Endocrine

Question 1

how does insulin work?

Answer 1

stimulates glucose uptake from the circulation into tissues, including skeletal muscle and fat, and increases use of glucose as an energy source.

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.

Question 2

what are the indications to take insulin?

Answer 2

diabetes, hyperkalaemia

Question 3

what are the contraindications to taking insulin?

Answer 3

renal impairment

Question 4

what are the side effects of insulin?

Answer 4

Hypoglycaemia, lipohypertrophy in site of SC injection

Question 5

what are the interactions with insulin?

Answer 5

other hypoglycaemic agents increases the risk of hypoglycaemia

systemic corticosteroids increases insulin requirements.

Question 6

what class of drug is gliclazide?

Answer 6

sulphonylurea

Question 7

how does gliclazide work?

Answer 7

lower blood glucose by stimulating pancreatic insulin secretion.

Question 8

what are the indications to take gliclazide?

Answer 8

type 2 diabetes (only used if metformin not tolerated)

Question 9

what are the contraindications to taking gliclazide?

Answer 9

hepatic and renal impairment

Question 10

what are the side effects of gliclazide?

Answer 10

hypoglycaemia, GI disturbances (nausea, vomiting, diarrhoea, constipation), hyponatraemia, rarely causes liver disturbances

Question 11

what are the interactions with gliclazide?

Answer 11

other antidiabetic drugs including metformin, thiazolidinediones (e.g. pioglitazone) and insulin.

The efficacy of sulphonylureas is reduced by drugs that elevate blood glucose, e.g. prednisolone, thiazide and loop diuretics.

Question 12

how does metformin work?

Answer 12

lowers blood glucose by increasing the response (sensitivity) to insulin

suppresses hepatic glucose production, increases glucose uptake and utilisation and suppresses intestinal absorption. Also reduces weight gain, preventing worsening insulin resistance

Question 13

what are the indications to take metformin?

Answer 13

Type 2 DM (first choice for blood glucose control)

Question 14

what are the contraindications to taking metformin?

Answer 14

hepatic and renal impairment

Ketoacidosis, general anaesthesia

Question 15

what are the side effects of metformin?

Answer 15

Anorexia, nausea, vomiting, diarrhoea, abdo pain, taste disturbance and rarely lactic acidosis

Question 16

what are the interactions with metformin?

Answer 16

any drug that interferes with hepatic or renal function

Prednisolone, thiazide and loop diuretics elevate blood glucose, hence oppose the actions and reduce efficacy of metformin.

Question 17

how does thyroxine work?

Answer 17

replaces T4 in the body which regulate metabolism and growth

Question 18

what are the indications to take thyroxine?

Answer 18

Primary hypothyroidism.

Hypothyroidism secondary to hypopituitarism.

Question 19

what are the contraindications to taking thyroxine?

Answer 19

coronary artery disease
hypopituitarism (can induce addisonian crisis)
thyrotoxicosis

Question 20

what are the side effects of thyroxine?

Answer 20

only get in excessive dose - gastrointestinal (e.g. diarrhoea, vomiting, weight loss), cardiac (e.g. palpitations, arrhythmias, angina) and neurological (e.g. tremor, restlessness, insomnia) manifestations.

(same as hyperthyroidism)

Question 21

what are the interactions with thyroxine?

Answer 21

gastrointestinal absorption of levothyroxine is reduced by antacids, calcium or iron salts

increased dose may be necessary in patients taking cytochrome P450 inducers (phenytoin, carbamazepine)

increase insulin or oral hypoglycaemic requirements in diabetes mellitus and enhance the effects of warfarin.

Question 22

what class of drug is carbimazole?

Answer 22

Anti-thyroid drugs

Question 23

how does carbimazole work?

Answer 23

Decreases uptake and concentration of inorganic iodine by thyroid also reducing the formation of di-iodotyrosine and thyroxine (so reduces production of T3 and T4)

Question 24

what are the indications to take carbimazole?

Answer 24

hyperthyroidism

Question 25

what are the contraindications to taking carbimazole?

Answer 25

Severe blood disorders

Question 26

what are the side effects of carbimazole?

Answer 26

Nausea, mild GI disturbance, taste disturbance, headache, fever, malaise, rash, pruritus, arthralgia

Question 27

what class of drug are alendronic acid, disodium pamidronate and zoledronic acid?

Answer 27

Bisphosphonates

Question 28

how do bisphosphonates work?

Answer 28

reduce bone turnover by inhibiting the action of osteoclasts, the cells responsible for bone resorption net effect is reduction in bone loss and improvement in bone mass.

Question 29

what are the indications to take bisphosphonates?

Answer 29

osteoporotic fragility fractures | Paget’s disease

Question 30

what are the contraindications to taking bisphosphonates?

Answer 30

renal impairment hypocalcaemia upper GI disorders smokers/ dental disease (risk of jaw osteonecrosis)

Question 31

what are the side effects of bisphosphonates?

Answer 31

oesophagitis (when taken orally) and hypophosphataemia | osteonecrosis of the jaw

Question 32

what are the interactions with bisphosphonates?

Answer 32

absorption is reduced if taken with calcium salts (including milk), as well as antacids and iron salts

Question 33

how do calcium and vitamin D supplements work?

Answer 33

Calcium – essential for normal muscle/bone/nerve/clotting function Vitamin D – controls calcium homeostasis along with parathyroid hormone) Reduces rate on bone loss

Question 34

what are the indications to take calcium/Vit D?

Answer 34

Osteoporosis, chronic kidney disease, severe hyperkalaemia, hypocalcaemia, vitamin D deficiency

Question 35

what are the contraindications to taking calcium/Vit D?

Answer 35

hypercalaemia

Question 36

what are the side effects of calcium/Vit D?

Answer 36

Dyspepsia, constipation, risk of cardiovascular collapse when given too quickly in treatment of hyperkalaemia

Question 37

what are the interactions with calcium/ Vit D?

Answer 37

Iron, bisphonsphonates, tetracyclines, levothyroxine (reduces absorption); sodium bicarbonate when given IV (risk of precipitation)

Question 38

what class of drug is fludrocortisone?

Answer 38

mineralcorticoid

Question 39

how do mineralcorticoids work?

Answer 39

works by causing the kidneys to retain sodium and acting as a replacement for cortisone when the body does not produce enough.

Question 40

what are the indications to take mineralcorticoids?

Answer 40

adrenocortical insufficiency in Addison disease treating salt-losing adrenogenital syndrome.

Question 41

what are the contraindications to taking mineralcorticoids?

Answer 41

Systemic infection, avoid live virus vaccines when receiving immunosuppressive doses

Question 42

what are the interactions with mineralcorticoids?

Answer 42

Anabolic steroids increase the risk of fludrocortisone's side effects Barbiturates, carbamazepine, estrogens, phenytoin, rifampin decrease fludrocortisone's effectiveness live vaccines, or smallpox vaccine because the effectiveness of these medicines may be decreased Anticoagulants because their effectiveness may be decreased or the risk of their side effects may be increased

Question 43

what are the side effects of mineralcorticoids?

Answer 43

Difficulty sleeping; dizziness or lightheadedness; headache; increased appetite; increased sweating; indigestion; nervousness; increase susceptibility to infection