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Mona Practice :) > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

List 3 examples for first generation sulphonylurea anti diabetics?

A

Chlorpropamide
Tolazamide
Tolbutamide

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2
Q

Main side effects of chlorpropamide

A 
Long t1/2
SIADH
Disulfiram like reaction 🥂
Weight gain
Hypoglycemia
Nausea and GI discomfort 
CI in renal disease, liver disease and frank jaundice
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3
Q

Mechanism of action of insulin secretagogues ( sulphonyl urea and meglitinides)

A

Close ATP dependent potassium channel, membrane depolarization,
Open voltage gated Ca channels allow Ca mediated exocytosis of insulin

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4
Q

Main side effects of metformin

A 
Metallic taste
Nausea, vomit 🤢, anorexia
Lactic acidosis 🥂
Decrease absorption of Vit B 12
Preoperative or before RMI - lactic acidosis esp in patient with renal disease.
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5
Q

What are the main side effects of Thiazolidinediones?

A

Liver toxicity ( met by CYP )
Weigh gain and fluid retention ( CI in severe heart failure💔)
Bose Osteopenia and increase fracture risk.

Rosiglitazine cause MI
Pioglitazone bladder cancer
Increase risk of pregnancy 🤰🏻

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6
Q

In which conditions is alpha glucosidase inhibitors contraindicated?

A

IBD
Colonic ulcer
Intestinal obstruction

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7
Q

Examples of DPPI

A

Sitagliptin
Saxagliptin ( met by CYP 3A4/5 inhibitors)
Linagliptin (no dose adjust in kidney disease)
Alogliptin

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8
Q

Effect of pioglitazone and Rosiglitazone on Lipids

A

Both increase HDL

Pioglitazone decrease TG
Rosiglitazone increase LDL and TG

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9
Q

Examples of Sodium glucose cotransporter 2 inhibitors

A

Promote renal secretion of glucose in proximal tubule
Take on EMPTY stomach in the Morning
Canagliflozin
Dapagliflozin

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10
Q

What are the main side effects of SGLT2 inhibitors.

A 
Urinary tract infection
Vulvovaginal candidiasis
Urinary frequency - osmotic diuretic
Dehydration 
Hypotension
Hyperkalemia
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11
Q

Antidiabetic medication should be taken 30 min before food or with first bite?

A

Meglitinides

Acarbose

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12
Q

Antidiabetic medication associated with increase fracture risk and osteopenia?

A

Thiazolidindiones

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13
Q

Effect of insulin on potassium level.

A

Insulin cause the shift of potassium from outside the cell to inside the cell.
Therefore used in treatment of hyperkalemia

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14
Q

Antidiabetic medication causing pancreatitis?

A

DPPI ( sitagliptin, saxagliptin, alogliptin, linagliptin)

GLP 1 - Incretin mimetics ( Exenatide, Liraglutide) 💉💉

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15
Q

Anti diabetic Cause nasophargitis and upper respiratory tract infection?

A

DPPI 4 inhibitors

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16
Q

Drugs that cause dysglycemia?

A 
Atypical antipsychotics 
B antagonist
Diuretics thiazides and loop
Diazoxide
Glucocorticoids
Niacin
Isoniazid
Pentamidine
Protease inhibitors
Tacrolimus
Interferon alpha
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17
Q

Risk for diabetes mellitus

A

Obesity
Age greater 40
Overweight, dyslipidemia, Hypertension
Vascular disease (coronary, cerebrovascular, peripheral)
Gestational diabetes
Vascular disease -(Coronary, cerebrovascular, peripheral)
History of impaired glucose tolerance or impaired fasting glucose
Schizophrenia

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18
Q

When should we start insulin therapy immediately in diabetic patient at time if diagnosis?

A

HbAC1 >= 9% عالي اوي. Or I can give 2 Oral medications

Normal 4-6٪‏

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19
Q

What are the vaccines recommended in Diabetes

A

Annual influenza vaccine

One time pneumococcal vaccine (2nd if older than 65 and received dose 5 years earlier)

20
Q

Monitoring in diabetes

A

Annual- foot exam, serum creatinine, ophthalmologist
3months- HbA1c. If good 6 months
3 months- lipid profile and start statins

21
Q

What is advantage of adding metformin to insulin?

A

Dec insulin dose
Less weight gain
Less Hypoglycemia

Avoid adding TZD to insulin-edema and wit gain inc HF

22
Q

Management of hypoglycemia

A

Conscious- oral glucose
Unconscious- IM or SC glucagon
OR
IV dextrose (malnutrition or alcohol induced)

23
Q

Medications for diabetic patients for vascular protection?

