Metabolic

Question 1

Examples of human insulins that are short acting

Answer 1

• actrapid
• humulin S

Question 2

Short acting insulin analogues

Answer 2

• humalog
• novorapid
• apidra

Question 3

Short acting insulin normally used at mealtimes in conjunction with carb monitoring as 1 unit per 10g of carbohydrate

Question 4

Example of long acting insulin

Answer 4

Levemir
Lantus
Adding other constituents to thee basic structure of insulin to slow down its breakdown at injection site

Question 5

What is DAFNE

Answer 5

Dose adjustment for normal eating

Carb counting to adjust dose of units of insulin

Question 6

What consideration before prescribing metformin

Answer 6

• if eGRF less than 45ml/min then adjust dose and if less than 30 stop
• stop in AKI as accumulates

Question 7

What is the small risk of using metformin

Answer 7

• lactic acidosis in patients with acute illness or aki as build of lactate occurs

Question 8

For patients with high CVD risk T2 DM or chronic heart failure what needs to be given other than metformin

Answer 8

• SGLT2 - inhibitors like dapaglifozins

If with duo therapy it doesn’t work - try other class of drugs

-l last resort is insulin but since is anabolic causes weight gain thus increasing CVD risk

Question 9

Side effects of pioglitazones

Answer 9

• weight gain
• hypoglycaemia
• oedema
• heart failure
• increased risk of bladder cancer
• increase risk of small Bone fractures in women

Question 10

Downside to DPP4 inhibitors

Answer 10

Low potency

Question 11

Risks associated GLP-1 analogues

Answer 11

• increased risk of pancreatitis

GI SE = N+V

Question 12

Which anti-diabetic drug class is cardioprotective and renoprotective

Answer 12

• sglt2- inhibitors
  ( but shouldn’t be used in DKA patients as increases euglycaemic DKA

Question 13

What is needed for diagnosis of DKA

Answer 13

• hyperglycaemia - >11

Ketones higher than 3

Acidameia - pH less than 7.3 or bicarbonate less than 15

Question 14

In DKA what kind of insulin is given

Answer 14

• fixed rate insulin infusion

But fluid resus should occur first as 1) would be perfusing kidney and also helps to dilute blood sugar) 2) if give insulin first it will move glucose form blood to cells and water will follow and lead to further dehydration and hypotension

Also need to give potassium at some point as action of above two will lead to plasma hypokalemia (arrhythmias…)

Question 15

How is HHS different to DKA

Answer 15

• IV fluids major key here as they already have endogenous insulin. Main problem here is that blood is too hyperglycaemic and hypovolemic

Question 16

What is the range for hypoglycaemia

Answer 16

• blood capillary less than 4
• if patient not able to swallow use glucogel at buccal mucosa

If aggressive and too confused and you have IV access do that or not glucagon IM

Question 17

what is the primary drug to alleviate symptoms of hyperthyroid

Answer 17

• beta blockers non selective such as propranolol
  (also act to decrease peripheral conversion of T4 to T3)

Question 18

carbimazole MOA

Answer 18

• decreases production of thyroid hormone through affecting iodide conversion to iodine in follicular cells which is then stored in colloid. hormones are bound to thyroglobulin
  (T4 is major hormone produced in thyroid)

inhibits enzyme such as thyroid peroxidase

+ but takes long to work as pre-existing store of T4 has long life of 4-6 weeks

Question 19

iodides can also be used

Answer 19

• blocks the production and release of hormones from thyroid
• cannot be used long term though 2-3 weeks
• used in surgery

Question 20

what is the alternative to carbimazole for pregnant women

Answer 20

• propylthiouracil PTU
• PTU inhibits peripheral conversion of T4 to T3
• half life of PTU is shorter so more times needed in day (3)

however PTU can cause severe hepatic failure

Question 21

other cautions associated with anti - thyrotoxicosis drugs

Answer 21

• agranulocytosis
• rashes and anaemia
• hepatic failure with PTU

Question 22

treatment of thyrotoxicosis regimens

Answer 22

1) Block and replace (shorter duration of treatment)

2) titration ( low dose to begin with?)

cant use block and replace in pregnancy

Question 23

other anti-thyroid treatment alternatives

Answer 23

1) radioactive iodine
2) thyroidectomy

Question 24

before radioiodine is given why is carbimazole given

Answer 24

-

Question 25

deficiency in ACTH: drug

Answer 25

• hydrocortisone

Question 26

deficiency in GH

Answer 26

not required in adults

Question 27

deficiency in TSH: drug

Answer 27

• levothyroxine

Question 28

deficiency in LH and FSH: drug

Answer 28

testosterone - men
HRT for women

Question 29

sick day rules for steroids

Answer 29

• up the dose

Question 30

management of addisonian crisis

Answer 30

• IV fluids
• hydrocortisone ( at high concs also has mineralocorticoid actuvity)
• prevent hypoglycaemia

Question 31

treatment for high prolactin

Answer 31

cabergoline - dopamine agonist (dopamine is a tonic inhibitor of prolactin)

or bromocriptine but more N+V side effects

Question 32

treatment of severe hypocalcemia

Answer 32

calcium gluconate

• Mg is needed for production and release of PTH

Question 33

treamtnet for hypercalcemia

Answer 33

• lots of IV fluids as dehydrated
• IV zolendronic acid (bisphosphonate)
• steroids

Question 34

MOA of bisphosphonates

Answer 34

• inhibit attachment of osteoclasts to bone thus inhibting bone resoprtion

Question 35

moa of cinacalcet

Answer 35

• mimics calcium on PTH receptors so gland thinks too much calcium so reduces secretion of PTH

Question 36

treatment for severe hyponatremia

Answer 36

• hypertonic saline

Question 37

tolvaptan

Answer 37

V2 receptor antagonist - blocks action of ADH

Question 38

use of tolvaptan

Answer 38

• PKD
• SIAD