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Pharmacology > Endocrine Drugs > Flashcards

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
Q

When may dose reduction of glicazides be required

A

those with renal or hepatic impairment

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26
Q

When should glicazides be prescribed with caution

A

those at risk of hypoglycaemia (malnutrition, elderly, hepatic impairment, malnutrition)

27
Q

What drug may mask effects of hypoglycaemia

A

B-vlocker

28
Q

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

A
  • Prednisolone
  • Loop diuretic
  • Thiazide diuretic
29
Q

What does DPP4i stand for

A

di peptidyl peptidase 4 inhibitors

30
Q

Explain MOA of DPP4i

A
  • 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
Q

Why are DPP4-i’s less likely to cause hypoglycaemia than sulphonylureas

A

Increase insulin in high glucose states

32
Q

What are 4 common side effects of DPP4is

A
  • Peripheral oedema
  • Nasopharyngitis
  • Headache
  • GI Upset
33
Q

When does hypoglycaemia occur with DPP4is

A

When used with other hypoglycaemic drugs

34
Q

What is a unique risk of DPP4i’s

A

Pancreatitis

35
Q

If a patient on DPP4is experiences abdominal pain, what should be suspected

A

Pancreatitis

36
Q

Give an example of two DPP4Is

A

Sitagliptin

Linagliptin

37
Q

What are 5 absolute CI to DPP4i

A
  • Pregnancy
  • Breast feeding
  • T1DM
  • DKA
  • Hypersensitivity
38
Q

When should DPP4I be used with caution

A

> 80 year-olds
History pancreatitis
Moderate renal impairment

39
Q

What does SGLT-2 stand for

A

Sodium glucose transporter-2

40
Q

Name two SGLT-2

A

dapaglifozin

empaglifozin

41
Q

What is MOA of SGLT-2

A

interfere with reabsorption glucose in renal tubules -increasing excretion

42
Q

What is the advantage of SGLT-2 over DPP4i

A

improve vascular outcomes

lower risk hypoglycaemia

43
Q

Give an example of a pioglitazone

A

thiazoldinedione

44
Q

What are two complications of pioglitazone

A

increase risk fractures and bladder cancer

45
Q

What is action of insulin on glucose

A

Increases uptake of glucose into liver and skeletal muscle

46
Q

How does insulin work in hyperkalaemia

A

Drives potassium into cells - reducing serum concentration

47
Q

What is problem with insulin for hyperkalaemia

A

Once insulin is stopped, potassium returns to circulation. Only use as a short-term measure, whilst other measures are put in place

48
Q

What is rapid acting insulin

A

Immediate onset, short-duration

49
Q

Name a rapid acting insulin

A

Insulin asparte

50
Q

What is the brand name of insulin aspart

A

Novorapid

51
Q

Describe short acting insulin

A

Early-onset, short-duration

52
Q

Name a short-acting insulin

A

Solbule Insulin

53
Q

What is the brand name of soluble insulin

A

Actarapid

54
Q

What is intermediate acting insulin called

A

Humalog (Insulin Isophane)

55
Q

What are the two types of long-acting insulin

A

Insulin Glargine

Insuline Detemir

56
Q

What is the brand name for insulin detemir

A

Levemir

57
Q

What is the brand name for insulin glargine

A

Lantus

58
Q

What do biphasic insulin preparations contain

A

Novomix contains insulin asparte (rapid-acting) and insulin asparte protamine (intermediate acting)

59
Q

In emergencies, when insulin is required what is used

A

Soluble insulin (Actarapid)

60
Q

What is the main SE of insulin

A

Hypoglycaemia

61
Q

What can insulin injections cause if continually injected at the same site

A

Lipohypertrophy

62
Q

When is risk of hypoglycaemia increased

A

Renal impairment - due to reduced clearance of insulin

63
Q

What drug will increase insulin requirements

A

Corticosteroids

64
Q

What is the basal bolus regimen

A

Lantus (Insulin glargine) is taken at night time. Then insulin aspart (novorapid) is taken before meals

Pharmacology (12 decks)

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