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drugs y3 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Types of insulin T2DM

A
  • sulphonylureas

- biguanides

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2
Q

example of sulphonylureas

A

Gliclazide

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3
Q

how does gliclazide work

A

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

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4
Q

when is gliclazide used

A

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

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5
Q

contraindications of gliclazide

A

cautious in renal and hepatic impairment

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6
Q

side effects of gliclazide

A
  • hypoglycaemia
  • weight gain (this can worsen diabetes)
  • GI upset
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7
Q

possible interactions with gliclazide

A

other anti-diabetic drugs increases risk of hypo

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8
Q

how does weight gain affect diabetes

A

increases insulin resistance

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9
Q

example of biguanides

A

metformin

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10
Q

how does metformin work

A

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
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11
Q

when is metformin used

A

first line in Type 2 diabetes

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12
Q

contraindications of metformin

A

AKI, severe tissue hypoxia, excess alcohol

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13
Q

side effects of metformin

A
  • GI disturbance
  • weight loss
  • rare but severe: lactic acidosis
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14
Q

possible interactions of metformin

A
  • 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
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15
Q

types of insulin T1DM

A
  • rapid acting
  • short acting
  • immediate acting
  • long acting
  • biphasic
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16
Q

rapid acting insulin

A

immediate and short duration

Novorapid

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17
Q

short acting insulin

A

early onset and short duration

Actrapid

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18
Q

immediate acting insulin

A

immediate acting and duration

Humulin 1

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19
Q

long acting insulin

A

flat acting and regular duration

Levemir, Lantus

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20
Q

biphasic insulin

A

mix between rapid and immediate acting insulin

Novomix 30

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21
Q

how does insulin work

A
  • similarly to endogenous insulin by increase glucose uptake in tissues, decreasing blood glucose
  • simulates gluconeogenesis, vetogenesis and protein synthesis
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22
Q

when is insulin used

A
  • T1DM (+T2 if not controlled by oral meds)
  • IV in diabetic emergencies like DKA or diabetic hyperosmolar syndrome
  • hyperkalaemia (alongside glucose to prevent hypos)
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23
Q

contraindications of insulin

A

renal impairment

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24
Q

side effects of insulin

A
  • hypoglycaemia

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

25
Q

how to administer insulin

A

sub cut injections before food

26
Q

thyroid drugs

A

levothyroxine / thyroxine

27
Q

how does thyroxine work

A

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

28
Q

when is levothyroxine used

A
  • hypothyroidism

- hypothyroidism secondary to hypopituitarism

29
Q

contraindications for levothyroxine

A

cautious in coronary artery disease

30
Q

side effects of levothyroxine

A

symptoms of hyperthyroidism

31
Q

possible interactions of levothyroxine

A

increase dose required if also taking cytochrome P450 inhibitors

32
Q

administration of levothyroxine

A

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

33
Q

example of anti-thyroid drugs

A

carbimazole

34
Q

how does carbimazole work

A

pro-drug which is converted to methimazole

- methimazole prevents thyroid peroxidase, reducing T3 and T4 production

35
Q

when is carbimazole used

A

hyperthyroidism

36
Q

contraindications of carbimazole

A
  • early months of pregnancy and breastfeeding
  • severe liver disease
  • blood disorders
37
Q

side effects of carbimazole

A
  • prurutis / rash (can be treated with anti-histamine)
  • bone marrow suppression resulting in neutropenia
  • stop if sore throat or fever
38
Q

possible interactions of carbimazole

A

warfarin, theophylline, erythromycin, steroids

39
Q

examples of bisphosphates

A

alendronic acid (PO), zoledronic acid (IV)

40
Q

how do bisphosphates work

A
  • absorbed in bone and promote apoptosis for osteoclasts, decreasing bone loss and increasing bone ,ass
41
Q

when are bisphosphates used?

A
  • osteoporosis (alendronic acid)
  • bone metastases / malignancies (zoledronic acid)
  • hypercalaemia of malignancy (zoledronic acid)
  • Paget’s disease (alendronic acid)
42
Q

contraindications of bisphosphates

A
  • hypocalcaemia
  • renal impairment
  • upper GI disorders
43
Q

side effects of bisphosphates

A
  • oesophagitis
  • hypophosphataemia
  • jaw osteonecrosis
44
Q

possible interactions of bisphosphates

A

absorption decreased if taken with calcium salts

45
Q

importance of calcium and vitamin D

A
  • 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
46
Q

when is calcium and vitamin D used

A
  • osteoporosis
  • CKD
  • hyperkalaemia
  • hypocalcaemia
  • lit D deficiency (rickets in children and osteomalacia in adults)
47
Q

calcium and vitamin D in osteoporosis

A

decreases rate of bone loss

48
Q

calcium and vitamin D in CKD

A

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

49
Q

calcium and vitamin D in hyperkalaemia

A

calcium gluconate given to protect the heart

50
Q

contraindications of calcium and vitamin D

A

hypercalcaemia

51
Q

side effects of calcium and vitamin D

A

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

52
Q

possible interactions of calcium and vitamin D

A

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

53
Q

examples of mineralocorticoids

A

aldosterone, fludrocortisone

54
Q

when are mineralocorticoids used?

A

adrenocorticol insufficiency (acts as replacement)

55
Q

when are mineralocorticoids contraindicated

A

systemic infection, live viral vaccines

56
Q

side effects of mineralocorticoid

A

immunosuppression, easy bruising, muscle weakness, mood changes

57
Q

possible interactions of mineralocorticoids

A
  • 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
58
Q

how do mineralocorticoids affect electrolytes

A
  • increase sodium and water retention and potassium excretion

drugs y3 (10 decks)

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