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Endocrinology > drugs > Flashcards

drugs Flashcards

1
Q

thyroid hormones mechanism of action

A

synthetic thyroxine

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2
Q

indications thyroid hormones

A

hypothyroidism, diffuse non-toxic goitre, thyroid carcinoma

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3
Q

eg thyroid hormones

A

levothyroxine sodium (thyroxine)

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4
Q

SEs thyroxine

A

occur at excessive dosage and at start of therapy with rapid inc in metabolism
arrhythmias, palpitations, skeletal muscle cramps and weakness, vomiting, diarrhoea, tremors, restlessness, headache, flushing, sweating, fever, excessive weight loss and sometimes anginal pain

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5
Q

cautions/contraindications thyroxine

A

panhypopituitarism or predisposition to adrenal insufficiency from other causes (initiate corticosteroid therapy before starting levothyroxine), lower starting dose in the elderly or CV dis.

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6
Q

Antithyroid drugs mechanism of action

A

interfere with synthesis of thyroid hormones

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7
Q

indications antithyroid drugs

A

long term management of thyrotoxicosis and to prepare pts for thyroidectomy
may be given with propanolol initially for symptom control

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8
Q

egs of antithyroid drugs

A

carbimazole
propylthiouracil
high dose continued til pt euthyroid, usually after 4-8 weeks, and dose is then gradually reduced over 6-24 months to a maintenance dose.

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9
Q

why would a combo of carbimazole and thyroxine be given

A

in a blocking-replacement regimen (not in preg)

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10
Q

SEs antithyroid drugs

A

bone marrow suppression - pts should be asked to report symptoms of infec esp sore throat. WCC performed if any clinical evidence of infec, and rx stopped immediately if clin evidence of neutropenia.

Nausea, GI disturbance, headache, rashes and pruritus occurs w carbimazole
Cutaneous vasculitis, hepatic necrosis, nephritis and lupus like syndrome with propylthiouracil

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11
Q

cautions and contraindications antithyroid drugs

A

liver disorders; over treatment can result in rapid development of hypothyroidism

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12
Q

What does the adrenal cortex normally secrete?

A

Hydrocortisone (cortisol) which has glucocorticoid activity and weak mineralocorticoid activity. It also secretes the mineralocorticoid aldosterone.

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13
Q

In primary adrenal insufficiency how is physiological replacement best achieved?

A

With corticosteroids - hydrocortisone and the mineralocorticoid fludrocortisone

hydrocortisone alone does not usually provide sufficient mineralocorticoid activity for complete replacement

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14
Q

In hypopituitarism what is given?

A

Glucocorticoids - aldosterone is not necessary as production is regulated by the renin-angiotensin system

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15
Q

mechanism of action for corticosteroids

A

replacement and anti inflam reactions

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16
Q

mech of action for anti inflam actions corticosteroids

A

induction of the synthesis Ikß an inhibitory protein which binds NF-Kappa B

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17
Q

Indications corticosteroids

A

inflam conditions - joints, lungs, skin, bowel, acute transplant rejection, autoimmune conditions, nephritic/nephrotic syndrome, cerebral oedema, acute hypersensitivity reactions

replacement therapy in adrenal insufficiency and hypopituitarism

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18
Q

dexamethasone

A

potent steroid with insignificant mineralocorticoid activity - makes it useful for high dose therapy in conditions where fluid retention (mineralocorticoid SE) would be a disadvantage e.g. cerebral oedema

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19
Q

prednisolone

A

predominantly glucocorticoid activity and is the corticosteroid most commonly used by mouth for disease suppression

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20
Q

hydrocortisone and cortisone - why not suitable for disease suppression on a LT basis?

A

high mineralocorticoid activity resulting in fluid retention

21
Q

hydrocortisone? e.gs of uses

A

used for adrenal replacement therapy and IV in the emergency management of some conditions, e.g. severe ulcerative colitis, anaphylactic shock

22
Q

other uses corticosteroids

A

inhalation in asthma
rectal admin in inflam bowel dis
topically in the inflam treatment of skin disease

23
Q

examples of corticosteroids

A

prednisolone
hydrocortisone
dexamethasone
methylprednisolone

24
Q

SEs corticosteroids

A

glucocorticoid SE’s incl diabetes and osteoporosis

mineralocorticoid SEs incl hypertension, sodium and water retention and potassium loss

25
Q

Cautions /contraindications corticosteroids

A

untreated systemic infection, avoid live virus vaccines in those receiving immunosuppressive doses

26
Q

oral antidiabetic drugs

A

metformin and sulphonylureas

27
Q

metformin mech of action

A
  • activates AMP-kinase which is involved in metabolism of the membrane glucose transporter, GLUT4, and fatty acid oxidation
  • inc gluc transport into cells, decreases hepatic gluconeogenesis and increases insulin sensitivity
28
Q

indications metformin use

A
  • first choice overweight pts in whom strict dieting has failed to control diabetes
  • used in combo with sulphonylureas, pioglitazone, repaglinide, nateglinide or insulin if diabetes inadequately controlled
  • improves fertility and weight reduction in pts with polycystic ovary syndrome
29
Q

SEs metformin

A 
anorexia
nausea
vom
diarrhoea
abdo pain
metallic taste
rarely type B (non hypoxic) lactic acidoses (mortality of 30-50%)
B12 def (dec absorption)
Hypoglycaemia doesn't usually occur with metformin
30
Q

Cautions / contraindications metformin

A

contraindicated in severe renal impairment (eGFR

31
Q

sulphonylureas mech of action

A

augment insulin secretion

32
Q

indications sulphonylureas

A

pts w T2 DM not overweight or whom metformin contraindicated

33
Q

diff types of sulphonylureas

A

glibenclamide
tolbutamide
gliclazide

34
Q

glibeclamide

A

a sulphonylurea

long acting and associated with a greater risk of hypoglycaemia and should be avoided in the elderly

35
Q

gliclazide and tolbutamide

A

sulphonylureas which are shorter acting that glibeclamide and a better choice

36
Q

SEs sulphonylureas

A

mild and infrequent
GI disturbances
weight gain
sulphonylurea-induced hypoglycaemia may persist for many hours and must always be treated in hosp
occasionally cholestatic jaundice, hepatitis, allergic ski reactions and blood disorders

37
Q

cautions and contraindications sulphonylureas

A

use short acting form in renal impairment
avoid in severe renal and hepatic impairment and in porphyria
contraindicated in breast feeding, and substitute insulin during pregnancy

38
Q

treatment of hypoglycaemia

A

initially glucose 10-20g (2-4 teaspoons of sugar, 50-100mL fizzy drink) is given by mouth or in unconscious pt glucose or glucagon given by injection

39
Q

mechanisms of action glucagon

A

glucagon mobilises glycogen stored in the liver

40
Q

indications glucagon

A

acute hypogylcaemia where glucose cannot be given either by mouth or IV

41
Q

SE glucagon

A

Nausea, vomiting, abdo pain, hypokalaemia, hypotension, hypersensitivity reactions

42
Q

cautions/contraindications glucagon

A

phaeochromocytoma

43
Q

what are lipid lowering drugs

A

statins

44
Q

mechanism of action statins

A

inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the rate limiting enzyme involved in cholesterol synthesis
more effective at lowering LDL-cholesterol than other classes of drugs but less effective than the fibrates in reducing triglycerides

45
Q

indications statins

A

secondary prevention of coronary and CV events in pts w hx of angina or MI, PAD, non-haemorragic stroke, TIA

primary prevention of coronary events in pts at inc risk of CHD such as inherited dyslipidaemias or a 10y CV risk of 20% or more

46
Q

egs statins

A

arvostatin and simvastatin

47
Q

SEs statins

A

reversible myositis / myopathy - pts should report unexplained muscle pain, measure CK
altered liver biochemistry - liver biochem should be measured and within 3 months at 12 mo of starting
GI effects incl abdo pain, diarrhoea, flatulence, vomiting

48
Q

Cautions / CI statins

A

Acute liver disease (acute viral hepatitis, alcoholic hepatitis), pregnancy, breast feeding and personal or fhx of muscle disorders

inc risk of myositis and rhabdomyolysis if statins are given with a fibrate, ezetimibe, ciclosporin, digoxin, warfarin, erythromycin and ketoconazole

Endocrinology (14 decks)

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