- T1DM (+T2 if not controlled by oral meds) - IV in diabetic emergencies like DKA or diabetic hyperosmolar syndrome - hyperkalaemia (alongside glucose to prevent hypos)

Endocrine Flashcards by Rosie Ziff

Types of insulin T2DM

sulphonylureas

- biguanides

How well did you know this?

Not at all

Perfectly

example of sulphonylureas

Gliclazide

How well did you know this?

Not at all

Perfectly

how does gliclazide work

decreases blood glucose by increasing insulin secretion from the pancreas
- does this by blocking ATP dependent K+ channel, depolarisation, opening of Ca2+ channel, increasing insulin secretion

How well did you know this?

Not at all

Perfectly

when is gliclazide used

Type 2 diabetes (not T1 as pancreatic function must be working still)
- used where metformin is contraindicated or in addition to metformin

How well did you know this?

Not at all

Perfectly

contraindications of gliclazide

cautious in renal and hepatic impairment

How well did you know this?

Not at all

Perfectly

side effects of gliclazide

hypoglycaemia
weight gain (this can worsen diabetes)
GI upset

How well did you know this?

Not at all

Perfectly

possible interactions with gliclazide

other anti-diabetic drugs increases risk of hypo

How well did you know this?

Not at all

Perfectly

how does weight gain affect diabetes

increases insulin resistance

How well did you know this?

Not at all

Perfectly

example of biguanides

metformin

How well did you know this?

Not at all

Perfectly

how does metformin work

decreases blood glucose by increase response to glucose and glucose uptake in cells
- does this by decreasing glucose intestinal absorption

since it does not increase insulin secretion, cannot cause hypos
also, increases weight loss and prevents weight gain and resistance to insulin, improving diabetes prognosis

How well did you know this?

Not at all

Perfectly

when is metformin used

first line in Type 2 diabetes

How well did you know this?

Not at all

Perfectly

contraindications of metformin

AKI, severe tissue hypoxia, excess alcohol

How well did you know this?

Not at all

Perfectly

side effects of metformin

GI disturbance
weight loss
rare but severe: lactic acidosis

How well did you know this?

Not at all

Perfectly

possible interactions of metformin

should be withheld 48hrs before injection of contrast such as in CT, coronary angiography
prednisolone / loop / thiazide diuretics reduce efficacy as oppose effects as increase glucose

How well did you know this?

Not at all

Perfectly

types of insulin T1DM

rapid acting
short acting
immediate acting
long acting
biphasic

How well did you know this?

Not at all

Perfectly

rapid acting insulin

immediate and short duration

Novorapid

How well did you know this?

Not at all

Perfectly

short acting insulin

early onset and short duration

Actrapid

How well did you know this?

Not at all

Perfectly

immediate acting insulin

immediate acting and duration

Humulin 1

How well did you know this?

Not at all

Perfectly

long acting insulin

flat acting and regular duration

Levemir, Lantus

How well did you know this?

Not at all

Perfectly

biphasic insulin

mix between rapid and immediate acting insulin

Novomix 30

How well did you know this?

Not at all

Perfectly

how does insulin work

similarly to endogenous insulin by increase glucose uptake in tissues, decreasing blood glucose
simulates gluconeogenesis, vetogenesis and protein synthesis

How well did you know this?

Not at all

Perfectly

when is insulin used

T1DM (+T2 if not controlled by oral meds)
IV in diabetic emergencies like DKA or diabetic hyperosmolar syndrome
hyperkalaemia (alongside glucose to prevent hypos)

How well did you know this?

Not at all

Perfectly

contraindications of insulin

renal impairment

How well did you know this?

Not at all

Perfectly

side effects of insulin

hypoglycaemia

- lipohypertrophy due to repeated injections in the same place (fat overgrowth)

how to administer insulin

sub cut injections before food

thyroid drugs

levothyroxine / thyroxine

how does thyroxine work

replacement of thyroid hormones: T4 (thyroxine) which is converted into triiodothyronine (T3) to regulate metabolism and growth

when is levothyroxine used

- hypothyroidism | - hypothyroidism secondary to hypopituitarism

contraindications for levothyroxine

cautious in coronary artery disease

side effects of levothyroxine

symptoms of hyperthyroidism

possible interactions of levothyroxine

increase dose required if also taking cytochrome P450 inhibitors

administration of levothyroxine

50-100 micrograms for life (decrease to 25-50 in elderly)

example of anti-thyroid drugs

carbimazole

how does carbimazole work

pro-drug which is converted to methimazole | - methimazole prevents thyroid peroxidase, reducing T3 and T4 production

when is carbimazole used

hyperthyroidism

contraindications of carbimazole

- early months of pregnancy and breastfeeding - severe liver disease - blood disorders

side effects of carbimazole

- prurutis / rash (can be treated with anti-histamine) - bone marrow suppression resulting in neutropenia - stop if sore throat or fever

possible interactions of carbimazole

warfarin, theophylline, erythromycin, steroids

examples of bisphosphates

alendronic acid (PO), zoledronic acid (IV)

how do bisphosphates work

- absorbed in bone and promote apoptosis for osteoclasts, decreasing bone loss and increasing bone ,ass

when are bisphosphates used?

- osteoporosis (alendronic acid) - bone metastases / malignancies (zoledronic acid) - hypercalaemia of malignancy (zoledronic acid) - Paget's disease (alendronic acid)

contraindications of bisphosphates

- hypocalcaemia - renal impairment - upper GI disorders

side effects of bisphosphates

- oesophagitis - hypophosphataemia - jaw osteonecrosis

possible interactions of bisphosphates

absorption decreased if taken with calcium salts

importance of calcium and vitamin D

- Calcium is essential for muscles, nerves, bones and clotting - Calcium homeostasis is controlled by PTH and vitamin D which increases calcium and calcitonin and bone mineralisation which decreases calcium levels

when is calcium and vitamin D used

- osteoporosis - CKD - hyperkalaemia - hypocalcaemia - lit D deficiency (rickets in children and osteomalacia in adults)

calcium and vitamin D in osteoporosis

decreases rate of bone loss

calcium and vitamin D in CKD

treats and prevents secondary hyperparathyroidism and renal osteodystrophy (in CKD, decreased vitamin D absorption and decreased phosphate excretion leading to hyperparathyroidism and hypocalcaemia)

calcium and vitamin D in hyperkalaemia

calcium gluconate given to protect the heart

contraindications of calcium and vitamin D

hypercalcaemia

side effects of calcium and vitamin D

dyspepsia, constipation, CV collapse if IV given too fast in hyperkalaemia

possible interactions of calcium and vitamin D

oral Ca decreases absorption of drugs such as bisphosphates, tetracyclines and levothyroxine

examples of mineralocorticoids

aldosterone, fludrocortisone

when are mineralocorticoids used?

adrenocorticol insufficiency (acts as replacement)

when are mineralocorticoids contraindicated

systemic infection, live viral vaccines

side effects of mineralocorticoid

immunosuppression, easy bruising, muscle weakness, mood changes

possible interactions of mineralocorticoids

- increase risk of PUD and bleeding with NSAIDs - increase risk of hypokalaemia with B2 agonists, theophylline, thiazide and loop diuretics - decreases immune response to vaccines

how do mineralocorticoids affect electrolytes

- increase sodium and water retention and potassium excretion