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BNF Chapters > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is diabetes

A

Metabolic disorder. Hyperglycaemia caused by limited insulin secretion and insulin resistance

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2
Q

Drivers + Diabetes

A

Warn DVLA, carry glucose meter/strips, check <2hrs before driving and every 2 hours (must be >5mmol)

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3
Q

Typical T1DM features

A

BMI<25, Young, glucose>11, ketosis

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4
Q

T1DM HbA1C recommendation

A

<48mmol/mol (6.5%)

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5
Q

Waking glucose(fasting):

A

4-7mmols/l

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6
Q

Before food - glucose fasting

A

5-7mmols/l

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7
Q

90 minutes after food (glucose fasting level)

A

5-9mmols/l

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8
Q

When does insulin need decrease

A

Intercurrent illness, reduced food intake, impaired renal function, endocrine disorders e.g. Addison’s, coeliac disease, renal/ hepatic impairment

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9
Q

When does insulin need increase

A

Trauma (accidental/surgery), infection, stress, puberty

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10
Q

What T1DM patients benefit from metformin

A

> 25 BMI/ >23 in South Asian people to minimise effective insulin dose

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11
Q

Who is continuous insulin offered to

A

Disabling hypos, high HBA1c>69

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12
Q

What insulin regimen is preferred in T1DM

A

Basal bolus

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13
Q

T2DM treatment goals

A

Reduce micro/macrovascular complications by maintaining effective glucose and maintaining HBA1c

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14
Q

Microvascular

A

Retinopathy, neuropathy, nephropathy

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15
Q

Macrovascular

A

Ischemic heart disease, peripheral vascular disease, and cerebrovascular disease

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16
Q

Metformin effect

A

Lowers glucose, increases insulin sensitivity, inhibits gluconeogenesis, inhibits glycogenolysis

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17
Q

Metformin contraindications

A

Renal impairment (<30), heart failure, liver failure, recent MI

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18
Q

Key metformin side effect

A

lactic acidosis

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19
Q

What diabetic drugs cause hypos

A

Sulfonylurea

Meglitinide

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20
Q

Sulfonylureas end in:

A

Ide = tolbutamide, gilbenclamide

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21
Q

When is long acting sulphonylurea not recommended:

A

Older patients because of hypos and confusion

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22
Q

When to stop HRT

A

Severe chest pain, breathlessness, swelling in one calf, severe stomach pain, liver problems , Hypertension, immobile, neurological issues

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23
Q

What activity does Tibolone have

A

It has oestrogenic, progestogenic and weak androgenic activity

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24
Q

What is vasopresin and desmopressin, and what are they used for

A

Antidiuretic hormones used to treat pituitary cranial diabetes insipidus

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25
Q

Key differences between vasopressin and desmopressin

A

Desmopressin is more potent and has longer duration

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26
Q

Sulfonylureas side effects

A 
Weight gain
Hypos
G6PD deficiency caution
Abdominal pain
diarrhoea
 nausea
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27
Q

Sulfonylurea mechanism of action

A

Increase insulin acting on pancreatic beta cells (augmenting insulin secretion)

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28
Q

Acarbose mechanism of action

A

Slows digestion to reduce rate of glucose release

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29
Q

Meglitinide mechanism of action

A

Similar to Sulfonylurea but act on different receptor to stimulate insulin release

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30
Q

Thiazolidinone manifestation - e.g. pioglitazone

A

Reduces insulin resistance

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31
Q

Cautions/What to look out for with pioglitazone

A

Heart failure, nausea, toxicity, dark urine, bladder cancer

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32
Q

DPP4 mechanism of action

A

Inhibit glucagon release, increases insulin secretion

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33
Q

Dpp4 warnings

A

Pancreatitis

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34
Q

SGLT2 inhibitors mechanism of action

A

Prevent reabsorption of glucose in kidneys

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35
Q

GLP1 Receptor antagonist mechanism of action

A

Produce insulin as they are incretin mimetics, (increase insulin secretion, suppressing glucagon secretion,
slow gastric emptying)

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36
Q

When to take Exanatide

A

1 hour before food and 6 hours apart, never after food

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37
Q

Exanatide warning

A

Pancreatitis

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38
Q

GLP1 MHRA Warning

A

Diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

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39
Q

SGLT2i MHRA warnings

A

SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
Increased risk of lower-limb amputation (mainly toes)
reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
Risk of diabetic ketoacidosis with sodium-glucose co-transporter 2 (SGLT2) inhibitors

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40
Q

SGLT2i side effects

A

Balanoposthitis; constipation; dyslipidaemia; increased risk of infection;
nausea;
thirst;
urinary disorders; urosepsis

