Endocrine Drugs Flashcards
A 74-year-old man presents to the emergency department with intense genital pain and skin changes affecting the surrounding area.
On examination there is oedema of the perineum with some necrotic areas. The patient denies any other systemic symptoms. He is known to have diabetes and states that he has recently been started on a new tablet.
What medication is likely to have caused this?
SGLT2 inhibitors - describing Fournier gangrene
A 42-year-old woman is started on daily hydrocortisone and fludrocortisone following a diagnosis of Addison’s disease. A week later she presents to her general practitioner as she wakes up 2 hours earlier than she used to in the morning and feels very tired all day.
She denies any other symptoms.
What is the most likely cause of this? and why?
Steroid-induced insomnia
= Corticosteroids may cause insomnia
A 32-year-old man with type 2 diabetes mellitus attends the GP surgery following an episode of feeling sweaty, dizzy and confused yesterday.
At his last check, 3 weeks ago, his HbA1c was found to be 62 mmol/mol. He was already taking metformin and so he was started on a second medication to treat his diabetes.
What medication was started in this patient?
sulfonylureas
= High HBA1c means hypoglycaemia which is a major side effect of the above drug
Patients on long-term steroids should what when they acquire another illness?
Double the dose
If Prolactin is high what drug should be prescribed?
Dopamine agonist > Cabergoline
A 57-year-old woman presents to the clinic complaining of worsening hip pain. She first noticed it six months ago and she describes it as dull and deep within the right hip joint. It gets worse by walking and climbing the stairs and does not seem to change throughout the day. She has a complex medical history and she is taking multiple medications.
On examination, she has limited active and passive range of movement in all planes and pain upon abduction and internal rotation. Palpation of the joint exacerbates the pain. An x-ray of the joint shows a crescent sign.
What is this describing above and what medication is the cause of her pain?
avascular necrosis of the femoral head
= prednisolone fault
A 45-year-old woman presents to her general practitioner complaining of sleep disturbances. She has not been able to fall asleep before 3 am in the past three weeks and she constantly wakes up during the few hours of sleep she gets. This has been impacting her work as during the day she feels tired and incapable to concentrate.
She does not complain of any other symptoms and looks alert and comfortable. Her past medical history comprises rheumatoid arthritis, asthma, urticaria and anxiety.
What medication is the most likely to cause her symptoms? and what is the above describing?
Insomnia
= due to prednisolone
What is agranulocytosis and in what drug is this a side effect for?
A severe drop in granulocytes (type of WBC) increases infection risk. Therefore always report back to your GP or doctor if you experience any symptoms such as sore throat or fever
= Carbimazole
Which one of the following types of oral steroids has the least amount of mineralocorticoid activity?
Fludrocortisone
Hydrocortisone
Dexamethasone
Prednisolone
Cortisone
Dexamethasone
What causes nipple discharge/ galactorrhoea?
Dopamine antagonists
= Metoclopramide
Pain, swelling, and redness in the genital or perineal area with severe pain + fever describes the side effect of what type of drug?
SGLT2 inhibitors as its describing Fournier’s gangrene
A 68-year-old man presents to the GP surgery for an appointment with a diabetic nurse specialist. He has type 2 diabetes mellitus that is difficult to control and has recently been prescribed a new medication.
A diabetic foot examination is performed and an ulcer that is 2 cm in diameter and sloughy is present on the dorsal aspect of the right hallux. The patient first noticed the ulcer after the new medication was prescribed but was not aware of it worsening as the sensation in his feet was reduced and he forgot to regularly check his feet.
What is the most likely cause and why?
Canagliflozin
= increases the risk of foot ulcers and infections due to its potential effects on dehydration, circulation, and high blood glucose, which can worsen diabetic complications like neuropathy
High blood glucose can cause nerve damage (neuropathy) and poor circulation, which makes it harder for the body to heal wounds, increasing the risk of foot ulcers and infections
A 54-year-old woman presents systemically unwell. She has recently started carbimazole for hyperthyroidism. What is the most important blood test to perform?
Full blood count
Needle phobia patients should avoid which drug
GLP-1 receptor agonists
What drug causes high neutrophil count?
Corticosteroids
A 56-year-old man is reviewed in the Cardiology outpatient clinic following a myocardial infarction one year previously. During his admission, he was found to be hypertensive and diabetic. He complains that he has put on 5kg in weight in the past 6 months. Which of his medications may be contributing to his weight gain?
Sulfonylureas
A 62-year-old man is reviewed in a diabetes clinic. His glycaemic control is poor despite weight loss, adherence to a diabetic diet and his current diabetes medications. He has no other past medical history of note. What medication would increase insulin sensitivity?
Pioglitazone
A 48-year-old man presents to your GP practice. He complains of needing to pass urine quite urgently much more frequently than normal. This has kept him up all night. He often has to rush to the toilet. During urination, he describes a burning sensation. Further questioning reveals that these symptoms have developed over the last 5 days.
The patient has a past medical history of type 2 diabetes mellitus for which he takes metformin, gliclazide and ertugliflozin. He works as a bus driver which has been made incredibly difficult as he now requires frequent toilet breaks.
On examination, you assess his observations, which are all normal, and then move onto examine his penis and perform a rectal examination. His penis appears normal and is uncircumcised. You identify a smooth, walnut sized mass with a midline groove on rectal examination. Urinalysis is positive for leukocytes, nitrites and red blood cells.
What is the most important risk factor for the diagnosis in this case? and why?
Ertugliflozin use
= increases risk of UTI infections
A 55-year-old man presents for his diabetes check-up. He is currently taking metformin 1g twice daily.
His HbA1c on review is 61mmol/mol.
His BMI is 36 kg/m² and he requests that any new medications started will not cause him any further weight gain.
What medication should be avoided?
Gliclazide
= causes weight gain
A 57-year-old man with type 2 diabetes is admitted with a short episode of confusion and sweating followed by loss of consciousness. A capillary blood glucose returns as 3.3mmol/L (normal range 3.5-5.5 mmol/L). His medication history is unavailable but there is no evidence that he injects insulin.
Which medication may explain this patient’s current condition?
Gliclazide
A 43-year-old male presents to the GP with weight gain, constipation and lethargy having just been started on a new medication. The GP orders thyroid function tests which confirm hypothyroidism.
What drug is the patient most likely to have been started on which caused this/
Amiodarone
A 45-year-old male has been recently diagnosed with type 2 diabetes. His GP explains that he may be started on an anti-diabetic drug which enhances the release of insulin by pancreatic islet cells by altering potassium channel activity in these cells.
What drug has he been prescribed?
Sulphonylureas
= Glimepiride, Glipizide, Glicazide
What drug can cause hyperthyroidism and hypothyroidism?
Amiodarone
A 58-year-old woman with type 2 diabetes has been prescribed glimepiride
What is the primary mechanism of action of glimepiride in lowering blood glucose levels?
Glimepiride is a sulfonylurea which primarily works by increasing insulin secretion from pancreatic beta cells
A 56-year-old male is diagnosed with Type 2 diabetes. He has started on pharmacological management. He asks his GP how his medication works and his GP states that it increases the body’s sensitivity to insulin by increasing glucose uptake into cells.
Which drug has he been started on?
Metformin
A 56-year-old man with a background of type 1 diabetes and hypertension is admitted with diarrhoea and vomiting. He is severely dehydrated with hypotension and a stage 3 acute kidney injury. His estimated glomerular filtration rate is now 22 ml/min
What medication should be continued and why?
Insulin
= Insulin should never be held from type 1 diabetics however, dose adjustments may be required in renal impairment
Which single endocrinological side effect is most likely to prompt the withdrawal of amiodarone?
Thyrotoxicosis
Which corticosteroid has very high mineralocorticoid activity but low glucocorticoid activity?
Fludrocortisone
A woman with hypothyroidism becomes pregnant.
What is the most appropriate change to her levothyroxine?
The dose should be increased
= LOOK AT MINDMAP U DUMB BITCH
A 52-year-old female on metformin, with type 2 diabetes mellitus, comes to the clinic for a review. She has noticed that lately she has increased the frequency of micturition. Her capillary blood glucose was found to be 13 mmol/l despite the metformin. Her glycosylated haemoglobin (HbA1c) was noted to be 56 mmol/mol (20-42 mmol/mol). A decision was made to start her on gliclazide.
What is the receptor in the pancreatic beta-cells on which gliclazide acts to exert its effects
ATP-dependent potassium channels
A 54-year-old man with type 2 diabetes regularly takes oral anti-glycaemic drugs. In the past 3 weeks, he has been having recurrent symptoms of pallor, sweating and palpitations.
What drug is most likely to be responsible?
sulphonylureas
PPAR-gamma receptors are associated with what drugs?
thialididazones
What best describes the mechanism of action of Exenatide?
GLP-1 analogue
What drug is given in patients with thyrotoxicosis?
Carbimazole
What drug is given to patients with hypothyroidism?
Levothyroxine
A patient in the cardiac ward is experiencing some palpitations. Recent electrolyte count showed evidence of hyperkalaemia.
What drug can be used to acutely treat this electrolyte disorder?
Insulin
What is the duration of action of insulin glargine?
Insulin glargine (Lantus) is a long-acting insulin given once daily
What diabetic medications increase the risk of bladder cancer?
Pioglitazone
Octreotide is a synthetic version of which hormone?
Somatostatin
What is the main adverse effect of DPP4 inhibitors?
Nausea
Non glucose effect of DPP4 inhibitors
Lowers blood pressure
Examples of DPP4 inhibitors
LIPTIN
sitagliptin, alogliptin, saxagliptin
Examples of GLP-1 receptor antagonists
GLUTIDE
liraglutide, semaglutide
‘reduce the peripheral breakdown of incretins’ This describes what?
Incretins - GLP-1 or GIP
therefore
= Gliptins (DPP-4 inhibitors)
A 51-year-old gentleman presents to the general practice complaining of a one-week history of muscle cramps and constipation. He is otherwise well. You decide to measure his serum potassium and find it below normal limits. You now want to identify why this is the case. What condition is associated with hypokalaemia?
Cushing’s syndrome
A 32-year-old woman has been admitted to the respiratory ward with breathlessness after contracting a SARS-CoV-2 infection. She is given 60% oxygen via a venturi mask, however, her oxygen saturation remains at 91%.
She has a past medical history of asthma, gout, rheumatoid arthritis and type II diabetes mellitus. The doctor decides to prescribe dexamethasone.
What effect will this drug most likely have?
Increased blood glucose levels
reduces breakdown suggests what
LIPTINS DRUGS
A 13-year-old boy is brought to the emergency department by his parents after the boy has been drowsy and complaining of severe abdominal pain for the past 6 hours. The boy has also been having nausea and vomiting. The boy’s past medical and surgical history reveals nothing significant, and there is no significant family history. On examination, the patient has dry mucous membranes, a heart rate of 94 beats per minute, a respiratory rate of 19 breaths per minute and a blood pressure of 89/62 mmHg. The attending doctor also notices that there is a fruity smell to the patient’s breath. A bedside glucose finger prick reveals glucose of 263 mg/dL.
While waiting for laboratory blood results to come back, the doctor requests the nurse to prepare the insulin infusion for this patient. What insulin preparations is the most appropriate for the management of this patient and why?
Short-acting (regular) insulin
= This boy presented with the signs and symptoms of diabetic ketoacidosis (DKA)
short-acting insulin is also in the management of DKA. It usually onsets within less than 1 hour and peaks at approximately 2 to 4 hours
A 59-year-old man is a known type 2 diabetic. He presents to the GP for review and is started on a new medication, a glucagon-like peptide (GLP-1) analogue. Physiologically, from what part of the body is this hormone normally secreted?
Ileum
A woman with rheumatoid arthritis is currently on daily oral prednisolone. She consults her GP because she wishes to discontinue the medication due to recently noticed weight gain and difficulty sleeping.
What serious medical complication could occur if she abruptly ceases taking this medication?
Addisonian crisis
A 3-year-old boy has adrenocortical insufficiency characterised by severely decreased levels of aldosterone. The doctor explains to the parents that aldosterone is a mineralocorticoid hormone responsible for sodium and water reabsorption in the kidneys. Consequently, his deficiency has resulted in hyponatremia and severe dehydration.
What corticosteroid is the most appropriate to administer to replace the deficient hormone? and why?
Fludrocortisone
= steroid with minimal glucocorticoid activity, very high mineralocorticoid activity
= Fludrocortisone is specifically used to replace aldosterone in conditions like primary adrenal insufficiency (Addison’s disease) and congenital adrenal hyperplasia where mineralocorticoid deficiency is prominent. Its primary function is to promote sodium and water reabsorption in the renal tubules, thereby correcting hyponatremia and dehydration
Which corticosteroid has the highest glucocorticoid activity?
Dexamethasone has the highest glucocorticoid activity (↑↑↑↑)
Which corticosteroid has the strongest mineralocorticoid activity?
Fludrocortisone has the highest mineralocorticoid activity (↑↑↑↑)
Which corticosteroid is the first-line treatment for Addison’s disease?
Hydrocortisone is used for Addison’s disease because it provides both glucocorticoid and mineralocorticoid effects
Which corticosteroid is commonly used for autoimmune diseases like rheumatoid arthritis and lupus?
Prednisolone is commonly used for autoimmune diseases due to its anti-inflammatory properties
Rank the corticosteroids from highest to lowest based on their glucocorticoid and mineralocorticoid activity
- Dexamethasone
(highest glucocorticoid activity) - Prednisolone
- Hydrocortisone
- Fludrocortisone
(highest mineralocorticoid activity)
A 76-year-old woman is admitted to a geriatric ward from her care home with new-onset confusion and agitation secondary to a urinary tract infection. Her past medical history is significant for COPD, type 2 diabetes mellitus, hypertension, and systemic lupus erythematosus.
Her regular medications include a combination inhaler, metformin, candesartan, and prednisolone.
Due to a prescribing error, the admitting medical team do not give the patient prednisolone during her stay in the hospital.
Given this prescribing error, what adverse event is the patient at risk of experiencing?
Addisonian crisis
Very high mineralocorticoid activity and minimal glucocorticoid activity means what bad side effect?
Fluid retention
A 62-year-old woman with type 2 diabetes visits her doctor to discuss her recent challenges in maintaining her blood sugar levels. She is currently taking metformin but has found maintaining a regular medication routine difficult due to an unpredictable daily meal routine.
The doctor suggests adding a medication to her treatment plan that helps regulate blood sugar by promoting glycosuria with a lower risk of causing hypoglycemia to allow flexibility in her schedule without worrying about blood sugar fluctuations.
What class of drugs is the doctor most likely considering?
Sodium-glucose co-transporter 2 (SGLT2) inhibitors
