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Endocrine Drugs Flashcards

1
Q

What is the MOA of metformin

A

Biguainde - increases gluconeogensis and glycogenlysis in the liver

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2
Q

Why does metformin not cause hypoglycaemia

A

As it does not affect insulin secretion

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3
Q

What is a desirable side effect of metformin

A

Weight loss

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4
Q

What is a rare, but serious side effect of metformin

A

Lactic acidosis

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5
Q

What GFR is the dose of metformin reduced

A

45

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6
Q

What GFR is metformin stopped

A

30

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7
Q

What are two conditions where metformin should be withheld

A
  • Acute tissue hypoxia

- AKI

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8
Q

What are 2 examples of tissue hypoxia

A
  • MI

- Sepsis

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9
Q

What condition should metformin be prescribed cautiously

A

Liver impairment

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10
Q

When should metformin be withheld

A

Acute alcohol consumption.

Do not prescribe in chronic alcohol abuse

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11
Q

Explain relationship between metformin and CT scans

A

stop metformin 48h before contrast CT due to kidney injury may decrease excretion and lead to lactic acidosis

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12
Q

With what drugs should metformin be used cautiously

A
  • Other drugs can cause decrease renal function
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13
Q

Name 3 drugs that may increase blood glucose and reduce effects of metformin

A
  • Thiazide diuretics
  • Loop diuretics
  • Prednisolone
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14
Q

What are common SE of metformin

A

GI disturbance:

  • Diarrhoea
  • N+V
  • Change in taste
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15
Q

When should you advise patients to take metformin

A

Take tablet with food to avoid GI side effects

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16
Q

What 3 drugs are usually stopped in AKI, due to decreased kidney function risking toxicity

A

Digoxin
Lithium
Metformin

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17
Q

What 5 drugs are stopped in AKI due to risk of causing further damage

A 
NSAIDs
ACEi
ARB
Diuretics 
Aminoglycosides
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18
Q

What is the MOA of sulphonylureas

A

Inhibit ATP-dependent K+ channels in B-islet cells of the pancreas. Retention of K+ causes depolarisation and calcium accumulation that leads to insulin secretion

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19
Q

What are more common SE of sulphonylureas

A

GI disturbance;

  • Vomiting
  • Diarrhoea
  • Constipation
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20
Q

What is a serious side effect of sulphonylureas

A

Hypoglycaemia

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21
Q

What are 3 rare hypersensitivity abnormalities with sulphonylureas

A
  • Hepatic toxicity
  • Drug hypersensitivity
  • Agranulocytosis
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22
Q

How will hepatic toxicity present

A

Cholestatic jaundice

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23
Q

What haematological abnormality can sulphonylureas cause

A

Agranulocytosis

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24
Q

Give an example of a sulphonylurea

A

Glicazide

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25
When may dose reduction of glicazides be required
those with renal or hepatic impairment
26
When should glicazides be prescribed with caution
those at risk of hypoglycaemia (malnutrition, elderly, hepatic impairment, malnutrition)
27
What drug may mask effects of hypoglycaemia
B-vlocker
28
Name 3 drugs that may increase blood glucose and reduce effects of sulphonylureas
- Prednisolone - Loop diuretic - Thiazide diuretic
29
What does DPP4i stand for
di peptidyl peptidase 4 inhibitors
30
Explain MOA of DPP4i
- High blood glucose stimulates release of incretins (glucagon like peptide 1 and glucose dependent insulinotropic peptide) - These act to enhance insulin release - They are rapidly degraded by DPP4 - DPP4i prevent this breakdown increasing incretins and potentiation of insulin
31
Why are DPP4-i's less likely to cause hypoglycaemia than sulphonylureas
Increase insulin in high glucose states
32
What are 4 common side effects of DPP4is
- Peripheral oedema - Nasopharyngitis - Headache - GI Upset
33
When does hypoglycaemia occur with DPP4is
When used with other hypoglycaemic drugs
34
What is a unique risk of DPP4i's
Pancreatitis
35
If a patient on DPP4is experiences abdominal pain, what should be suspected
Pancreatitis
36
Give an example of two DPP4Is
Sitagliptin | Linagliptin
37
What are 5 absolute CI to DPP4i
- Pregnancy - Breast feeding - T1DM - DKA - Hypersensitivity
38
When should DPP4I be used with caution
>80 year-olds History pancreatitis Moderate renal impairment
39
What does SGLT-2 stand for
Sodium glucose transporter-2
40
Name two SGLT-2
dapaglifozin | empaglifozin
41
What is MOA of SGLT-2
interfere with reabsorption glucose in renal tubules -increasing excretion
42
What is the advantage of SGLT-2 over DPP4i
improve vascular outcomes | lower risk hypoglycaemia
43
Give an example of a pioglitazone
thiazoldinedione
44
What are two complications of pioglitazone
increase risk fractures and bladder cancer
45
What is action of insulin on glucose
Increases uptake of glucose into liver and skeletal muscle
46
How does insulin work in hyperkalaemia
Drives potassium into cells - reducing serum concentration
47
What is problem with insulin for hyperkalaemia
Once insulin is stopped, potassium returns to circulation. Only use as a short-term measure, whilst other measures are put in place
48
What is rapid acting insulin
Immediate onset, short-duration
49
Name a rapid acting insulin
Insulin asparte
50
What is the brand name of insulin aspart
Novorapid
51
Describe short acting insulin
Early-onset, short-duration
52
Name a short-acting insulin
Solbule Insulin
53
What is the brand name of soluble insulin
Actarapid
54
What is intermediate acting insulin called
Humalog (Insulin Isophane)
55
What are the two types of long-acting insulin
Insulin Glargine | Insuline Detemir
56
What is the brand name for insulin detemir
Levemir
57
What is the brand name for insulin glargine
Lantus
58
What do biphasic insulin preparations contain
Novomix contains insulin asparte (rapid-acting) and insulin asparte protamine (intermediate acting)
59
In emergencies, when insulin is required what is used
Soluble insulin (Actarapid)
60
What is the main SE of insulin
Hypoglycaemia
61
What can insulin injections cause if continually injected at the same site
Lipohypertrophy
62
When is risk of hypoglycaemia increased
Renal impairment - due to reduced clearance of insulin
63
What drug will increase insulin requirements
Corticosteroids
64
What is the basal bolus regimen
Lantus (Insulin glargine) is taken at night time. Then insulin aspart (novorapid) is taken before meals

Pharmacology (12 decks)

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