endo Flashcards
what are some examples medication for insulin
insulin aspart
insulin glargine
biphasic insulin
soluble insulin
MOA of insulin
stimulate glucose uptake from the circulation into tissues incl skeletal muslce and fat
inc use of glucose as an energy source
stimulate glycogen, lipid and protein synthesis
inhibits glyconeogenesis and ketogenesis
drive K+ into cells
what are the different types of insulin
fast - insulin aspart slow - soluble insulin short intermediate acting - Bisphane insulin long - insulin glargine
which form of insulin is used when IV injection is required for hyperkalameia?
soluble insulin
contra-indication for insulin
renal impairment (insulin clearance is reduced)
side effect of insulin
hypoglycaemia
fat overgrowth when subcut is injected
interaction of insulin
combination of insulin with other hypoglycaemic agents inc risk of hpoglycaemia
use with systemic corticoteriods inc insulin requirement
indication for insulin
T1/2 DM
Iv injection for diabetic emergencies eg DKA and hyperglycaemic hyperosmolar syndrome
alongside glucose for hyperkalaemia
what drug class is metformin
Biguanide
MOA for metformin
inc response to insulin - dec blood glucose
suppress hepatic glucose production
inc glucose uptake and utilisation by skeletal muscle
suppress intestinal glucose absorption
encourage weight loss and prevent worsening of insulin resistance
indication for metformin
T2 DM - 1st line
contra-indication for metformin
metformin is excreted unchanged by the kidney
kidney impairment
should be stopped when AKI
should be stopped in sepsis, shock or dehydration or severe tissue hypoxia eg cardic or resp failure
hepatic impairment - clearance of excess lactate maybe impaired
stop when acute alcohol intoxication - lactic acidosis
chronic alcohol overuse - risk of hypoglycaemia
side effect of metformin
GI upset
excess weight loss
lactic acidiosis - rare and esp in ill pt as it can cause accumulation and inc lactate production
interaction of metformin
must be stopp for 48 hrs after injection of Iv contrast media - renal impairment
any other drugs which can cause renal impairment - ACEi, NSAIDs, diuretics
prednisolone, thiazide and loop diuretics - elevate blood glucose and so not work with metformin
what is an example of sulphonylureas
gliclazide
MOA for gliclazide
stimulate pancreatic insulin secretion - lower blood glucose
only effect in pt with residual pancreatic function
stimulate weight gain too and can worsen DM
contrad-indication for gliclazide
metabolised in the liver
hepatic impairment
caution in renal impairment
caution in pt with risk of hypoglycaemia
side effect of gliclazide
GI upset
hypoglycaemia
hypersensitivity reaction - hepatic toxicity (cholestatic jaundice)
interaction of gliclazide
combination with other blood glucose lower drug - hypoglycaemia eg metformin, thiazolidinediones and insulin
reduced efficacy by prednisolone, thiazide and loop diuretics as they inc glucose
what are some examples of thyroid hormones
levothyroxine, liothyronine
MOA of thyroid hormone
levothyroxine - synthetic T4
liothyronine synthetic T3
liothyronin shorter short life than levothyroxine and so resevred for emergency
indiction for levothyroxine and liothyronine
primary hypothyroidism
secondary hypothyroidism
contra-indication for levothyroxine and liothyronine
inc HR - inc coronary artery disease - caution
in hypopituitarism, corticosteriod must be started first or else an Addisonian crisis may occur
side effect of levothyroxine and liothyronine
overdose - lead to symptoms of hyperthyroidism
inc HR
GI upset
neruological - tremor, restlessness, insomnia
interaction of levothyroxine and liothyronine
separation of thyroid hormone (4 hours) should be done with antacid, calcium or iron salts - reduced absorption in the gut
inc dose when cytochrome p450 inducers eg phenytoin, carbamazepine
can cause change in metabolism and hence should increase insulin or hypoglycaemic agents
enhance effect of warfarin
what are some examples of anti-thyroid drug
carbimazole
MOA for carbimazole
converted to methimazole which inhibits the thyroid peroxidase - less T3/T4 production
indication for carbimazole
hyperthyroidism
thyroidectomy preparation
radio-iodine treatment
contra-indication for cabrimazole
severe blood disorder
hepatic impairment
pregnancy/breast feeding
side effect of carbimazole
GI upset
bone suppression
interaction of carbizmazole
coumarins
what are some examples of bisphosphates
alendronic acid, disodium pamidronate, zoledronic acid
MOA for alendronate/alendronic acid
reduce bone turnover by inhibiting the action of osteoclasts
bisphosphonats as it has a similar structure to pyrophosphate, it is readily incorporated into bone and into osteolclasts and so they can nto work
main indication for alendronate/alendronic acid
1st line for pt at risk of osteporotic fragility fractures
pamidronate and zoledronic acid - use in treatment for severe hypercalcaemia of malignancy eg myeloma and breast cancer
also 1st line for metabolically active Paget’s disease which reduce bone turnover
contra-indication of alendronic acid/alendronate
excreted in renal - renal impairment
in pt who is hypocalcaemia
oral admin - contraindicated with active upper GI disorders
caution for smokers and dental disease - risk of jaw osteonecrosis
side effect of alendoronic acid/alendronate
oesophagitis
hypophosphataemia
osteonecrosis of jaw - rare
atypical femoral fracture
interaction of alendronic acid/alendronate
reduce efficacy whentaken with calcium salt, antacids and iron salts
what are some examples of calcium and vit D
Calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol
physiology of calcium
calcium homestasis is controlled by PTH and vit D - inc serum calcium levels and bone mineralisation)
calcitonin - reducs serum calcium levels
MOA for calcium and vit D
oral calcium - bind phosphate in the gut
aldacalcidol - provide vit D which does not depend on renal activation
calcium rias the myocardial threshold potential -reduce excitability and risk of arrhythmias
indication for calcium carbonate/gluconae, colecalciferol/alfacalcidol
osteoporosis
used in CKD to maintain calcium and phosphate level - prevent secondary hyperparathyroidism and renal osteodystrophy
severe hyperkalaemia - prevent life-thretening arrythmia
hypoclacaemia
vit D deficiecny
contra-indication for calcium carbonate/gluconae, colecalciferol/alfacalcidol
hypercalaemia
side effect of calcium carbonate/gluconae, colecalciferol/alfacalcidol
dyspepsia
constipation
CI collapse when IV use if injected too fast
interaction of calcium carbonate/gluconae, colecalciferol/alfacalcidol
calcium reduce the absorption of many drugs inclduing iron, bisphosphate, tetracyclines and levothyroxine
IV Ca must not be allowed to mix with sodium bicarbonate due to risk of precipitation
what is an example of mineralcorticoids
fludrocortisone
MOA of fludrocortisone
Binds to aldosterone receptors, inc BP, inc Na+/H2O, less K+
indication for fludrocortisone
adrenocorticla insufficency
Addisons
Cushings
contra-indications
adrenal suppression
infections
corticosteroid withdrawal
psychiatric
side effect of fludrocortisone
high BP
Na/H20 retention
potassium & calcium loss
