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Year 3 Drug > endo > Flashcards

endo Flashcards

1
Q

what are some examples medication for insulin

A

insulin aspart
insulin glargine
biphasic insulin
soluble insulin

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2
Q

MOA of insulin

A

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

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3
Q

what are the different types of insulin

A 
fast - insulin aspart 
slow - soluble insulin 
short 
intermediate acting - Bisphane insulin 
long - insulin glargine
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4
Q

which form of insulin is used when IV injection is required for hyperkalameia?

A

soluble insulin

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5
Q

contra-indication for insulin

A

renal impairment (insulin clearance is reduced)

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6
Q

side effect of insulin

A

hypoglycaemia

fat overgrowth when subcut is injected

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7
Q

interaction of insulin

A

combination of insulin with other hypoglycaemic agents inc risk of hpoglycaemia

use with systemic corticoteriods inc insulin requirement

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8
Q

indication for insulin

A

T1/2 DM

Iv injection for diabetic emergencies eg DKA and hyperglycaemic hyperosmolar syndrome

alongside glucose for hyperkalaemia

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9
Q

what drug class is metformin

A

Biguanide

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10
Q

MOA for metformin

A

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

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11
Q

indication for metformin

A

T2 DM - 1st line

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12
Q

contra-indication for metformin

A

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

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13
Q

side effect of metformin

A

GI upset
excess weight loss
lactic acidiosis - rare and esp in ill pt as it can cause accumulation and inc lactate production

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14
Q

interaction of metformin

A

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

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15
Q

what is an example of sulphonylureas

A

gliclazide

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16
Q

MOA for gliclazide

A

stimulate pancreatic insulin secretion - lower blood glucose

only effect in pt with residual pancreatic function

stimulate weight gain too and can worsen DM

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17
Q

contrad-indication for gliclazide

A

metabolised in the liver

hepatic impairment
caution in renal impairment
caution in pt with risk of hypoglycaemia

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18
Q

side effect of gliclazide

A

GI upset
hypoglycaemia
hypersensitivity reaction - hepatic toxicity (cholestatic jaundice)

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19
Q

interaction of gliclazide

A

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

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20
Q

what are some examples of thyroid hormones

A

levothyroxine, liothyronine

21
Q

MOA of thyroid hormone

A

levothyroxine - synthetic T4
liothyronine synthetic T3

liothyronin shorter short life than levothyroxine and so resevred for emergency

22
Q

indiction for levothyroxine and liothyronine

A

primary hypothyroidism

secondary hypothyroidism

23
Q

contra-indication for levothyroxine and liothyronine

A

inc HR - inc coronary artery disease - caution

in hypopituitarism, corticosteriod must be started first or else an Addisonian crisis may occur

24
Q

side effect of levothyroxine and liothyronine

A

overdose - lead to symptoms of hyperthyroidism

inc HR
GI upset
neruological - tremor, restlessness, insomnia

25
Q

interaction of levothyroxine and liothyronine

A

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

26
Q

what are some examples of anti-thyroid drug

A

carbimazole

27
Q

MOA for carbimazole

A

converted to methimazole which inhibits the thyroid peroxidase - less T3/T4 production

28
Q

indication for carbimazole

A

hyperthyroidism
thyroidectomy preparation
radio-iodine treatment

29
Q

contra-indication for cabrimazole

A

severe blood disorder
hepatic impairment
pregnancy/breast feeding

30
Q

side effect of carbimazole

A

GI upset

bone suppression

31
Q

interaction of carbizmazole

A

coumarins

32
Q

what are some examples of bisphosphates

A

alendronic acid, disodium pamidronate, zoledronic acid

33
Q

MOA for alendronate/alendronic acid

A

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

34
Q

main indication for alendronate/alendronic acid

A

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

35
Q

contra-indication of alendronic acid/alendronate

A

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

36
Q

side effect of alendoronic acid/alendronate

A

oesophagitis
hypophosphataemia
osteonecrosis of jaw - rare
atypical femoral fracture

37
Q

interaction of alendronic acid/alendronate

A

reduce efficacy whentaken with calcium salt, antacids and iron salts

38
Q

what are some examples of calcium and vit D

A

Calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

39
Q

physiology of calcium

A

calcium homestasis is controlled by PTH and vit D - inc serum calcium levels and bone mineralisation)

calcitonin - reducs serum calcium levels

40
Q

MOA for calcium and vit D

A

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

41
Q

indication for calcium carbonate/gluconae, colecalciferol/alfacalcidol

A

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

42
Q

contra-indication for calcium carbonate/gluconae, colecalciferol/alfacalcidol

A

hypercalaemia

43
Q

side effect of calcium carbonate/gluconae, colecalciferol/alfacalcidol

A

dyspepsia
constipation
CI collapse when IV use if injected too fast

44
Q

interaction of calcium carbonate/gluconae, colecalciferol/alfacalcidol

A

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

45
Q

what is an example of mineralcorticoids

A

fludrocortisone

46
Q

MOA of fludrocortisone

A

Binds to aldosterone receptors, inc BP, inc Na+/H2O, less K+

47
Q

indication for fludrocortisone

A

adrenocorticla insufficency

Addisons
Cushings

48
Q

contra-indications

A

adrenal suppression

infections

corticosteroid withdrawal

psychiatric

49
Q

side effect of fludrocortisone

A

high BP
Na/H20 retention

potassium & calcium loss

Year 3 Drug (12 decks)

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