaemia
Hyppnatraemic convulsions
18
Q
What does polyphagia, polydipsia mean?
A
Excessive hunger
Excessive thirst
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
20
Q
Interaction between ACE inhibitor and insulin?
A
Hyperkalaemia
Hypoglycemic
21
Q
Which drugs antagonise hypoglycemic effect of insulin?
A
Corricosteroids
Oral contraceptives
Loop/thiazide diuretics
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
23
Q
When should you consider stopping gliflozins?
A
If dehydrated as they can cause volume depletion
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
25
How do you convert dose of beef insulin to human insulin?
Reduce dose by 10%
26
How do you covert dose from pork insulin to human insulin?
No dose change
27
How to manage pts on insulin treatment undergoing surgery?
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
28
When do you consider dual antidiabetic therapy in type 2 dm?
When HBA1C rises to 58mmol
29
When will you consider triple therapy or insulin therapy in type 2 dm?
If on dual therapy but still the HBA1C rises to 58mmol
30
What's the short acting sulponylurea and its advantage?
Gliclazide
Tolbutamide
Lower risk of hypo so use in elderly and renal impairment
31
What's the long acting sulponylurea?
Glibenclamide
| Glimepiride
32
Which sulponylurea causes electrolyte imbalance and what electrolyte?
Glipizide and glimepiride causes hyponareaemia
33
What side effects does sulponylurea cause?
```
Hyponareaemia
Hypoglycaemia
Weight gain
Jaundice
Hypersensitivity reaction the first 6 to 8wks
```
34
Interaction between warfarin and sulponylurea?
Increased risk of Hypoglycaemia
35
Interaction between ACE inhibitor and sulponylurea?
Increased risk of Hypoglycaemia
36
Interaction between sulponylurea and NSAIDS?
Reduced renal excretion
37
What's the NICE advise on treatment plan with pioglitazone (thiazolinedione)?
Continue if HBA1C is reduced by 0.5% within 6 months
38
Side effects of pioglitazone?
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
39
What's the drug group of gliflozins? Canagliflozin, dapagliflozin, empagliflozin
SGLT2 inhibitors
| Sodium glucose co-transporter 2
40
Side effects of SGLT2 inhibitors
Life threatening atypical DKA with only moderately raised blood glucose level
Volume depletion - report postural hypotension, dizziness
41
What's the safety info regarding canagliflozin?
Increased risk of lower limb amputation - report skin ulceration, discolouration, new pain
- stay hydrated, foot care
42
Drug names of DPP4 inhibitors?
```
Linagliptim
Saxagliptin
Sitagliptin
Alogliptin
Vilagliptin
```
43
Side effects of DPP4 inhibitors?
Pancreatitis - report persistent, severe abdominal paim
Liver toxicity with vildagliptim - stop and report N and V, jaundice, dark urine
44
Drug names of meglitinides?
Nateglinide
| Repaglinide
45
Side effects of metaglinide?
Hypersensitivity reaction
Nateglinide - abdominal pain, constipation, diarrhoea, n and v
Raoaglinide - visual disturbances
46
Patient advise on metaglinide
Particular care to avoid Hypoglycaemia as metaglinide stimulate insulin secretion
Take 30mins before main meal
47
When do you use acarbose?
Reserved for when other oral hypoglycemics cannot be taken
48
Side effects of acarbose?
Flatulence - improves with time and antacids do not help
Diarrhoea - withdraw or reduce dose
49
Pt counselling on acarbose?
Chew with fisrt mouthful of food or Swallow whole with little liquid immediately before food
Carry glucose to counteract hypo if happens
50
Drugs of GLP 1 agonist?
```
Glucacon like peptide 1
Exenatide
Albiglutide
Dulaglutide
Liraglutide
Lixisenatide
```
51
Advantages of using GLP1 agonists?
Prevents weight gain
| SC injection available
52
Side effects of GLP1 agnosit?
Pancreatitis
53
Pt advise on GLP1 agonist?
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
54
What's the HBA1C target for diabetic pt at high risk of arterial disease?
Below 48mmol
55
What medications should an African diabetic pt receive?
Both an ACE inhibitor and a diuretic/CCB
56
What's the normal cholesterol target and the target for high risk pt such as diabetic pt?
Normal below 5mmol
| Diabetic below 4 mmol
57
How do you treat emergency Hypoglycaemia?
```
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
```
58
Whats advised against for treatment of Hypoglycaemia?
