Endocrine Pharmacotherapeutics Flashcards
What are the HbA1c, FBG, and PPG targets for T2DM?
HbA1c < 7%
FBG 4-7
PPG <10
What is the dosing regimen for metformin IR?
initiate: 500-850mg OD
increase dose by 500-850mg every 1-2 weeks
max: 2500-2550
What is the dosing regimen for metformin ER?
initiate: 500mg OD
increase by 500mg every week
max: 2g
What is the CrCL cut off for metformin?
30
When is metformin contraindicated?
heart failure, sepsis, hepatic impairment, alcoholism, >= 80yo
What is the sulfonylurea preferred in renal impairment?
glipizide
What is the dosing regimen of glipizide?
5mg BD –> 40mg/day
What diabetes drugs are not recommended to be given in pt with acute pancreatitis?
DPP4i, GLP-1 agonists
What is the dosing regimen for sitagliptin (inc. renal dosing)?
100mg OD
CrCL 30-45 50mg OD
CrCL <30 25mg OD
What is the eGFR cut off when SGLT2i is initiated for glycemic control only?
eGFR < 45
What is the eGFR cut off when SGLT2i is initiated for cardiorenal benefit? When should it be discont?
dapag 25
empag 20
discont on dialysis
What is the dosing regimen for empag and dapag?
empag 10mg - 25mg OD
dapag 5mg - 10mg OD
Which types of insulin can be mixed?
NPH + regular
NPH + rapid acting
How much time before meal should rapid-acting insulin be administerd?
5 mins
What oral medications can be continued / discontinued upon insulin initiation?
Continue: metformin, SGLT2i
Discont: TZD
SU: discont / reduce dose by 50% if basal insulin is started, discont completely if PPG started
Outline the 15-15-15 rule for hypoglycaemia
15g of fast acting carbs - 15 mins - test, if still under, then 15g of carbs again
When converting from NPH BD to glargine/determir OD, how much should insulin dose be reduced?
20%
How is insulin usually initiated?
10u NPH at bedtime / 0.1-0.2/kg/day
How is basal insulin usually titrated?
increase by 2u every 3 days until target
increase by 4u every 3 days if FBG consistently >10
decrease by 10-20% if hypoG
What is the maximum basal insulin to be given?
0.5/kg/day
If A1c is above target after basal insulin has reached maximum, what should be done?
- add mealtime glucose
- 4u or 10% of basal
also reduce basal by 4u or 10% if a1c < 8% - split NPH insulin (1/3 bedtime, 2/3 morning)
When should insulin be considered in a patient?
- ongoing weight loss
- hyperG symptoms
- A1c > 10% / BG > 16.7
SC GLP-1 agonists are given ________.
once weekly
What should be done if a patient is discovered to be experiencing the somogyi effect?
reduce dose of bedtime basal insulin
When should ulipristal 30mg be taken for prevention of preg?
within 5 days
When should levonorgestrel be taken for prevention of preg?
best within 12 hours, max 72h
When should a copper IUD be inserted for emergency contraception?
within 5 days
What are the goals of therapy for both hypo and hyperthyroidism?
- improve symptoms, improve QoL
- prevent long-term damage of organs
- normalise T4 and TSH
What is firstline in the treatment of hypothyroidism?
Levothyroxine
Outline the dosing regimen of levothyroxine
initial:
adults < 60 (w/o CVD): 1.6mcg/kg/day
adults > 60 (w/o CVD): 50mcg/kg/day
with CVD: 12.5-25mcg/day
titrate to desired TSH
How should levothyroxine be taken?
30-60mins before breakfast or 4 hours after last meal
What are the safety monitoring parameters for levothyroxine (inc SE)?
BP. HR, cardiac abnormalities, chest pain, fractures (bone mineral density), hyperthyroidism
What is the TSH target for pregnant women with hypothyroidism in the respective trimesters?
1st: <2.5
2nd: <3
3rd: <3.5
How should the dose of levothyroxine be adjusted in women who are pregnant?
increase dose by 30-50%
What is the TSH target for non-pregnant adults?
0.4 - 4
How does lithium affect the thyroid?
can increase or decrease thyroid function
What is the first line treatment for hyperthyroidism?
radioactive iodine ablative therapy
Radioactive iodine ablative therapy can be used in pregnant women
no
How long do thionamides take to work?
4-6 months
What thionamides should be used in the various trimesters of pregnancy for hyperthyroidism?
1st: PTU
2nd/3rd: Carbimazole
Which is the preferred thionamide for Graves disease?
Carbimazole
Outline the dosing regimen of propylthiouracil.
initiate: 50-150mg TDS
50mg BD/TDS once euthyroid
Outline the dosing regimen for carbimazole
initiate 15-60mg OD in 2-3 divided doses
5-15mg OD once euthyroid
What are the adverse effects to watch out for in thionamide therapy?
Hepatotoxicity (PTU)
Rash - risk of SJS
agranulocytosis (early in treatment, within first 3m)
- watch out for fever
What is the role of non-selective beta blockers in hyperthyroidism?
What is the role of iodides in hyperthyroidism? (inc duration)
At what duration do iodides have limited efficacy?
When should liothyronine be used?
What is the dose of liothyronine?
