Endocrinology Flashcards
What is the most common side effect of metformin?
GI disturbance
Which diabetic medication should be stopped in AKI?
Metformin
Which class of T2DM drug is useful in bringing down glucose quickly?
Sulphonylureas
- glimepiride, gliclazide, glipizide
Which T2DM drug is useful if insulin resistance is significant?
Pioglitazone
Which class of T2DM drug is useful in cardiovascular risk?
SGLT2 inhibitors
- canagliflozin, dapagliflozin, empagliflozin
SGLT2 inhibitors carry risk of what type of infection?
Urinary tract infection, thrush
- due to mode of action of increasing glucose excretion in urine
Which class of T2DM medications are commonly used for weight loss?
GLP1 analogues
- liraglutide, semaglutide, exenatide
Which class of T2DM drugs is useful in protecting kidneys if there is albumin or protein in the urine?
SGLT2 inhibitors
- canagliflozin, dapagliflozin, empagliflozin
What is the recommended cut off HbA1c for diagnosing diabetes?
48mmol/mol
When should we not utilise HbA1c testing for diabetes diagnosis?
Children, suspected type 1, pregnancy, acute illness, symptomatic for less than 2 months
Which test is used for detecting microvascular kidney complications in diabetes?
ACR
What is the upper limit of normal for ACR in men and women?
2.5mg/mmol men
3.5mg/mmol women
When replacing insulin in DKA, which electrolyte is important to monitor?
Potassium
- Insulin decreases blood potassium
What are the three main things to administer in a DKA patient?
Fluids + insulin + potassium
Steroids can have what effect on blood glucose?
Increase
Type 3c diabetes can be caused by what conditions?
Acute/chronic pancreatitis, pancreatic cancer, cystic fibrosis, haemochromatosis
How may Cushing’s disease/syndrome lead to diabetes?
Elevated cortisol leads to increased insulin resistance
Excessive growth hormone may lead to what effect on insulin?
Resistance
Name 4 hormones that can increase insulin resistance/impede it’s secretion
Cortisol, adrenaline, thyroid, growth hormone
What is target blood pressure for those with diabetes?
<140/90mmHg
- NB same as those without diabetes
Which painkiller is first line in painful peripheral neuropathy in diabetics?
Amitriptyline
- note cannot use in glaucoma
During puberty what do we usually need to do to insulin dosages?
Increase them
- due to increasing insulin resistance at puberty
Alcohol does what to glucose levels?
Hypoglycaemia
- due to alcohol inhibiting the livers ability to regulate blood glucose
How many grams of quick acting carbohydrate should we give to those who we suspect hypoglycaemia who are conscious and talking?
15-20g
In hypercalcaemia, what happens to PTH levels?
Reflexively decreased
What is the most common cause of primary hyperparathyroidism?
Parathyroid adenoma
Subarachnoid haemorrhage is associated with which electrolyte abnormality?
Hyponatraemia
Thiazide diuretics can cause a triad of what electrolyte abnormalities?
Hyponatraemia + hypokalaemia + hypercalcaemia
Choose high/low:
Addisons disease has what effect on sodium, potassium and glucose?
Sodium - low
Potassium - high
Glucose - low
How should hydrocortisone dose in Addison’s disease be split throughout the day?
Split with more in the morning, less in the evening
Note - to mimic the bodies natural cortisol production
Fill in the blanks:
To be able to consider trial of levothyroxine in asymptomatic subclinical hypothyroidism patients, TSH levels must be over __ on __ separate occasions, __ months apart.
- 10
- 2
- 3
Fill in the blanks:
In symptomatic subclinical hypothyroidism patients, TSH levels must be between ___ - ___ on 2 occasions more than 3 months apart to consider levothyroxine trial.
5.5 - 10
How should a patient over 65 with subclinical hypothyroidism be managed?
Watchful waiting
Which antithyroid treatment should be avoided in thyroid eye disease?
Radioiodine
Metformin carries risk of which metabolic abnormality?
Lactic acidosis
What is the most common side effect of bisphosphonates?
Oesophagitis
Osteonecrosis of which bone may occur with bisphosphonate therapy?
Jaw
Deficiency of what 2 parameters should be corrected before initiating bisphosphonate therapy?
Calcium and vitamin D
What is the appropriate management in a patient:
1. 75+ with a fragility fracture?
2. Under 75 with a fragility fracture?
- Initiate bisphosphonates without DEXA
- Conduct DEXA
Over correction with levothyroxine increases risk of developing what?
Osteoporosis
Recent myocardial infarction should prompt the cessation of what diabetes drug?
Metformin
Prolonged diarrhoea results in a metabolic acidosis associated with what levels of:
1. Potassium
2. Chloride
- Hypokalaemia (low potassium)
- Hyperchloraemia (high chloride)
Name the 2 contraindications to statin therapy
Macrolide therapy (clarithromycin, erythromycin) and pregnancy
Fill in the blank:
Statins should be stopped if ALT rises to and persists to __ times upper limit
3
In primary prevention of hyperlipidaemia, what is the target percentage reduction in non-HDL cholesterol?
> 40%
Total cholesterol level over what should prompt suspicion of familial hypercholesterolaemia?
Over 7.5mmol/l
