Core Medications Flashcards
examples of SABA
salbutamol
Terbutaline
examples of LABA
salmeterol
formoterol
MOA of beta agonist
beta2 receptors on smooth muscles, GI tracts, Heart and bronchi
activation of Beta2 receptors = relaxation of muscles by causing the Na+/K- ATPase pumps to shift K+ extacellular to intracellular
indications for beta agonist
asthma
COPD
hyperkalaemia
SE of beta agonist
tachycardia palpitation anxiety inc glucose level inc serum lactate level if high dose - cause the breakdown of smooth muscles muscle cramps
examples of short-acting antimuscarinic
ipratropium
examples of long-acting antimuscarinic
Tiotropium
MOA of antimuscarinic
binds to the muscarinic receptors and act as competitive inhibitors of ACTH
block parasympathetic effects = dec smooth muscle tone and dec secretion
indication of antimuscarinic
asthma
COPD
contra-indications of antimuscarinic
angle closure glaucoma - can cause inc intraocular pressure
SE of antimuscarinic
dry mouth
examples of ICS
beclometasone
budesonide
fluticasone
MOA of ICS
meds pass through the membrane to get into the nucleus of the cells to modify gene transcription
pro-inflammatory interleukins, cytokines and chemokines are downregulated
dec mucosal inflammation, widen the airways and dec mucus secretion
Indications of ICS
asthma
COPD
contra-indications of ICS
COPD patient with a pneumonia
child - growth stint
SE of ICS
oral candida
horse voice
pneumonia in COPD pts
advice to avoid pneumonia when using ICS
wash your mouth straight afterwards
pathology of type 1 DM
autoimmune destruction of the pancreatic beta cell
pathology of type 2 DM
insulin resistance - free fatty acids and pro-inflammatory cytokines in plasma
reduce glucose transport into muscle cells, inc hepatic glucose production and in break down of fate and dec insulin production
RF for T1DM
other autoimmune diseases eg thyroid disease and coeliac disease
younger age (<50)
genetic (30%)
exact cause unknown
RF for T2DM
older age
obesity
ethnicity - asian, african
FH - 80% genetics
low birth weight non-alcoholic liver disease excess alcohol hypertension previous gestational diabetes
symptoms of T1DM
polyuria polydipsia lethargy unexplained weight loss hyperglycaemia ketosis
symptoms of T2DM
polyuria
polydipsia
lethargy
recurrent infection - thrush
symptoms of DKA
D+V polyuria polydipsia weight loss inability to tolerate fluids abdo pain lethargy/confusion
ketonuria
fruity smelling breathe - acetone
Kusmaul breathing
hypoglycaemia
hypogylcaemia - 3.5 mmol lethargy confusion irriration hungry anixety/irritability tingling tips sweating impaired vision
seizures
loss of consciousness
coma
what are the signs of dehydration
mild - clinical detectable only - BP etc
moderate - dry skin/mucous membrane, reduced skin turgor
severe - sunken eyes, prolonged cap refill
shock
diagnosis of T1DM
urine dip + cap blood glucose
C-peptide, anti-islet cells bodies, anti-glutamic acid decarboxylase antibodies - not routinely tested but if atypical presentation eg unusual pattern of symptoms BMI > 25, not in teenage/young adult
diagnosis of T2DM
urine dip/ACR
diagnostic bloods - if symptomatic then 1 +ve test is enough, if not then 2 +ve tests are required
1) venous bloods - fasting >7, random > 11
2) HbA1c - > 48 (42-47 pre-diabetic state) - does not work with people who have anaemia
when to refer a patient with DM?
same day referral to an endocrinologist if a young/teenage person suspected of T1DM
if stage 4/5 CKD - nephrologist
DKA
sudden loss of vision, rubeosis iriditis, pre-retinal/vitreous haemorrhage, retinal detachment
moderate-high risk of developing diabetic foot problems - refer to foot protection service
what is the sick day rule of diabetes
continue to take insulin during illness to maintain blood sugar level and try to maintain a diet and good hydration 3L
if solid food not toleratable - try to drink sugary drinks and take ORS
measure blood glucose 3-4 hours a day
what is the target of blood glucose level in T1DM
before meal/fasting - 4-7
after meal - 5-9
who should you inform when you are diagnosed with diabetes
DVLA - due to risk of hypoglycaemia
management of T1DM
3 regimes
1) basal-bolus - intermediate/long-acting throughout the day + rapid/short acting before/immediate after meal
2) multiple daily injections of short/rapid-acting insulin
3) continuous insulin pump - rapid/short-acting insulin
need to check blood glucose 4-5 times a day
