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GPhC Exam: The Endocrine System

GPhC Pre-Reg Exam Preparation Specialists

What are the key topics in the endocrine system?

The endocrine system houses a number of glands that create and secrete hormones which are crucial for a number of regulatory bodily functions such as metabolism, reproduction, mood, growth, and sleep, to name a few. Some of the major areas within this section includes diabetes, corticosteroid therapy, bone metabolism (i.e. osteoporosis), sex hormones (i.e. contraception, erectile dysfunction, prostatic hyperplasia), and thyroid function.

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Top tips on the endocrine system GPhC exam questions

  • All insulins are not the same and you must understand the range of options available and when they are to be used.
  • Rapid-acting: administer immediately prior to or with a meal; effect takes place within about 10-20 minutes i.e. insulin aspart.
  • Short-acting insulins: administer before meals; works within about 30-60 minutes i.e. human insulin.
  • Long-acting: administer once or twice daily; effects can last up to 24-36 hours i.e. insulin glargine.
  • Intermediate-acting: usually administered alongside a short-acting insulin; effects begin to take place within an hour of administration and can last up to 18-24 hours i.e. isophane insulin.
  • During your pre-reg work placement you may come across lots of different treatment options for type 2 diabetes. You can have a discussion with your pre-reg tutor to understand the stepwise add-on drug options for those with uncontrolled type 2 diabetes.
  • Diabetes is commonly related to other health issues such as, cardiovascular disease, nephropathy, and neuropathy. Thus, try to make and understand the links between a hormone system and other disease states.
  • Learn the differences between combined hormonal contraception and progesterone-only options i.e. monophasic/multiphasic preparations, risks carried by each type, what a female needs to do when she has “missed a pill”.
  • Often the legal aspects of pharmacy practice are ignored during revision sessions. For example in this section, ensure you know the legal rules of providing the emergency hormonal contraceptive pill or over-the-counter Sildenafil 50mg for erectile dysfunction – perhaps for such scenarios, you can buddy up with a partner and do role play as part of your learning. In fact, if you feel that you do not get enough one-one or discussion time with your fellow colleagues, you may find that doing role play activities is an excellent method to cover a wide range of drugs and clinical scenarios that are included in the endocrine system.
  • You may come across various Medicines and Healthcare products Regulatory Agency (MHRA) advisory notes in the BNF for drugs in this section. It is worth reviewing these as the information is fairly succinct and shall aid your revision.
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Example high risk drugs in this section

INSULIN

Drug action

What is it used for?

Cautions

(Very) common side effects

·        Regulates glucose metabolism (the movement of glucose into cells and tissues).

·        Supports fatty acid, glycogen, and protein synthesis.

·        Inhibits: proteolysis; gluconeogenesis in the liver; lipolysis in adipocytes.

·        Diabetes mellitus

·        Diabetic ketoacidosis

·        Hypoglycaemia

·        Risk of cutaneous amyloidosis at site of injection – this can affect the absorption of insulin, hence can have an effect on glycaemic control.

·        Oedema

THIAZOLIDINEDIONE: PIOGLITAZONE

Drug action

What is it used for?

Cautions

(Very) common side effects

  Peripheral insulin   

      resistance

      Sensitivity of cells  

      to insulin

      Blood glucose

      levels

·        Type 2 diabetes (alone or combined with: metformin and/or a sulfonylurea i.e. Gliclazide; or with insulin)

·        Risk of heart failure when used alongside Insulin

·        Heightened risk of bone fractures

·        Current risk factors for heart failure

·        Current risk factors for bladder cancer

·        Bone fracture

·        Increased risk of infection

·        Loss of sensation

·        Visual impairment

·        Weight gain

Example questions

  1. If a patient takes Prednisolone 35mg daily for one week for a given condition, what would be the total equivalent dose of Dexamethasone? Write your answer in milligrams and round write down the full calculated figure.

Equivalent anti-inflammatory doses of corticosteroids:

Prednisolone 5mg  =  Betamethasone 750mcg
                   
                 Deflazacort 6mg               
                                     Dexamethasone 750mcg
   
                                     Hydrocortisone 20mg
     
                                     Methylprednisolone 4mg
                                    Prednisone 5mg#
                                    Triamcinolone 4mg

       

  1. Mrs H has brought in a new prescription with “Ibandronic Acid 70mg once weekly, supply 4 tablets”. She tells you that it is for the treatment of postmenopausal osteoporosis. From the following options, what would be the best course of action to take?
  • Dispense and supply the medication
  • Call the prescriber and explain that Ibandronic Acid should be prescribed as 150mg once monthly
  • Call the prescriber and explain that Ibandronic Acid should be prescribed as 50mg once daily.
  • Call the prescriber and enquire about whether they intended to prescribe Alendronic Acid 70mg as this is to be taken once weekly, and the quantity on the prescription states “4 tablets” which would cover a month’s supply.
  • Call the prescriber and inform them that they have made an error as Ibandronic Acid is not indicated for the treatment of postmenopausal osteoporosis.

Written by Fatima Sazzad, GPhC Reg No. 2212805

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