Endocrine system

Question 1

Facts about metformin

Answer 1

First choice for all patients except CI

Question 2

Does metformin make you gain weight or cause hypoglycaemia?

Answer 2

No

Question 3

State the side effects of Metformin

Answer 3

Lactic acidosis

Question 4

What is the contraindication if metformin

Answer 4

DKA( Acute metabolic acidosis)
Avoid if egfr is < 30ml/min because it can cause RF which increases risk of lactic acidosis

Question 5

State the MOA of Biguanide

Answer 5

Decreases gluconeogenesis and increases peripheral utilisation of glucose. Acts only in the presence of insulin, so only effective when there is some function of pancreatic cells

Question 6

Is metformin safe in BF and pregnancy?

Answer 6

Yes it is.

Question 7

Caution while on Biguanide

Answer 7

Conditions which worsen renal function and risk factors for Lactic acidosis

Question 8

Monitoring for metformin

Answer 8

Renal function before starting treatment and atleast annually

Question 9

Patients and carers advice for metformin

Answer 9

Inform patients of risk of lactic acidosis and how to recognise signs

Question 10

Signs of Lactic acidosis

Answer 10

Dyspnoea (difficulty breathing)
Muscle cramp
Abdominal pain
Hypothermia
Asthenia ( gen. Body weakness/lack of energy)

Question 11

State the drugs in the class Sulphonylureas

Answer 11

Gliclazide
Glimepiride
Tolbutamide
Glipizide

Question 12

Facts about Sulphonylureas

Answer 12

Can cause hypoglycaemia
Can make you gain weight
Hypo more likely with LA ones eg glimepiride
For pt metformin is CI or underweight

Question 13

Is Sulphonylureas safe in BF and pregnancy?

Answer 13

No

Question 14

Is Sulphonylureas safe during surgery?

Answer 14

Avoid on the day of surgery, use insulin instead
Avoid long acting in elderly due to risk of hypos. Give short acting instead

Question 15

State the MOA of Sulphonylureas

Answer 15

Augment insulin secretion and consequently only effective when some residual pancreatic beta cells activity is present

Question 16

State the side effects of Sulphonylureas

Answer 16

Nausea, vomiting, diarrhoea and Constipation
Hepatic impairment (jaundice, Hepatitis, heptathlon failure)
Allergic skin reactions in first 6-8weeks

Question 17

Cautions an contraindications with Sulphonylureas safe

Answer 17

Presence of ketoacidosis
Avoid in acute porphyria
Avoid or reduce dose in renal or hepatic impairment
Caution elderly and pts with G6PD deficiency

Question 18

Facts about about alpha glucosidase inhibitor

Answer 18

Affects the absorption of sucrose
Interferes with sucrose absorption

Question 19

What is the MOA of Acarbose

Answer 19

Acarbose, an inhibitor of intestinal alpha glucosidases, delays the digestion and absorption of starch and sucrose; it has a small but significant effect in lowering blood glucose.

Question 20

State how to tx hypoglycaemia on patient taking Acarbose

Answer 20

Give glucose

Question 21

State the side effects of Acarbose

Answer 21

Diarrhoea (may need to reduce dose); gastrointestinal discomfort; gastrointestinal disorders

Uncommon
Nausea; vomiting

Frequency not known
Acute generalised exanthematous pustulosis (AGEP); thrombocytopenia

Question 22

Is acarbose safe during pregnancy and breastfeeding?

Answer 22

Avoid

Question 23

Is acarbose safe in renal impairment?

Answer 23

Avoid if creatinine clearance less than 25 mL/minute.

Question 24

Is acarbose safe in severe renal impairment?

Answer 24

Manufacturer advises avoid in severe impairment.

Question 25

Acarbose is contraindicated in?

Answer 25

Disorders of digestion or absorption; hernia (condition may deteriorate); inflammatory bowel disease; predisposition to intestinal obstruction
Pregnancy and breastfeeding
Avoid in severe hepatic impairment

Question 26

Monitoring requirements while on acarbose

Answer 26

Liver function

Question 27

State how to admi

Answer 27

Manufacturer advises tablets should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food.

Question 28

Patients and carer advice while on Acarbose

Answer 28

Antacids unlikely to be beneficial for treating side-effects.

To counteract possible hypoglycaemia, patients receiving insulin or a sulfonylurea as well as acarbose need to carry glucose (not sucrose—acarbose interferes with sucrose absorption).

Patients should be given advice on how to administer acarbose tablets.

Question 29

What is the MOA of Thiazolidinediones eg Pioglitazone

Answer 29

reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration.