Endocrine Drugs Flashcards
What is the correct order for type 2 diabetes drugs?
(0) Lifestyle changes and exercise
(2) Metformin
(first-line unless contraindicated, such as in severe renal impairment)
(2) Second-line treatment:
SGLT-2 inhibitors
(eg, empagliflozin, dapagliflozin)
OR
GLP-1 receptor agonists
(eg, liraglutide, semaglutide)
ONLY if the patient has obesity (BMI ≥ 30) or cardiovascular disease
(3) Third-line:
Add one more drug while continuing metformin =
DPP-4 inhibitors
(eg, sitagliptin, linagliptin)
OR
Sulfonylureas
(eg, glimepiride, gliclazide)
(4) Fourth-line:
Thiazolidinediones (eg, pioglitazone) or insulin therapy
(5) Fifth-line:
Combination therapy with insulin and other oral agents
(eg, metformin or GLP-1 receptor agonists)
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
