Endocrine Flashcards
A patient, 32 years old, has been experiencing the following. Fatigue
Polyuria, Nocturia, Polydipsia, Unintentional weight loss, Blurred vision, Paraesthesias, Infections (candidal). What is this condition and how is treated?
Type 2 diabetes
DISCUSS METFORMIN CLINICAL PHARM?
MOA:
- Metformin lowers blood glucose primarily by reducing hepatic glucose output (glycogenolysis and gluconeogenesis. Increasing glucose uptake and utilisation by skeletal muscle.
- Activation of adenosine monophosphate-activated protein kinase (AMP kinase).
Indications:
- Type 2 diabetes, as the first-choice medication for control of blood glucose. Used alone or in combination with other oral hypoglycaemic drugs (e.g. sulphonylureas, DPP-4 inhibitors) or insulin.
Adverse effects:
- GI upset, including nausea, vomiting
- Taste disturbance
- Lactic acidosis
- renal impairment
- increased lactate production (e.g. sepsis
Warnings:
- ▴renal impairment
- ▴hepatic impairment
- ▴acute alcohol intoxication
- ▴chronic alcohol abuse (risk of hypoglycemia)
Contraindications:
- ✗acute kidney injury
- ✗severe tissue hypoxia
Interactions:
- ▴IV contrast media
- ACE inhibitors, NSAIDs, diuretics) with potential to impair renal function
- Prednisolone, thiazide and loop diuretics elevate blood glucose
Monitoring:
- A common regimen is to start metformin 500 mg once daily with breakfast, increasing the dose by 500 mg weekly to 500–850 mg three times daily with meals.
- Assess blood glucose control by measuring HBA1c
- HBA1c target using single drug is <48 mmol/mol
- Second agent if the HbA1c is >58 mmol/mol, (new target of <53 mmol/mol)
I present as the following:
- Typical age of first presentation 5-15 years
- Polyuria, polydipsia, weight loss, excessive tiredness
- In serioud stages: Nausea/vomiting, abdominal pain, tachypnoea, lethargy
What am i and how do you manage it?
Type 1 diabetes
DISCUSS INSULIN CLINICAL PHARM
MOA:
- Insulin stimulates glycogen, lipid and protein synthesis and inhibits gluconeogenesis and ketogenesis.
- For the treatment of hyperkalaemia, insulin drives K+ into cells, reducing serum K+ concentrations
Adverse effecs:
- hypoglycaemia
- lipohypertrophy same subcutaneous injection site
Warning/caution:
- ▴renal impairment
- risk of hypoglycaemia
Interactions:
- combining insulin with other hypoglycaemic agents increases the risk of hypoglycaemia. systemic corticosteroids cause this
Monitoring:
- SC insulin is often administered using ‘pens’ containing insulin in solution (100 units/mL)
- Advise them that lifestyle measures, including a healthy, balanced diet and regular exercise
- Hypoglycaemia ( dizziness, sweating, confusion)
- Measure capillary blood glucose regularly
I present with the following symptoms:
Goiter, Symptoms of thyrotoxicosis e.g, sweating/palpitations, heat intolerance. All due to transient release of thyroid hormones, weight gain, fatigue, cold intolerance, memory problems, depression, hair loss, dry skin, constipation
Menstrual abnormalities in females
What am I?
Hypothyrodism (hashimotos disease)
DISCUSS THYROXINE CLINICAL PHARM
Drug names: Levothyroxine
MOA:
- The thyroid produces T4, which is converted to the more active triiodothyronine (T3). Thyroid hormones regulate metabolism and growth.
Deficiency of these hormones causes hypothyroidism, with clinical features including lethargy, weight gain, constipation and slowing of mental processes. levothyroxine is long term treatment
Adverse effects:
- gastrointestinal (e.g. diarrhoea, vomiting, weight loss
- cardiac (e.g. palpitations, arrhythmias, angina)
- neurological (e.g. tremor, restlessness, insomnia)
Warnings/cautions:
- ▴coronary artery disease
- ▴hypopituitarism
- avoid precipitating an Addisonian crisis.
Interactions:
- gastrointestinal absorption of levothyroxine is reduced by antacids, calcium and iron salts. Have 4 hours between taking them.
- Increase in levothyroxine dose may be required in patients taking cytochrome P450 inducers, e.g. phenytoin.
Monitoring:
- For thyroid hormone replacement, a starting dose of 50–100 micrograms daily. Elderly or people with cardiac disease, who should start on 25 micrograms daily.
- treatment will replace a natural hormone that their body has stopped making and that this will give them more energy and make them feel better.
- Treatment for life should not stop taking it. If the following: shakiness, anxiety, sleeplessness, diarrhoea contact the doctor as its too much
DISCUSS CARBIMAZOLE CLINICAL PHARM
Indication: Hyperthyrodism (Graves disease)
Adverse effects:
- Nausea, taste disturbance, headache, fever, malaise, arthralgia, skin reactions
- Pancytopenia, haemolytic anaemia
- Alopecia
- Acute pancreatitis
Warnings/caution:
- Mild to moderate hepatic impairment
Contraindication:
- People with severe blood disorders
- People with severe hepatic impairment
- People with acute pancreatitis
- Women of childbearing potential ( risk of congenital malformations)
Interactions:
- Azathioprine
- Methotrexate (risk of myelosuppresion)
- Trimethoprim
- Dixozin
Monitoring:
monitor symptom improvements, and if there is any develpoment of side effects
DISCUSS PROPYLURACIL CLINICAL PHARM
Indications:
- Hyperthyrodism helps control tremors and controls the overproduction of thyroxine.
Adverse effects:
- vasculitis
- leucopenia, thrombocytopenia
- aplastic anaemia
- lupus like syndrome
- vomiting
Warning/cautions:
- Hepatic impairment
- Renal impairment
Contraindications:
- Severe hepatic impairment
- Galactose intolerance
- glucose-galactose malabsorption
Interactions:
- Methotrexate
- Azathioprine
- Trimethoprim
