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MRCP Master > Endocrine DM > Flashcards

Endocrine DM Flashcards

1
Q

MOA -Flozin

A

SGLT2 Inhibition

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2
Q

Define Impaired fasting glucose

A

> or equal to 6.1 but< 7.0 mmol/l
offered an oral glucose tolerance test

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3
Q

Define impaired glucose tolerance (IGT)

A

fasting plasma glucose > 7.0 mmol/l
OGTT 2-hour : > or = to 7.8 mmol/l but < 11.1 mmol/l

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4
Q

Rx DM1 and a BMI > 25

A

Metformin

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5
Q

In pregnancy what is fasting glucose & 2-hour glucose cut off?

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

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6
Q

Increase levels of incretins such as GLP-1 and GIP

A

DPP-4 inhibitors
-Gliptan

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7
Q

bind to an ATP-dependent K+ channel on the cell membrane of pancreatic beta cells; blking channel = stimulation of insulin release

A

Sulfonylurea

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8
Q

average plasma glucose using HbA1c

A

average plasma glucose = (2 * HbA1c) - 4.5

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9
Q

HNF-1 alpha is ass w/

A

MODY

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10
Q

drug & class= increasing urinary glucose excretion

A

Gliflozins - SGLT2 inhibitors

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11
Q

To be given w/ risk of CVD or chronic heart failure

A

In patients with T2DM, SGLT-2 should be introduced at any point

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12
Q

Insulin in DKA

A

started at a rate of 0.1 units/kg/hour.
If falls below 15mmol/L but the pt is still acidotic w/ ketones then an infusion of 5% dextrose & and cont 0.9% sodium chloride, and insulin.

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13
Q

Fluids in DKA

A

1L 0.9% sodium chloride over an hour, followed but 2x 1L 0.9% sodium chloride over 2 hours etc

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14
Q

Insulin in hyperglycaemic hyperosmolar state (HHS)

A

0.05 units/kg/hour

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15
Q

AntiDms that Stimulate the secretion of insulin from pancreatic
β cells (Insulinotropic agents )
-Glucose-dependent 2
-Glucose-independent (2)

A
  1. Glucose-dependent (GLP-1 agonists, DPP-4 inhibitors): Insulin secretion is stimulated by elevated bl glucose levels (postprandially).
  2. Glucose-independent (sulfonylurea, meglitinides): Insulin is secreted regardless of the blood glucose level, → risk of hypoglycemia

Depend on residual β-cell function

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16
Q

Sulfonylureas MOA

A

-ide
Trigger the closure/ blockage of ATP-sensitive K+ channels,= stim insulin exocytosis
Increase insulin secretion from pancreatic β cells

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17
Q

SE Sulfonylureas (4)

A
  1. Risk of hypoglycemia (2nd gen)
  2. Weight gain
  3. Disulfiram-like reaction
    (first generation)
  4. Hematological changes: agranulocytosis, hemolysis
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18
Q

Contraindications of Sulfonylureas (4)

A
  1. Severe cardiovascular comorbidity
  2. Obesity
  3. Severe renal or liver failure
  4. Sulfonamide allergy (particularly long-acting substances)
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19
Q

MOA Meglitinides

A

Increase insulin secretion from pancreatic β cells

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20
Q

SE Meglitinides
Nateglinide
Repaglinide

A

Risk of hypoglycemia
Weight gain

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21
Q

MOA DPP4 - gliptin

A

-gliptin
Inhibit GLP-1 degradation → ↑ glucose-dependent insulin secretion
↓ glucagon secretion,
slow gastric emptying (↑ feeling of satiety, ↓ weight)

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22
Q

SE DPP4 - gliptin(6)

A
  1. GI symptoms
  2. Pancreatitis
  3. Nasopharyngitis URTI
  4. Headache, dizziness
  5. Arthralgia
  6. Edema
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23
Q

MOA: Glucagon-like peptide-1
(GLP-1) agonists (incretin mimetic drugs) - tide- ( gulptide)

A

tide-
Stimulate the GLP-1receptor directly

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24
Q

SE: GLP-1 agonists
tide-(gulptide)

A
  1. ↑ Risk of pancreatitis and possibly 2. pancreatic cancer
  2. Nausea
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25
Q

Contraindications GLP-1 agonists
tide-(gulptide)

A

Preexisting, symptomatic gastrointestinal motility disorders

26
Q

MOA Biguanides

A

acts by activation of the AMP-activated protein kinase (AMPK)
Enhances the effect of insulin
1. Increase glucose up take
2. Increase glucose sensitivity
3. decrease glycogenesis

27
Q

SE Biguanides (4)

A
  1. Lactic acidosis
  2. Weight loss
  3. GI (diarrhea, abdominal cramps)
  4. ↓ Vitamin B12 absorption
28
Q