Avoid chocolate or biscuits as fats delay glucose absorption
Sulponylurea induced hypo is always treated in hospital bc it can persist for hours
59
If Hypoglycaemia unresponsive or unconscious, what should you do?
Give sc/IM glucagon
60
What to do if unresponsive to glucagon after 10mins or hypo prolonged?
IV glucose
61
Symptom of DKA?
```
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
```
62
What's the safe info regarding SGLT2 inhibitors?
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
63
Side effects of SGLT2 inhibitors?
```
Balantis
Back pain
Dyslipidaemia
Hyooglycaemia
Polyuria
```
64
What's the advantage of desmopressin over vasopressin?
More potent and has a longer duration of action than vasopressin
Unlike vasoprew, desmopressin has no vasoconstriction effect
65
How is desmopressin and vasopressin administered?
Given by mouth or intranasally
| Injection if unconscious
66
How is desmopressin used for diagnosis of diabetes insipidus?
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
67
Unlicensed but what can be used for partial pituitary diabetes insipidus?
Carbamazepine
68
Vasopressin can also be used in.?
Nocturnal enuresis
| Control variceal bleeding in portal hypertention
69
What can be used for the treatment of Hyponatraemia resulting from inappropriate secretion of antidiuretic hormone?
1st line is demeclocycline
Or
Tolvaptan
70
What happens if you correct Hyponatraemia rapidly?
Osmotic demyelination leading to serious neurological eventa
71
What's the side effect of vasopressin?
Hyponatraemia esp for elderly and renal impairment
72
Drugs to avoid when using vasopressin?
Tricyclic antidepressants as they increase secretion of vasopressin
73
Intranasal desmopressin cannot be given for what indication?
Nocturnal enuresis as increased side effects
74
Desmopressin are contra indicated in preg bc?
Small oxytocic effect in third trimester
| Increased risk of pre eclampsia
75
How can steroids be beneficial in sepsis?
High dose corticosteroid should be avoided in sepsis. However, low dose of hydrocortisone and fludrocortisone can help adrenocortical insufficiency resulting from septic shock
76
Which corticosteroid is used to suppress corticotropin secretion in congenital adrenal hyperplasia?
Dexamethasone and betamethasone
77
Why is D and B used for suppressing corticotropin secretion? And when are they best given?
None or little mineralcorticoid action and have a long duration of action.
Give at night
78
High mineralcorticoid activity means?
Fluid retention
79
Which steroid has the highest mineralcorticoid activity?
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
Side effects of mineralcorticoid?
Sodium and water retention leading to hypertention
| Potassium and calcium loss
81
What's the effect of glucocorticoid activity?
Anti inflammation
82
What steroid has the most potent glucocorticoid activity?
Dexamethasone
Betamethasone
Used if fluid retention is a disadvantage so HF
83
What steroid has significant glucocorticoid activity?
Prednisolone
Most common steroid used by mouth
Deflazcort
84
Side effects of glucocorticoid?
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
How to avoid osteoporosis in steroid use?
If more than 3 months of steroid use, prophylaxis with bisphosphonates required
86
How to minimise GI side effects of steroid?
Take with or after food
87
Symptoms of adrenal suppression?
| How to minimise it happening
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
MHRA safety info methylprednisolone?
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
Counselling points on corticosteroids?
Risk of infecriom
Adrenal suppression
Psychiatric reactions
How to withdraw if needed
90
When to withdraw corticosteroid?
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
When are steroid cards issued?
Taking long term corticosteroid for more than 3wks
92
Are steroids safe to use in pregnancy and BF?
Generally safe
| Monitor fluid retention in pregnancy
93
What steroid is used in adjunct to adrenaline to teary anaphylaxis?
Hydrocortisone IV injection
94
MHRA warning on corticosteroids?
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
How do you withdraw steroids?
Can reduce rapidly down to pred 7.5mg OM or equivalent and the more slowly from there
96
What is cortisol?
Natural glucocorticoid secereted in the adrenal cortex
97
What is aldosterone?
Natural mineralcorticoid secretes in the adrenal cortex
98
Hwo does adrenal insufficiency occur?
Addisons disease or adrenalectomy
99
How do you treat adrenal insufficiency?
Adrenal replacement therapy with a combination of hydrocortisone and fludrocortisone
100
How do you give steroids in adrenal replacement therapy?
Give hydrocortisone in 2 doses
=20mg OM and 10mg PM
Larger dose in the morning and smaller in the evening
101
How to treat acute adrenocortical insufficiency?
IV hydrocortisone preferably as sodium succinate every 6-8hrs in NACL IV 0.9%
102
Symptoms of addisons disease?
