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Pharmacology > Endocrine System > Flashcards

Endocrine System Flashcards

1
Q

Insulin

Mechanism of Action

A

Exogenous replacement of deficient hormone to stimulate glucose absorption, glycogenesis, lipogenesis, proteosynthesis and inhibit gluconeogeneis and ketogenesis, also increases K+ absorption and act in short, intermediate or long-term (biphasic = rapid and intermediate)

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2
Q

Insulin

Indications

A

T1DM, poorly controlld T2DM, DKA, peri-operative glycaemic control, hyperkalaemia

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3
Q

Insulin

Contra-indications

A

Reduced clearance proportionate to renal impairment (further renal imp req’s lower dose)

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4
Q

Insulin

Side Effects

A

Hypoglycaemia (coma/death), lipohypertrophy at injection site

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5
Q

Insulin

Interactions

A

Corticosteroids reduce effect

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6
Q

Sulphylurea

Name

A

Gliclazide

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7
Q

Sulphylurea (Gliclazide)

Mechanism of Action

A

Lowers blood glucose via stimulation of pancreatic insulin secretion - blocks ATP-dependent K+ channels in beta-cell membranes causing depolarisation - requires residual pancreatic function

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8
Q

Sulphylurea (Gliclazide)

Indications

A

T2DM - when metformin is C/I or combined if insufficient

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9
Q

Sulphylurea (Gliclazide)

Contraindications

A

Hepatic/renal imp, high risk of hypoglycaemia, T1DM, DKA, pre-coma/coma

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10
Q

Sulphylurea (Gliclazide)

Side effects

A

GI upset, hypoglycaemia, weight gain, hyponatraemia (SIADH), cholestatic hepatitis

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11
Q

Sulphylurea (Gliclazide)

Interactions

A

Other diabetic drugs

Drugs that increase glucose - steroid, thiazides, loops

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12
Q

Biguanide

Name

A

Metformin

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13
Q

Biguanide (Metformin)

Mechanism of action

A

Increases insulin sensitivity and glucose uptake in skeletal muscle, suppresses hepatic glucose production by AMPK activation

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14
Q

Biguanide (Metformin)

Indications

A

T2DM - first choice for control of blood glucose

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15
Q

Biguanide (Metformin)

Contraindications

A

Renal impairment, AKI, severe tissue hypoxia, acute alcohol intoxication, chronic overuse

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16
Q

Biguanide (Metformin)

Side effects

A

Lactic acidosis with severe liver/renal disease, GI upset (dose dep, common), reduced appetite, weight loss, vitamin B12 resorption

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17
Q

Biguanide (Metformin)

Interactions

A

IV contrast media (CKD/lactic acidosis risk), drugs that increase glucose, recent hypoxia (MI/sepsis)

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18
Q

Thyroid Hormones

Names

A

T3 - Liothyronine (active, IV use in emergency)

T4 - Levothyroxine (pro-hormone)

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19
Q

Levothyroxine

Mechanism of action

A

Agonist of thyroid receptors

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20
Q

Levothyroxine

Indications

A

Primary or Secondary (low TSH) hypothyroidism

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21
Q

Levothyroxine

Contraindications

A

CAD, hypopituitary state must initiate corticosteroid before thyroid therapy to avoid Addisonian crisis

22
Q

Levothyroxine

Side effects

A

As Hyperthyroidism - GI, cardiac and neuro manifestations

23
Q

Levothyroxine

Interactions

A

GI absorption reduced by antacids/Ca/Fe salts
CYP450 inducers reduce efficacy
Levothyroxine may change metabolism affecting insulin and warfarin

24
Q

Anti-thyroid

Name

A

Carbimazole

25
Q

Carbimazole

Mechanism of action

A

Converted to thimazole which inhibits coupling of iodothyronine to suppress T3/4 synthesis

26
Q

Carbimazole

Indications

A

Hyperthyroidism, preparing for thyroidectomy, pre-radio-iodine therapy

27
Q

Carbimazole

Contraindications

A

Hypersensitivity, serious haematological conditions or hepatic insufficiency

28
Q

Carbimazole

Side effects

A

GI upset, bone marrow suppression, lymphadenopathy, hypersensitivity, insulin autoimmune syndrome, bleeding

29
Q

Carbimazole

Interactions

A

Vitamin K antagonist - intensifies anticoagulants

Increase prednisolone clearance

30
Q

Bisphosphantes

Name

A

Alendronate, Zoledronate, Disodium pamidronate

31
Q

Bisphosphonates

Mechanism of action

A

Inhibit action of osteoclast by accumulating within and inhibiting their activity and inducing apoptosis to increase bone mass

32
Q

Bisphosphonates

Indications

A

Osteoporosis (elderly, post-menopausal), severe hypercalcaemia (malignancy, myeloma, Paget’s disease of bone) can be given IV

33
Q

Bisphosphonates

Contraindications

A

Renal impairment, hypocalcaemia, upper GI disorders, smoker/dental disease

34
Q

Bisphosphonates

Side effects

A

Oesophagitis, hypophosphataemia, osteonecrosis of the jaw, atypical femoral fracture

35
Q

Bisphosphonates

Interactions

A

Bind to calcium in stomach/anatacids/iron salts, reducing effectiveness

36
Q

Calcium/Vitamin D supplements

Names

A

Calcium carbonate, colecalciferol, calcium gluconate

37
Q

Ca/vD supplements

Mechanism of action

A

Restoration of bone mass/density to prevent fraction - seen in CKD (renal osteodystrophy), Ca increases myocardial threshold/arrhythmia risk in hyperkalaemia

38
Q

Ca/vD supplements

Indications

A

Osteoporosis, CKD, severe hyperkalaemia, asx hypocalcaemia (tetany, petechiae, paraesthesia), vD deficiency (Rickett’s, osteomalacia)

39
Q

Ca/vD supplements

Contraindications

A

Hypercalcaemia

40
Q

Ca/vD supplements

Side effects

A

Dyspepsia, constipation, CV collapse if IV too fast

41
Q

Ca/vD supplements

Interactions

A 
Oral Ca reduces Fe
Bisphosphonates
Tetracycline
Levothyroxine
- Sodium bicarbonate IVI may precipitate
42
Q

Calcium gluconate emergency dosage

A

10mL at 10% over 10 minutes

43
Q

Mineralocorticoid

Name

A

Fludrocortisone

44
Q

Mineralocorticoid

Mechanism of action

A

Enhances deposition of liver glycogen, retains Na+, increases K+ secretion

45
Q

Mineralocorticoid

Indications

A

Adrenocortical insufficiency e.g. Addison’s disease

46
Q

Mineralocorticoid

Contraindications

A

systemic infections, oedematous state

47
Q

Mineralocorticoid

Side effects

A

Anti-inflammatory, immunosuppressive, hypertensive, MSK pain/weakness, cushingoid, GI upset

48
Q

Mineralocorticoid

Interactions

A

Extensive:

NSAIDs, thyroid meds, anti-diabetes meds, anticoagulants/anti-hypertensives, immunosuppressants

49
Q

Mineralocorticoid

Prescription advice

A

Risk of acute adrenal insufficiency syndrome if suddenly stopped

50
Q

Sitagliptin

When to use first line

A

DDP-4 inhibitor if eGFR <30mls/min

51
Q

Glitazones

Side effects

A

Weight gain, fluid retention, liver dysfunction, fractures

Pharmacology (14 decks)

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