Endocrine

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  • Created by: AJ-A
  • Created on: 23-05-22 20:53
Women with pre-existing diabetes who are planning on becoming pregnant should aim to keep their HbA1c concentration below
48mmol/mol (6.5%)
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All oral antidiabetic drugs, except ________ should be discontinued before pregnancy
Metformin
(the rest should be substituted with insulin therapy)
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first-choice for long-acting insulin during pregnancy
Isophane insulin
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Pregnant Women who have a fasting plasma glucose above 7 mmol/litre at diagnosis should be treated with
insulin immediately
Metformin first if below 7mmol/litre after attempting a change in diet and exercise
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A target HbA1c concentration of __________
is generally recommended when type 2 diabetes is managed by diet and lifestyle alone or when combined with a single antidiabetic drug not associated with hypoglycaemia
48 mmol/mol (6.5%)

should usually aim for an HbA1c concentration of 53 mmol/mol (7.0%) when treating with more than metformin
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If HbA1c concentrations are poorly controlled it is usually considered to be a rise of HbA1c to
58 mmol/mol (7.5%) or higher
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If metformin hydrochloride does not control HbA1c to below the agreed threshold treatment should be intensified with:
a sulfonylurea (glibenclamide, gliclazide, glimepiride, glipizide, tolbutamide);
Pioglitazone;
a dipeptidylpeptidase-4 inhibitor (linagliptin, saxagliptin, sitagliptin, or vildagliptin);
a sodium glucose co-transporter 2 inhibitor (canagliflozin, dapaglif
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If triple therapy is required to manage diabetes use
Metformin and a -gliptin and a sulfonylurea;
Metformin and pioglitazone and a sulfonylurea;
Metformin and a sulfonylurea and one of the sodium glucose co-transporter 2 inhibitors;
Metformin and pioglitazone and a sodium glucose co-transporter 2 inhibitor
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When should glucagon-like peptide-1 receptor agonist be prescribed?
In triple therapy with metformin, sulfonylurea and should only be prescribed for patients who have a BMI of 35 kg/m2 or above
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If metformin is contra-indicated or not tolerated, initial treatment should be single therapy with:
a sulfonylurea (glibenclamide, gliclazide, glimepiride, glipizide, or tolbutamide) (first choice), or
a dipeptidyl peptidase-4 inhibitor (linagliptin, saxagliptin, sitagliptin, or vildagliptin), or
Pioglitazone.
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Repaglinide should only be used in combination with
metformin
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Examples of rapid acting analogue (Bolus insulin)
Lispro (Humalog)
Aspart (novorapid)
Glulisine (Apridra)
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Example of intermediate acting insulin (Basal insulin)
Isophane (never give IV)
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Example of long acting insulin (basal insulin)
Glargine (lantus)
Detemir (levemir)
Degludec (Tresiba)
Protamine zinc (not given IV)
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Types of insulin regimens
Multiple Injection Regimen
Bi-phasic mixture regimen
Long/intermediate acting regimen
continuous subcutaneous infusion
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Interactions of insulin with ACEi
Hyperkalaemia and hypoglycaemia
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Which drugs antagonise the hypoglycaemic effect of insulin
corticosteroids, oral contraceptives and loop/thiazide diuretics
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Mineralocorticoid side effects
calcium loss
potassium loss
sodium retention
water retention
hypertension
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steroids with high mineralocorticoid activity
fludrocortisone, hydrocortisone, corticotropin and tetracosactide
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Glucocorticoid side effects
diabetes
osteoporosis
muscle wasting (myopathy)
peptic ulceration and perforation
psychiatric reactions
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Adrenal insufficiency is treated by physiological glucocorticoid replacement with mainly
hydrocortisone, prednisolone and rarely dexamethasone
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Adrenal crisis Treatment involves
prompt glucocorticoid replacement with hydrocortisone, and rehydration using a crystalloid fluid (e.g. sodium chloride 0.9%)
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Most common cause of cushing's syndrome is
exogenous steroid use
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Which drugs are licensed for the management of cushing's syndrome
Metyrapone is licensed for the management of Cushing’s syndrome.

Ketoconazole is licensed for the treatment of endogenous Cushing's syndrome.
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Symptoms of Cushing's syndrome include
skin thinning, easy bruising, moon face, acne, hirsutism (abnormal hair growth particularly in women) and amenorrhoea (absence of menstruation)
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First line for patients with postmenopausal osteoporosis
alendronic acid and risedronate sodium
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What are alternative options for women who are intolerant of oral bisphosphonates or in whom they are unsuitable
parenteral bisphosphonates or denosumab
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what is recommended for postmenopausal women with severe osteoporosis at very high risk of fractures
teriparatide and remosozumab
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who should be considered for bone protection management
those ≥70 years, OR with a previous fragility fracture, OR who are taking large doses of glucocorticoids (prednisolone ≥7.5 mg daily or equivalent)
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what are first line options for bone-protection treatment?
alendronic acid or risedronate sodium
Zoledronic acid, denosumab or teriparatide are alternative options
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Bisphosphonate treatment should be reviewed after ___ years of treatment with alendronic acid, risedronate sodium or ibandronic acid, and after ___ years of treatment with zoledronic acid
5 & 3
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Signs and symptoms of hypothyroidism include
fatigue, weight gain, constipation, menstrual irregularities, depression, dry skin, intolerance to the cold, and reduced body and scalp hair
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what is primary hypothyroidism
Primary hypothyroidism refers to when the condition arises from the thyroid gland
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Overt hypothyroidism is characterised by...
thyroid stimulating hormone (TSH) levels above the reference range and free thyroxine (FT4) levels below the reference range
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subclinical hypothyroidism is characterised by
TSH levels are above the reference range but FT4 and free tri-iodothyronine (FT3) levels are within the reference range
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First line treatment for overt hypothyoidsm
Offer levothyroxine sodium as first-line treatment and aim to maintain thyroid-stimulating hormone (TSH) levels within the reference range
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what is the recommended choice of antithyroid drug
carbimazole with propylthiouracil considered for those in whom carbimazole is unsuitable
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eGFR for osteoporosis treatment
Alendronic Acid - 35ml/min
Risedronate Sodium - 30ml/min
Ibandronic Acid - 30ml/min

Zoledronic Acid - 30ml/min (Malignancy induced)
-35ml/min (paget's disease induced, Use in Post-menaupausal and Use in men)
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Other cards in this set

Card 2

Front

All oral antidiabetic drugs, except ________ should be discontinued before pregnancy

Back

Metformin
(the rest should be substituted with insulin therapy)

Card 3

Front

first-choice for long-acting insulin during pregnancy

Back

Preview of the front of card 3

Card 4

Front

Pregnant Women who have a fasting plasma glucose above 7 mmol/litre at diagnosis should be treated with

Back

Preview of the front of card 4

Card 5

Front

A target HbA1c concentration of __________
is generally recommended when type 2 diabetes is managed by diet and lifestyle alone or when combined with a single antidiabetic drug not associated with hypoglycaemia

Back

Preview of the front of card 5
View more cards

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