```
Similar to depression and anorexia
Fatigue
Weakness
Weight loss
Appetite loss
Dizziness
Later can get hyperpigmentation of the skin
```
103
What level of cortisol will be sus of insufficiency?
Below 200mmol/L
104
How to treat addisons crisis?
Pt will be shocked and hypotensive so
Fluid reolacement
Glucose as potentially Hypoglycaemic
IV steroids
Monitor K as risk of Hyperkalaemia
105
Symptoms of over replacement in addisons?
Hypertention
Thin skin
Easily bruise
Hyprrglycaemia
106
Symptoms of under replacement in addisons disease?
Fatigure
Postural hypotention
Weight loss
Appetite loss
107
What is hypopituitarism?
Pituitary gland does not stimulate hormone secretion by target glands
108
How to manage hypopituitarism
| ?
Replacement therapy
Hydrocortisone but Not fludrocortisone
Bc renin angiotensin system still working to regulate aldosterone
Replace other hormones if necessary
Sex hormones
109
Although steroids are used in pregnancy, there is still a risk of?
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
Children taking steroids should be monitored for?
The height and weight of children should beonitored annually
111
Safe practice info on prednisolone?
Has been confused with propranolol
112
What is cushings disease/syndrome?
Characterised by hypercortisolism
| High cortisol
113
What can cause cushings?
```
Exogenous glucocorticoid administration
= reduce dose or withdraw
Tumour
Obesity
Glucose intolerance
Menstural irregularities
Moon face
```
114
Symptoms of cushings disease?
```
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
Treatment of cushings?
Surgical like adrenalectomy, transsphenodial
1st line is metyrapone
2nd line under specialist is ketoconazole
Others octreotide, mifepeistone
116
How does ketoconazole work in cushings?
Potent inhibitor of cortisol
117
Max dose of ketoconazole?
1200mg/day
118
Max dose of ketoconazole when taken with cobicistat?
200mg/daily
119
MHRA warning on ketoconazole?
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
Pt advice on ketoconazole?
Use effective contraception in women bc of teratogenicity
Liver disorder
Affects driving
121
. Monitoring requirements for ketoconazole?
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
What sugar level is considered Hypoglycaemia in diabetic pt?
Below 4mmol/L
123
Symptoms of hyperthyroidism?
```
Weight loss
Diarrhoea
Tachycardia
Heat intolerance
Excitability
Tremors
Angina oain
Sweating
Arrhythmia
Goitre
Bulging eyes
```
124
What condition is it if the TSH is hight but T4 is low?
Primary hypothyroidism
125
What condition is it if the TSH and T4 are both low?
Secondary hypothyroidism
126
What condition is it if the TSH is low but T4 is high?
Hyperthyroidism
127
What condition is it if the TSH is slightly high but T4 is normal?
Subclinical hypothyroidism
128
Normal TSH level?
0.4-4.0 mU/L
129
Normal T4 level?
9-25pmol/L
130
Normal T3 level?
3.5-7.8 pmol/L
131
Hyperthyroidism treatment?
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
Why should hypothyroidism be avoided in pregnancy?
Can cause fatal Goitre
133
Dose of carbimazole?
15-40mg OD until the pt is euthyroid (usually after 4-8wks after), then reduce to 5-15mg, reduce dose gradually
134
How long is carbimazole treatment?
Usually 12-18months
135
The equivalent doses of carbimazole to propylthiouracil?
1mg of carbimazole= 10mg of propylthiouracil
136
MHRA warning on carbimazole?
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
Side effects of propylthiouracil?
Severe hepatic reactions Inc fatal cases where liver transplan was required
138
Symptoms of thyrotoxicosis?
```
Increased HR over 140
Tachycardia, arrhythmia
Heat intolerance
Diarrhoea, N&V, dehydration
Seizures
Delirium, confusion, psychosis
```
139
What is used for thyrotoxicosis?
Radioactive sodium iodide solution
| Propranolol for rapid relief of the symptoms
140
Management of thyrotoxic crisis?
Emergency treatment with IV administration of fluids, propranolol, and hydrocortisone, oral iodide solution and carbimazolr/propylthiouracil
141
What's needed before Thyroidectomy?
Iodine 10-14 days before partial Thyroidectomy
| Adjunct to antithyroid drugs but not long term
142
What treatment if hyperthyroidism is contra indicated in pregnancy?
Blocking replacement therapy and radioactive iodine
143
Management of hyperthyroidism in pregnancy?
