Endocrine Drugs

Question 1

What are 2 examples of Sulphonylureas?

Answer 1

Gliclazide

Glimepiride

Question 2

What is the MoA of sulphonylureas?

Answer 2

Stimulates B cells of the pancreas to produce more insulin
Increase cellular glucose uptake and glycogenesis; reduces gluconeogenesis
Glicazide is short acting (12 hours approx)

Question 3

what are the indications for sulphonyulereas?

Answer 3

T2DM with diet and exercise

Question 4

list some side effects of sulphonyuleras?

Answer 4

Hypoglycaemia
Rashes
Nausea
Vomiting
Stomach pain
Indigestion
Weight gain

Question 5

What is important clinically regarding pharmacokinetics/dynamics for sulphonyulereas?

Answer 5

Renally excreted so accumulate in renal failure

Glimepiride is long acting sulphonylureas

Question 6

What info should be given to patient before starting a sulphonyulerea?

Answer 6

Compliance important
Maintain consistent diet
Avoid alcohol

Question 7

What is an example of a biguanide?

Answer 7

Metformin

Question 8

what is the MoA of metformin?

Answer 8

Increase the activity of AMP-dependent protein kinase (AMPK)
This inhibits gluconeogenesis
Reduces insulin resistance

Question 9

What are the indications for a biguanide?

Answer 9

Type 2 diabetes mellitus along with diet and exercise

Metabolic and reproductive abnormalities associated with Polycystic ovarian syndrome

Question 10

List some side effects of metformin:

Answer 10

Diarrhoea
Nausea
Vomiting
Taste disturbances
Lack of apetite
Risk of lactic acidosis in patients with renal failure

Question 11

What is important clinically regarding pharmacokinetics/dynamics for metformin?

Answer 11

Not recommended in pregnancy and renal failure (eGFR <30 mls/min)
Absorption reduces when taken with food

Question 12

What info should be given to patient before starting metformin?

Answer 12

take at same time every day

avoid alcohol

Question 13

What is metformin’s affect on weight?

Answer 13

It does not increase weight (may loose some due to side effects)

Question 14

What are 2 examples of GLP-1 (glucagon like peptide) Agonists?

Answer 14

Exanatide

Liraglutide

Question 15

What is the MoA for a GLP-1 Agonist?

Answer 15

GLP-1 is a hormone that is released after meals to increase insulin secretion
These drugs are a GLP-1 agonist - it increases insulin secretion, decreases glucagon secretion and reduces hunger

Question 16

what is the indication for GLP-1 agonists?

Answer 16

T2DM

Question 17

list some side effects of GLP-1 agonists:

Answer 17

Hypoglycaemia
Nausea
Vomiting
Diarrhoea

Question 18

What is important clinically regarding pharmacokinetics/dynamics for exanatide and liraglutide?

Answer 18

It can lower glucose alone, but when given in combination with metformin, sulfonylureas, and/or insulin it can improve glucose control
Renally excreted so dose adjustment needed in renal failure

Question 19

What info should be given to patient before starting a GLP-1 agonist?

Answer 19

Only given as injections

Twice a day

Question 20

what is the synthetic thyroid hormone drug called?

Answer 20

levothyroxine

Question 21

what is the MoA for levothyroxine?

Answer 21

Thyroxine increases the metabolic rate of all tissues in the body
Synthetically prepared levo-isomer of thyroxine
Acts like T4 and gets converted to T3 in the liver and kidney
Maintain brain function, food metabolism, and body temperature, among other effects

Question 22

what are the indications for synthetic thyroid hormone?

Answer 22

Hypothyroidism

Chronic lymphocytic thyroiditis

Question 23

list some side effects of levothyroxine

Answer 23

Chest pain
Coma
Diarrhoea
Tachycardia
Itching
Muscle cramps
(shouldn't happen if dose is correct)

Question 24

What is important clinically regarding pharmacokinetics/dynamics for levothyroxine?

Answer 24

Primarily eliminated by the kidneys
Intravenous formulations are available
The half-life is long (6 to 7 days) so thyroid function should be rechecked 6 weeks after a dose adjustment

Question 25

what info should be given to patient before starting levothyroxine?

Answer 25

Take 30-60 minutes before breakfast.

Question 26

what are 2 examples of anti-thyroid drugs - thionamides?

Answer 26

Carbimazole

Propylthiouracil

Question 27

what is the MoA of thionamides?

Answer 27

Reduces activity of peroxidase enzyme (required for the production of thyroid hormones)
May also reduce peripheral conversion of T4 to T3
Carbimazole is a pro-drug

Question 28

what are the indications for carbimazole and propylthiouracil?

Answer 28

Hyperthyroidism
Thyrotoxicosis
Preparing patients for thyroid surgery

Question 29

list some side effects of thionamides:

Answer 29

rash
agranulocytosis
sore throat

Question 30

What is important clinically regarding pharmacokinetics/dynamics for thionamides?

Answer 30

Carbimazole is rapidly metabolised to thiamazole. The mean peak plasma concentration occurs one hour
It crosses the placenta and can be found in breast milk
The effect of anti-thyroid drugs can take several weeks to occur so are usually prescribed alongside a beta-blocker to reduce symptoms of hyperthyroidism

Question 31

what info should be given to patient before starting a thionamide?

Answer 31

Compliance is important

Regular blood checks will be needed to monitor treatment response and renal, hepatic function and full blood counts.