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41
Q

What sort of T2DM drug is needed for elderly

A

Short acting e.g. tolbutamide, gluclazide

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42
Q

When are GLP1 agonists used

A

After triple therapy

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43
Q

Meglitinide examples

A

Repaglinide, nateglinide

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44
Q

What antidiabetic is used concomitantly with weight management products

A

GLP1 agoists

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45
Q

How/when are meglitinides used

A

In combination with metformin when metformin alone inadequate

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46
Q

When to use short acting insulin

A

15-30 minutes before food

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47
Q

Soluble insulin peak

A

1-4 hours

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48
Q

Soluble insulin duration

A

9hrs

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49
Q

Rapid insulin names

A

Aspart, glulisine, lispro

50
Q

Rapid insulin onset time

A

<15 minutes

51
Q

Rapid insulin duration

A

2-5hrs

52
Q

When to use rapid insulin

A

Just before meal

53
Q

Intermediate insulin name

A

Isophane

54
Q

Intermediate onset

A

1-2 hours

55
Q

Intermediate peak

A

3-12hours

56
Q

Intermediate action

A

11-24 hours

57
Q

Biphasic insulin consists of what

A

Intermediate +short/rapid

58
Q

Long acting insulin duration

A

Up to 36 hours

59
Q

How long does it take for long acting to get to steady state

A

2-4 days

60
Q

Diabetes pregnancy HbA1C aim

A

48

61
Q

What oral diabetes medicine can be used in pregnancy

A

Only metformin possibly gilbenclamide during breastfeeding

62
Q

Insulin in pregnancy preference

A

Isophane firstline then rapid, (long acting if good control)

63
Q

When to pharmacologically treat Gestational diabetes

A

> 7mmol/l fasting plasma

https://bnf.nice.org.uk/treatment-summary/diabetes-pregnancy-and-breast-feeding.html

64
Q

Gestational diabetes treatment

A

Metformin, insulin or gilbenclamide

https://bnf.nice.org.uk/treatment-summary/diabetes-pregnancy-and-breast-feeding.html

65
Q

Insulin adaptation for minor elective surgery in patient with good control

A

Normal but long acting reduced by 20% onday of surgery

66
Q

Insulin adaptation for major surgery in patient or poor glycaemic control

A

Rate adjusted, long acting 80% and others normal. On the day only long acting (80%) , no other insulin until eating, iv infusion of KCl w/glucose and NaCl to prevent hypo

67
Q

When should BD mixed insulin regimes be restarted after surgery

A

Breakfast/dinner

68
Q

DKA symptoms

A

Nausea, drowsy, pear drop, vomiting

69
Q

DKA treatment

A

Soluble insulin, KCl, NaCl, (and then long acting insulin)

70
Q

Hypoglycaemia symptoms

A

‘like hungry’, agitated, drunk-like, confusion, sweating, Excessive sweating, pallor, palpitations, trembling

71
Q

When is ACE/ARB given for diabetes

A

Three positive serum creatinine tests

72
Q

What to with Sulfonylurea in patients having surgery

A

Stop until first meal after surgery

73
Q

What to with SGLT2i in patients having surgery

A

Stop until stable

74
Q

What to do with metformin when insulin given during surgery

A

Metformin does not need to be stopped

75
Q

How to tackle nephropathy in diabetes patients

A

Attempt to lower BP and start ACE/ARB

76
Q

How to treat diabetic foot infections

A

Flucloxacillin

77
Q

DKA treatment

A

500ml 0.9% NaCl over 10-15min
Give KCl
Start IV soluble insulin Give long acting insulin subcutaneously
Aim to reduce glucose by 3mmol/hour and ketone by 0.5mml/l/hr once glucose below 14 give glucose with NaCl (continue insulin until patient can eat)

78
Q

Examples of SGLT2

A

gliflozin’s canagliflozin, dapagliflozin

79
Q

Examples of DPP4i

A

gliptins, linagliptin, sitagliptin

80
Q

What diabetes meds put patients at risk of pancreatitis

A

DPP4i, Meglitinide

81
Q

Thiazolidinediones examples

A

Pioglitazone

Rosiglitazone

82
Q

Liothyronine vs levothyroxine

A

Liothyronine more rapidly metabolised

83
Q

Hyperthyoidism drug treatment

A

Carbimazole if not then propylthiouracil. 12–18 month course using either a block and replace regimen (combination of fixed high-dose carbimazole with levothyroxine sodium), or a titration regimen (dose based on thyroid function tests). Radioacive iodine is however first line.

84
Q

Thyrotoxicosis treatment

A

Propranolol/nadolol (beta blocker)+ radioactive iodine

85
Q

What is a blocking replacement regimen

A

Giving combo of hyper and hypo thyroidism drugs

86
Q

Hypothyroidism definition

A

Thyroid stimulating hormone (TSH) levels above the reference range and free thyroxine (FT4) levels below the reference range.