Contraindications Biguanides

A
  1. CKD
  2. paused before administration of iodinated contrast medium and major surgery.
29
Q

MOA: Sodium-glucose cotransporter 2
(SGLT-2) inhibitors -gliflozin

A

-gliflozin
Increase glucose excretion with urine through the inhibition of SGLT-2 in the kidney

30
Q

SE: SGLT-2 inhibitors -gliflozin

A

-gliflozin
1. Genital yeast infections and UTIs
Glucosuria
2. Polyuria & dehydration
4.DKA
2. Weight loss
3. ?breast cancer, bladder cancer

31
Q

Contraindications: SGLT-2 inhibitors -gliflozin

A

-gliflozin
Recurrent urinary tract infections
CKD

32
Q

Interactions with GLP-1 agonists
tide-(gulptide)

A

Warfarin: ↑ INR

33
Q

MOA Thiazolidinediones
-glitazones

A

-glitazones
-Reduce insulin resistance through the stimulation of peroxisome proliferator-activated receptors
(PPARs)
- Increase transcription of adipokines

34
Q

SE: Thiazolidinediones
-glitazones

A

1.Edema
2. Cardiac failure
3. Weight gain
4.↑ Risk of bone fractures (osteoporosis)
5.↑ LDL

35
Q

MOA: Alpha-glucosidase inhibitors - Acarbose

A

Inhibit alpha-glucosidase (a brush border enzyme expressed by intestinal epithelial cells) → delayed - & ↓ intestinal glucose absorption
- & ↓ carbohydrate breakdown,
- resulting in ↓ hyperglycemia after food ingestion

36
Q

SE: Acarbose

A
  1. GI sx (flatulence, bloating, abdominal discomfort, diarrhea)
37
Q

Contraindications to Acarbose

A
  1. Severe renal failure
  2. IBD
  3. Conditions associated with malabsorption
38
Q

Fx insulin

A

Stim uptake of glucose in Liver, Mscl & fat = decrease glucose in the blood

39
Q

What is sugar stored as in the liver and how is it stored in cells

A

Liver Glycogen
Cells - ATP

40
Q

What the Fx GLP

A

Stim b- cells to release insulin

41
Q

What happens when there is not enough sugar in the blood

A

Glucagon is released by alpha cells
which breaks down stored glycogen

42
Q

Most common form of Mody & genetics

A

MODY 3
60% of cases
due to a defect in the HNF-1 alpha gene
is associated with an increased risk of HCC

43
Q

RX MODY

A

very sensitive to sulfonylureas, insulin is not usually necessary

44
Q

2 drugs that increase insulin sensitivity & reduce production of glucose

A

Biguanies
Thiazolidinediones

45
Q

MOA metfotmin

A
46
Q

How does metformin increase insulin sensitivity

A

Ampk inhibits genes that promotes gluconeogenesis
Causes gult 4 to inbed in plasma membrane of skeletal & fat tissue =allow glucose to enter

47
Q

How does meformin (3)

A
  1. Via ampk inhibits glconeogenesis
  2. Via AMPK increases insulin sensitivity of tissues by causing the Gult4 in mscl & fat to imbed Into plasma membranes =increase uptake of glucose
  3. decrease intestinal abs of glucose
48
Q

MOA thiazolidinediones “glitazones” ?

A

Via ppar gamma receptor that regulates tanscription = increase of insulin sensitivity in mscl , fats, liver

  1. Increase syn. Of protein in lipid metabolism = decrease in triglycerides increase HDL & LDL
49
Q

SE glitazones

A
50
Q

Describe release of insulin

A

Sugar in blood cause glut2 receptors on cell to open & glucose to made into ATP
ATP closes k+ channels = build of of K which = open is ca2+ channel
Ca2+ = exocytosis of insulin

51
Q

Effect of sulfonylureas on K channels

A

Closes k= build up of k=ca2+ channels open = release of insulin

52
Q

SE sulfonylureas

A
53
Q

Which is the drug that acts like sulphurias

A
54
Q

Fx and example of incretins

A

Hormones like glp1 cause reduced bl glucose after a meal
by stim insulin release

55
Q

Fx of glp 1 agonists

A
56
Q

What is the fx of dpp4?

A

Breakdown of glp1

57
Q

Se dpp4 inhibitor (4)

A
58
Q

Explain the transportation of lipids (lipoprotein)

A

Chylomicrons - travel from gut to liver
VLDL- carrying triglycerides & cholesterol to body from liver
LDLcarry cholesterol to the body from liver
HDL is secreted from the liver to pick up excess cholesterol and bring them back to the liver

59
Q

How do stains work?

A

Inhibit cholesterol synthesis via HMG-CoA reductase
No cholesterol will cause increased hepatocyte receptors for LDL, vLDL

60
Q

MOA Fibrates

A
61
Q

SE fibrates

A

MRCP Master (47 decks)

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