Endocrinology Flashcards
What is type 1 diabetes
Autoimmune destruction of islet beta cells of the pancreas and therefore no insulin production.
what are 6 symptoms of diabetes
Always hungry
Always thirsty
Frequent urination
Weight Loss
Poor wound healing
Blurry vision
frequent vaginal and penile thrush
What are 3 complication of diabetes
- Retinopathy
- Neuropathy
- Nephropathy
how is type 1 diabetes diagnosed
Oral glucose tolerance test, HbA1c test, antibodies test
what is first line treatment of T1DM
Multiple daily injection of basal and bolus insulin
Name 3 rapid acting insulin analogues
aspart
glulisine
lispro
Name 3 long acting insulin analogues
detemir
glargline
degludec
What long acting insulin analogue is twice daily dosing
Detemir
when should bolus insulin be given
Before meals NOT AFTER
what are two alternatives to multiple daily basal/bolus injection regimens
- Biphasic human mixed isophane insulin - humulin
- Biphasic analogue mixed insulin - NovoMix(aspart) or humalogMix(lispro)
- Continuous subcutaneous insulin infusion(pump)
What insulin analogue is ultra-long acting
Insulin Degludec
What long-acting insulin analogue is chosen for nocturnal hypoglycaemia
Insulin Degludec
What adjunctive anti-diabetic medicine is given in T1DM and why
Metformin to improve glycaemic control and minimise insulin dose
How should you store insulin
Unopened insulin must be stored in refrigerator and kept away from direct sunlight.
Opened insulin can be stored at room temperature for 4 weeks
How often should type 1 diabetics self monitor their blood glucose
four times day
(before each meal and before bed )
what are 5 DVLA instructions for diabetics
- Monitor BM no more than 2 hours before driving
- Monitor 2 hours after driving
- BM must be above 5mmol/L
- Driver must have fast-acting glucose available in car.
- Must not drive if experiencing a Hypo
What is clinically hypoglycaemia
blood sugar less than 4mmol/L
What is treatment for hypoglycaemia if patient is conscious and able to swallow
Conscious and able to swallow: fast-acting carb (glucogel/sugar water/ half can of coke)
What is treatment for hypoglycemia if patient is unconscious
IM glucagon, repeat after 10 minutes if not effective
What is T2DM and what is the blood sugar reading suggestive of it
Insulin resistance and/or insulin deficiency.
> 11mmol/L
What is target HbA1c for T2DM for drugs not associated with hypos
48mmol/mol
What anti-diabetic drugs are associated with hypos
Sulfonylureas(gliclazide) or insulin
What is target HbA1c for T2DM for drugs associated with hypos
53 mmol/mol
What is first-line non drug treatment for diabetes
Diet and lifestyle advice
What is first line treatment for T2DM
Metformin
what is metformin dose
500mg OD, then BD, then TDS increased in weekly intervals
What to do if metformin causes GI side effects
change to modified release
What should you add onto metformin if a patient has heart failure or CVD
SGLT2 inhibitor with proven CVD benefits i.e Dapagliflozin
what is second line treatment in T2DM
Dual therapy with following choices
- DPP-4 inhibitors(gliptins)
- Plioglitazone
- gliclazide
- SGLT2 inhibitors
5 symptoms of hypothyroidism
- Fatigue
- Dry skin
- Weight gain
- Cold Intolerance
5.. Hair loss
What is overt and subclinical hypothyroidism
Overt: high TSH and Low T4
Subclinical: high TSH normal T4
what is the autoimmune disease that causes hypothyroidism
Hashimotos
What is treatment for hypothyroidism
Levothyroxine OM before 30 minutes food and drinks
What foods should you avoid with levothyroxine
Calcium containing products i.e dairy must leave 4 hours apart
Caffeine must leave 30 minute gap
When is menopause diagnosed
after 12 months of amenorrhea
What is the cause of menopause
Loss of ovarian follicular function and depletion of oocyte stores which results less production of oestrogen and progesterone and thus no menstruation
What is the mean age of menopause in the UK
51 but varies between ethnic groups
What are 10 symptoms of menopause
Weight gain
Night sweats
hot flushes
Brain fog
Hair loss
Anxiety
depression
vaginal atrophy
osteoporosis
fatigue
What is the treatment of vasomotor symptoms in menopause for women without a uterus
Oestrogen only - oral or transdermal
What is the tx of vasomotor symptoms in menopause for women with a uterus
oestradiol with progesterone oral or transdermal
Why is progesterone given to women with a uterus
Unopposed oestrogen increases the risk of endometrial hyperplasia and endometrial cancer, progesterone is protective to the endometrium and prevents it from growing too much.
what are the urogenital symptoms of menopause
Vaginal atrophy, dryness, itching, iritiation, loss of libido
What 3 conditions are menopausal women at higher risk of
- Osteoporosis(oestrogen maintains healthy bones)
- CVD
- Stroke
What is self care advice for hot flushes and night sweats in menopausal women
- Weight loss
- regular excercise
- Sleep in cool room
- Wear lighter clothing
- reduce stress
- avoid triggers such as spicy foods, smoking and alcohol
What other treatments are there for urogenital symptoms of menopause
Vaginal lubricants or moisturisers
HRT increases the risk of what 3 cancers
Ovarian, endometrium, ovarian
What are 3 non cancerous risks of HRT
VTE, STROKE, CHD
What is GINA
Oestradiol vaginal tablets
What is GINA used to treatment
Vaginal atrophy from menopause
What legal class is GINA
P-medicine
Who can you supply GINA to
- Post menopausal over 50
- No period for atleast 1 year
- With or without a womb
Who can you not supply GINA to (7)
- Liver disease
- Heart issues
- Cancer
- DVT or PE
- Hypersensitivity to oestradiol
- vaginal infections
- Intact uterus previously treated with unopposed oestrogens
What is one non-drug treatment of menopause
CBT has been found to reduce the frequency and severity of hot flushes
What is the dose of GINA
Initiation: One tablet vaginal daily for two weeks
Maintenance: One tablet vaginal twice a week
How long does it take for full benefits of GINA to be felt
8-12 weeks
What is benign prostate hyperplasia
Enlargement of prostate gland which causes LUTS
What are voiding symptoms of LUTs
Weak/intermittent urinary stream
Straining
Hesitancy
Dribbling
Incomplete emptying
What are storage symptoms of LUTS
Increased frequency
Urgency
Nocturia
Urinary Incontinence
What post micturition symptoms of LUTS
- Sensation of incomplete emptying
- post micturition dribbling
What are conservative treatments of LUTS
Pelvic floor excercises
Bladder training
Lifestyle changes
What are the lifestyle changes for BPH
- Bladder training
- Reduce intake of caffeine, alcohol, carbonated drinks
- Reduce intake of fluids after 4pm
- Massage back of testicles after peeing to ensure full emptying
What are the two treatments for BPH
Alpha-blockers and 5-alpha reductase inhibitors
What alpha blockers are used for BPH
Tamsulosin, Doxazocin, alfuzosin
what drugs are 5 alpha reductase inhibitors
Finasteride and dutasteride
Are women allowed to touch finasteride or dutasteride
That women should not handle crushed or broken tablets of finasteride, or leaking capsules of dutasteride, if they are pregnant or may be pregnant.
To use a condom if his sexual partner is pregnant or likely to become pregnant.
What side effects of finasteride
Sexual dsyfunction
Breast abnormalities(in men and risk of breast cancer)
Depression/suicidal thoughts
What is a key side effect of alpha-blockers
Dizziness/postural hypotension
What patient group is alpha blockers cautioned in
Elderly