87
Q

Hypothyroidism in pregnancy definition

A

Elevated TSH levels (using trimester-specific reference ranges) regardless of FT4 levels.

88
Q

Hyperparathyroidism pharmacological treatment

A

Vitamin D and cincalcet

89
Q

Hyperparathyroidism symptoms

A

Hypercalacaemia = thirst high urine output, constipation, fatigue ,memory problems , CVD, kidney stones, osteoporosis, fractures

90
Q

Hyperthyroidism symptoms

A

Goitre, hyperactivity, disturbed sleep, fatigue, palpitations, anxiety, heat intolerance, increased appetite with unintentional weight loss, and diarrhoea

91
Q

Gonadotrophin inhibitors

A

Cetorelix, ganirelix, danazol

92
Q

Endometriosis treatment

A

Danazol, pituitary gonadotrophin inhibitors

93
Q

How to treat cushings

A

Metyrapone surgery

94
Q

Heavy menstruation treatment

A

Tranexamic acid, NSAID, ulipristal acetate, a levonorgestrel-releasing intrauterine system(first line in less severe),

95
Q

When should a bisphosphonate free period start

A

5 years, but continued if they actually have broken something

96
Q

First line osteoporosis treatment

A

Alendronic, risedronate

97
Q

When/how to take bisphosphonate

A

Empty stomach.
30 mins before first food of the day, 2 hour before/after other meals.
To sit upright. Particularly avoid milk/calcium containing.
Take same time each week

98
Q

Bisphosphonate counselling points

A

Osteonecrosis of jaw and auditory canal when taken for more than 2 years so report related issues

99
Q

Osteoporosis risk factors

A

Age, low body mass index (BMI), cigarette smoking, excess alcohol intake, lack of physical activity, vitamin D deficiency and low calcium intake, family history of hip fractures, a previous fracture at a site characteristic of osteoporotic fractures and early menopause.

100
Q

What does HRT alleviate

A

Menopausal symptoms e.g. Vaginal atrophy or vasomotor instability

101
Q

Risks that arise due to HRT

A

Venous thromboembolism, stroke, endometrial cancer (reduced by a progestogen), breast cancer, and ovarian cancer

102
Q

What hormone should be added to oestrogen in women with a uterus and why

A

Progestogen to reduce risk of cystic hyperplasia

103
Q

Hyperthyroidism complications

A

Graves’ orbitopathy, thyroid storm (thyrotoxic crisis), pregnancy complications, reduced bone mineral density, heart failure, and atrial fibrillation

104
Q

Graves disease

A

An autoimmune disorder mediated by antibodies that stimulate the thyroid-stimulating hormone (TSH) recepto

105
Q

Hyperthyroidism and TSH/FT4/FT3

A

TSH levels below the reference range and free thyroxine (FT4) and/or free tri-iodothyronine (FT3) levels above the reference range

106
Q

Non-drug hyperthyroidism treatment

A

Radioactive iodine or surgery

107
Q

What laxative safe in pregnancy

A

Bulk forming as not absorbed

108
Q

What drug is used in bed wetting

A

Desmopressin

109
Q

Where is hydrocortisone (Cortisol) secreted

A

Adrenal cortex normally secretes

110
Q

Dopamine-receptor agonists indication

A

Inhibits release of growth hormone
treats acromegaly
and galactorrhea

111
Q

Endometriosis treatment

A

gonadotropin-releasing hormones, pain relief, contraceptive

112
Q

Glucorticoid vs mineralocoricoid

A

High glucocorticoid is useless if mineralocorticoid activity is also high e.g. Fludrocortisone

113
Q

5mg Prednisolone is equivalent to how much dexamethasone and hydrocortisone

A

20mg hydrocortisone, 750 mcg dexamethasone

114
Q

Betamethasone mineralo vs gluco

A

low mineralocorticoid, high glucocorticoid

115
Q

Dexamethasone mineralo vs gluco

A

low mineralocorticoid, high glucocorticoid

116
Q

Prednisolone glucocorticoid vs mineral

A

Mainly glucocorticoid

117
Q

Hydrocortisone mineralocorticoid vs glucocorticoid

A

High mineralocorticoid

118
Q

When is corticosteroid needed

A

Asthma , rheumatoid arthritis, haemorrhoids, ulcerative colitis , crohn’s , raised intracranial pressure

119
Q

Corticosteroid side effects

A

Insomnia, suicidal thoughts, irritability, euphoria, nightmares

120
Q

What class of antidiabetic drugs increases likelihood of thrush

A

SGLT2i

121
Q

What antidiabetic drugs result in weight loss and increase insulin utilisation

A

Metformin

122
Q

What combinations of antidiabetic drugs may result in hypos

A

Sulfonylurea and DPP4, Dose of concomitant sulfonylurea or insulin may need to be reduced.

BNF Chapters (11 decks)

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