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Applied Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Metformin - Indication

A

Type 2 diabetes

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2
Q

Metformin - MOA

A

Metformin decreases hepatic production of glucose
it also increases uptake and utilisation of glucose by skeletal muscle via AMP kinase
Thus lowering circulating levels of glucose

  • Metformin (a biguanide) lowers blood glucose primarily by reducing hepatic glucose output (glycogenolysis and gluconeogenesis)
  • And, to a lesser extent, increasing glucose uptake and utilisation by skeletal muscle.
  • The cellular mechanisms are complex, involving activation of adenosine monophosphate-activated protein kinase (AMP kinase).
  • This is a cellular metabolic sensor, activation of which has diverse effects on cell functions. - Its effects on glucose metabolism can be accompanied by other metabolic changes, notably modest weight loss, which can be a desirable side effect.
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3
Q

Metformin - Adverse effects

A
  • GI upset : nausea & vomiting, taste disturbance, anorexia & diarrhoea
  • Lactic Acidosis
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4
Q

Metformin - Contraindications

A
  • Acute kidney injury
  • Sever tissue hypoxia
  • Withheld in acute alcohol intoxication
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5
Q

Metformin - Caution

A

Renal impairment:

  • dose reduction: if eGFR is < 45mL/min per 1.73 m2
  • Drug stopped: if if eGFR is < 30mL/min per 1.73 m2

Hepatic impairment

Chronic alcohol abuse

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6
Q

Metformin - Key interactions

A
  • Withheld before and 48 hours after injection of IV contrast media in increased renal impairment
  • ACEi, NSAIDs, diuretics
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7
Q

Metformin - Monitoring

A
  • Assess HbA1c : target with single agent is < 48 mmol/mol

- Assess renal function before starting treatment

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8
Q

Metformin - Patient Education

A
  • Long-term treatment to control blood sugar and reduce complications
  • Advice on lifestyle measure
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9
Q

Insulin - Indications

A

1) T1DM / T2DM

2) Diabetic emergencies (e.g. DKA)
3) Hyperkalaemia

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10
Q

Insulin - MOA

A

In DM:

  • Acts like endogenous insulin
  • so increases the uptake of glucose from circulation into skeletal muscle and fat.
  • thus lowering the circulating levels of glucose.
  • It also inhibits gluconeogenesis.

In Hyperkalaemia:
- it drives the K+ into cells lowering the circulating levels of serum K+

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11
Q

Insulin - Adverse effects

A
  • hypoglycaemia

- if recurrently injected at the same site can cause irritation or overgrowth

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12
Q

Insulin - Caution

A
  • avoid in renal impairment

- use with other anti-diabetic drugs (increased risk of hypoglycaemia)

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13
Q

Thyroxine - Example

A

levothyroxine

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14
Q

Thyroxine - Indication

A

1) Primary hypothyroidism

2) hypothyroidism secondary to pituitary disorder

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15
Q

Thyroxine - MOA

A
  • Long-term synthetic replacement of thyroid hormones.
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16
Q

Thyroxine - Adverse Effects

A
  • Similar to hyperthyroidism = palpitations, arrhythmias, angina, tremor, insomnia
  • GI = diarrhoea, weight loss
17
Q

Thyroxine - Interaction

A
  • Cytochrome P450 inducer
  • Insuline
  • Decreased GI absoprtion by antacids, calcium + iron
18
Q

Thyroxine - Interaction

A
  • Cytochrome P450 inducer
  • Insuline
  • Decreased GI absoprtion by antacids, calcium + iron
19
Q

Carbimazole and Propylthiouracil - Indications

A

Hyperthyroidism

20
Q

Carbimazole - MOA

Propylthiouracil - MOA

A
  • It is an anti-thyroid agent acting on the thyroid peroxidase.
  • This lowers the uptake of inorganic iodine hence preventing the synthesis of thyroid hormones
  • inhibits the conversion of iodide to iodine
21
Q

Carbimazole and Propylthiouracil - Adverse Effects

A
  • neutropenia/agranulocytosis
  • -> main side effect - check WCC
  • may present with sore throat
    haemolytic anaemia & thrombocytopenia, pancreatitis are more rare
22
Q

Carbimazole and Propylthiouracil - Contraindication

A
  • Severe blood disorders
23
Q

Carbimazole and Propylthiouracil - Caution

A
  • pregnancy/breastfeeding

- hepatic impairment

24
Q

if there is any signs of acute pancreatitis after carbimazole and propylthiouracil use what should you do?

A

discontinue immediately

25
Q

Dipeptidylpeptidase-4 inhibitors - Examples

A

sitagliptin
linagliptin
saxagliptin

26
Q

DDP4-inhibitors - Indications

A

T2DM - as single agent or combined

27
Q

DPP4-inhibitors - MOA

A
  • Incretins and GIPs are responsible for insulin secretion
  • however DPP4 usually hydrolyses the Incretin molecules.
  • Thus, inhibition of DDP4 allows insulin secretion and thus the lowering of glucose.
28
Q

DDP4-inhibitors - Adverse Effects

A
  • GI upset
  • headaches
  • peripheral oedema
  • more seriously hypoglycaemia
29
Q

DPP4-inhibitors - Contraindications

A

Do not give in hypersensitivity, T1DM or ketoacidosis, pregnancy/breastfeeding,

30
Q

DDP4-inhibitors - Caution

A

renal impairment, pancreatitis and elderly (>80)

31
Q

Sulphonylurea - Example

A

Glicazide

32
Q

Sulphonylureas indications

A

T2DM = either as single agent or combined

33
Q

Sulphonylureas - MOA

A
  • Lowers blood glucose by stimulating pancreatic secretion of insulin.
  • This is mainly by acting on the K+ channels on pancreatic β-cell.
  • Resulting in depolarisation , causing an increase in calcium levels
  • Increase in intracellular Ca2+ stimulates insulin secretion which subsequently lowers glucose levels
34
Q

Sulphonylureas - Adverse Effects

A

GI upset: Nausea & vomiting, diarrhoea and constipation

more seriously = hypoglycaemia and hypersensitivity

35
Q

Sulphonylureas - Caution

A

Hepatic/renal impairment

risk of hypoglycaemia or elderly

36
Q

Sulphonylureas - Interactions

A
  • Beta - blockers = may mask symptoms of hypoglycaemia

- Reduced efficacy by drugs that elevate blood glucose: prednisolone, thiazide and loop diuretics

37
Q

Carbimazole - Interactions

A

Digoxin

Applied Pharmacology (11 decks)

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