Endocrine Flashcards
What are the indicators of metformin?
T2DM
What is the mechanism of action of metformin?
reduces hepatic glucose output
does not stimulate insulin secretion - no hypos
What are important adverse effects of metformin?
GI upset
lactic acidosis
What are warnings when using metformin?
renal impairment
hepatic impairment
acute alcohol intoxication, chronic alcohol abuse
What are important interactions of metformin?
IV contrast media
What are the indications for levothyroxine?
hypothyroidism
What is the mechanism of action for levothyroxine?
it is synthetic T3
What are important adverse reactions with levothyroxine?
hyper
cardiac - palpitations, arrhythmias
GI - diarrhoea, vomiting, weight loss
neuro - tremor, restlessness, insomnia
What are the warnings with levothyroxine?
coronary artery disease - t4 increases HR so can precipitate cardiac ischaemia
hypopitutarism - need steroids first
What are important interactions with levothyroxine?
calcium, iron, antacids - reduce GI absorption of levothyroxine
CYP impacts
impacts insulin, glucose, warfarin
What are the names of rapid acting insulins? How do they work?
humalog, novorapid
give just before or up to 15 mins after meal
peak 1hr post meal, last 3-5 hours
What are the names of short acting insulins?
actrapid, Humulin S
give 20 mins before meal
peaks 2 hours after injection, last 6-8 hours
What are the names of medium acting insulins?
Humulin I, insulatard
Given 1-2x daily
What are the names of long acting insulins?
Lantus, Levemir
can last 24 hours, usually given at night
What are the two exmaples of mixed insulins? How do they work?
Premixed - Humulin M3 (short and medium) - give 15-20 min before meal, never pm, need bedtime snack
Biphasic analouge mixtures - Humalog mix 25, Novomix 30 (rapid and medium) - with or up to 15 min after meal, never pm, x2 daily (breakfast and tea)
What are indications of glucose?
to provide water, to treat hypoglycaemia, hyperkalaemia, dilation of drugs
What are the adverse reactions of glucose?
Glucose 50% irritating to veins - painful, thrombosis
Can cause hyperglycaemia
What are warnings of glucose?
Do not give in thiamine deficiency as can cause Wernicke’s - give thiamine too
do not give in renal failure, hyponatraemia,
What are interactions with glucose?
Insulin due to opposite natures
What is the indication of sulfonylureas and an example?
gliclazide - T2DM
What is the mechanism of action of gliclazide?
act on pancreas to increase secretion of insulin
What are adverese reactions of gliclazide?
hypoglycaemia, weight gain, GI upset, hypersensitivity
What are some warnings of gliclazide?
DKA, hypoglycaemia
hepatic or renal impairment
What are some interactions with gliclazide?
beta blockers
other diabetic medication
alcohol
What are the indications of insulin?
DM
hyperkalaemia
What is the mechanism of action of insulin?
drives K+ into cells
drives movement of glucose from blood into tissue
What are adverse reactions of insulin?
hypoglycaemia
lipohypertrophy at injection site
oedema
What are warnings of insulin?
renal impairment - increases chance of hypo
What are interactions with insulin?
other hypoglycaemics
corticosteroids increase insulin requirement
What are some dipeptidylpeptidase-4 inhibitors, what are they used for and how do they work?
sitagliptin, linagliptin, saxagliptin
they are used to treat T2DM alongside metformin or instead of if it cannot be tolerated
incretins are released by intestine (especially in response to food) and they increase insulin secretion - incretins are broken down by DPP-4 and these drugs inhibit those and therefore incretin breakdown
What are some adverse reactions of dipeptidylpeptidase-4 inhibitors?
hypoglycaemia
pancreatitis
GI upset, headache, nasopharyngitis, peripheral oedema
What are some warnings and interactions of dipeptidylpeptidase-4 inhibitors?
Contraindications - hypersensitivity, T1DM, ketoacidosis, pregnancy, breastfeeding
Caution - previous pancreatitis, elderly, renal impairment
Interactions - other hypoglycaemia drugs, B-blockers can mask hypos, reduced effect if used with drugs that increase glucose (prednisilone, thiazide, loop diuretics)
What are some uses of oestrogens and progesterones?
hormonal contraception
HRT
What are some adverse effects of oestrogens and progesterons?
irregular bleeding, mood changes
cardiovascular disease and stroke
breast and cervical cancer
What are some warnings and interactions of oestrogens and progesterons?
breast cancer, VTE, cardiovascular disease
cytochrome P450 indcuers reduce contraceptive effect