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
Is hashimoto disease hypo or hyper thyroidism?
Hypo
145
Symptoms of hypothyroidism?
```
Weight gajn
Constipation
Bradycardia
Cold intolerance
Lethargy
Muscle cramps
Slow movemebts
Depression
Thin hair
```
146
What drugs can cause hypothyroidism?
Amiodarone and lithium
147
How to take levo thyroxine?
OM at least 39mins before breakfast, caffeine containing liquids or other meds
148
Management of severe hypothyroid emergencies?
Liothyronine by IV injection with IV fluids, hydrocortisone
149
Liothyronine advantage over levothyroxine?
More rapid effect and more potent
| So ideal in severe hypothyroid
150
Initial dose advice on levothyroxine and liothyronine in pts with CV disorders?
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
Osteoporosis risk factors?
```
Low body weight
Elderly
Smoking
Lack of exercise
Excess alcohol
Family history
Menopause esp if early
Long term corticosteroid use
```
152
2nd line option for osteoporosis prophylaxis?
IV bisphosphonates (ibandronic acid, zoledronic acid),
denosumab
raloxifene hcl
153
What's last resort treatment for severe osteoporosis?
Teriparatide
154
Other treatment options for osteoporosis?
HRT for younger postmenopausal women (restricted to younger bc increased risk of CV disease and cancer)
155
How do bisphosphonates work?
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
Drug of choice in prevention and treatment of osteoporosis?
Alendronic
| Risedronic
157
Alendronic, risedronate, ibandronic acid's treatment duration?
5yrs
158
Zoledronic acid's treatment duration?
3yrs
159
How to take risedronate?
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
Which bisphosphonate has the highest risk of bone metastases in breast cancer and severe Hyoercalcaemia of malignancy?
Pamidronate
Zolendronic acid = IV and most potent drugs
Also has the highest risk of osteonecrosis of the jaw
161
Names of natural oestrogen?
Estrone
Estradiol
Estriol
162
Names of synthetic oestrogen?
Ethinylestradiol
| Mestranol
163
How to manage vaso motor symptoms causes by post menopausal syndrome?
Synthetic oestrogen tabs or patches
164
How to apply oestrogen patches?
Apply below waistline away from waist band or breast
165
If synthetic oestrogen are contraindicated in treating vaso motor symptoms caused by manopausal, what can be given?
Clonidine
| A vasodilator antihypertensive but has unacceptable side effects like rebound hypertention
166
Choice of HRT for women without a uterine?
Oestrogen alone continuously
| Oestrogen HRT
167
Choice of HRT for women with a uterus?
Combined HRT
| Oestrogen and progestogen cyclically or continuously if want to avoid withdrawal bleeding
168
Continuous combined HRT is unsuitable in what kind of pts?
Peri menopausal
Or
12 months after last periods as irregular bleeding still going on
169
What to do if irregular bleeding continues after stopping continuous combined HRT?
Rule out endometrial cancer
170
HRT and surgery?
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
HRT and contraception
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
Side effects of HRT?
Ovarian cancer
Breast cancer
Cervical cancer
Endometrial cancer
Coronary heart disease
If combined HRT started 10yrs after Menopause
173
How to reduce risk of endometrial cancer whne using HRT?
Add progestogen
| Reduces additional risk if given at least 10days cycle or given continuously
174
Reason to stop HRT immediately?
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
What an antioetrogen used for secondary amenorrhoea line PCOS and infertility in women due to olihomenorrhoea?
Clomifene
| A ovulation stimulant
176
Side effects of clomifene?
Multiple Preganancies
177
Safety info on clomifene?
Use do 6 cycles only as can increase risk of ovarian cancer
178
What's testosterone used for?
Replacement therapy in androgen deficiency
179
Side effects of testosterone?
```
Masculinisation
Acne
Anxiett
Malte pattern baldness
Sexual development in pre pubescent males
Virilusarion in women
```
180
Do not apply testosterone gels to where?
Genital areas
181
Name of male sex hormone antagonism?
Cyproterone = hepatotoxic
182
Target post prandial (food) blood glucose conc for non diabetics?
Below 7.8mmol/L
183
Target post prandial (food) blood glucose conc for type 1 Dm?
5-9mmol/L
184
Target post prandial (food) blood glucose conc for type 2 Dm?
Below 8.5
185
Pre prandial blood sugar levels?
Both for type 1 and 2 is 4-7
186
What is tibolone?
Combined HRT taken continuously
| Contains oestrogen, progestogen and weak androgenic