A
  1. Antiplatelets ( macrovascular or microvascular complications , long standing diabetes, age greater 45 male , 50 females)
  2. Statin male greater than 45 , female greater than 55
  3. Blood pressure less than 130/80
24
Q

Medications for pregnant women 🤰🏻and diabetic?

A

Insulin (Lispro, Aspart)
Glyburide
Metformin

25
Q

What is meant by metabolic syndrome?

A

Central obesity, hypertension, dyslipidemia, insulin resistance, glucose abnormalities.
Short term diabetes risk
Long term cardiovascular risk

26
Q

Management of Diabetic ketoacidosis?

A

Fluids
Potassium
Insulin IV
Bicarbonate

27
Q

Thyroid hormone interact with?

A 
Calcium 
Antacid
Fe supplement
Sucralfate -2hrs separate
Cholestrylamine; Colestipol-separate 6hrs
Soya fiber
Raloxifene (Separate 12 hours)
28
Q

Pregnant 🤰🏻 thyroxine requirement
Elderly 👴🏽thyroxine requirement
Patient with coronary disease requirement 💔

A

Pregnant 🤰🏻- Inc dose due to inc in thyroid binding globulin.

Elderly 👴🏽thyroxine requirement -
Patient with coronary disease requirement 💔-
Both start low dose 12mcg/day and titrate every 4 weeks

29
Q

Conditions associated with hyperthyroidism

A

Grave’s disease 👀protrusion of eye ball
Plummer disease
Diffuse toxic goiter
Toxic nodular goiter

30
Q

DOC for woman with hyperthyroidism and pregnant 🤰🏻

A

Polythiouracil

More agranulocytosis

31
Q

Are corticosteroids used in hyperthyroidism ?

A

Yes
Adjuvant in treatment of resistant hyperthyroidism
Dexamethasone-Thyroid storm
Hydrocortisone- Myxedema Coma

32
Q

How to inhibit prolactin secretion 🍼

A

Bromocriptine/Cabergoline activate D2 receptor in Pituitary -> Inhibit prolactin secretions

33
Q

Where is prolactin secreted from?

A

Anterior pituitary

34
Q

Where is Oxytocin and vasopressin secreted from?

A

Posterior pituitary VO

35
Q

Management of thyroid storm

A

B blocker to stop sympathetic stimulation (CCB if pt asthma or HF)
PTU stop hormone production
Iodides inhibit hormone release
Glucocorticoids

36
Q

What are the secretions of the hypothalamus?

A 
Thyrotropin Releasing Hormone-TRH
Prolactin Releasing Hormone-PRH
Corticotropin Releasing Hormone-CRH
Growth Hormone Releasing Hormone -GHRH
Gonadotropin Releasing Hormone - Gn RH
37
Q

Secretions from anterior pituitary?

A 
Prolactin
Thyrotropin Stimulating Hormone TSH
Adrenocorticotropic hormone ACTH - Corticotropin
LH
FSH
38
Q

Growth hormones inhibiting hormones

A

Octreotide- Somatostatin analogue that binds to somatostatin receptors in pituitary and decrease Growth hormone ( ttt of acromegaly) and dec TSH ( ttt of thyrotropinoma in pituitary) and in secretory diarrhea due to Vipoma.

Pegvisomat 🐷🐷 GH receptor Antagonist

39
Q

What is the mechanism of Raloxifen and side effects?

A

Agonist on bones (ttt of osteoporosis)

Antagonist on breast and uterine 🙂

Hot Flashes
DVT, PE
Retinal vein Thrombosis
Leg cramps

40
Q

Androgens Examples

A

Danazol
Stanozolol
Nandrolone

Oxandrolone
Fluoxymesterone

OF - Oral

41
Q

Examples of antiandrogens?

A

Inhibit androgen synthesis -5a reductase inhibitors
Dutasteride
Finasteride

Block androgen receptor - BNF
Bicalutamide
Nilutamide
Flutamide

42
Q

Gonadotropin Releasing Hormone - Gonadorelin

A

Synthetic analogues act on GnRH receptors

Leuprolide

Goserelin 👨🏻جوزي
Nafarelin 🤧 نف
Histrelin

43
Q

Gonadotropin

A

Gonadotropin are glycoproteins from posterior pituitary

Menotropin (HMG) - LH + FSH
Chorionic gonadotropin hCG - LH
Urofollitropin -FSH
Follotropin

44
Q

Managment of hyperaldosteronism

A 
Due to inc in aldosterone
Cause:
-Alkalosis
-Hypokalemia
-retention of Na and water
- Loss of K and H

Treatment
Spironolactone
Eplerenone

45
Q

Diagnosis of Cushing syndrome

Treatment of Cushing syndrome

A

Diagnosis-Dexamethasone

Treatment-Ketoconazole or surgery

Mona Practice :) (24 decks)

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