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CPT - Other Drugs > Endocrine System > Flashcards

Endocrine System Flashcards

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1
Q

What is an example of a rapid-acting insulin?

A

Insulin aspart (Novorapid)

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2
Q

What is an example of a short-acting insulin?

A

Soluble insulin (Actrapid, Humulin S)

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3
Q

What is an example of an intermediate-acting insulin?

A

Isophane insulin (NPH)

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4
Q

What is are two examples of long-acting insulin?

A

Insulin degludec

Insulin glargine

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5
Q

Why can’t you give insulin orally?

A

It’s a protein so would be digested in the gut, usually given s.c

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6
Q

What are some ADRs of insulin?

A
  • Hypoglycaemia

* Lipodystrophy (lipoatrophy and lipohypertrophy) at injection sites

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7
Q

What are some DDIs of insulin?

A

Increase dose if given with systemic steroids

Caution with other hypoglycaemic agents

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8
Q

What is a contraindication of insulin?

A

Renal impairment - risk of hypoglycaemia as insulin is excreted renally

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9
Q

What is basal-bolus dosing?

A

If a young, active person with T1DM has good adherence, can use this method - Taking a rapid-acting insulin e.g. aspart as a bolus post-meals and then a long-acting e.g. glargine basally, throughout the day (at night)

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10
Q

Describe the onsets of action and durations of insulin aspart, soluble insulin, isophane insulin and insulin glargine…

A
  • Insulin aspart: 10-20 mins, 3-5 hrs
  • Soluble insulin: 30-60 mins, 5-8 hrs
  • Isophane insulin: 60-120 mins, 18-24 hrs
  • Insulin glargine: 60-90 mins, 20-24 hrs
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11
Q

When are dextrose, glucagon and glucose given?

A
  • Dextrose - same as glucose
  • Glucagon - diabetic hypoglycaemia, severe hypotension (due to beta-blocker overdose), diagnostic aid
  • Glucose - oral glucose tolerance test, to establish gestational diabetes, hypoglycaemia, energy source, water replacement, ketoacidosis management
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12
Q

Give an example of a biguanide.

A

Metformin

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13
Q

What is an example of a sulfonylurea?

A

Gliclazide

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14
Q

What is are two examples of thiazolidinediones/glitazones?

A

Pioglitazone

Rosiglitazone

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15
Q

What is the mechanism of action of thiazolidinediones?

A

PPARy(gamma) receptor agonist - increases insulin sensitisation in muscle and adipose tissue

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16
Q

Is there weight gain with the thiazolidinediones?

A

Yes - due to fat cell differentiation

17
Q

What are some ADRs of thiazolidinediones?

A
  • GI upset
  • Fluid retention
  • Fracture risk
  • Bladder cancer - hence used less often
18
Q

Give two examples of GLP1 analogues.

A
  • Exenatide

* Liraglutide

19
Q

How do GLP1 analogues work?

A

Incretin mimetics - increase glucose dependent synthesis of insulin secretion from beta-cells by activating the GLP1 receptor and are resistant to degradation by DPP-4

20
Q

When do you use e.g. exenatide?

A

As an add-on if triple therapy is ineffective

21
Q

What are the ADRs of GLP1 analogues?

A
  • GI upset

* Decreased appetite with weight loss (initially useful if high BMI, but monitor)

22
Q

What are two examples of sodium-glucose co-transporter 2 (SGLT-2) inhibitors?

A
  • Canagliflozin

* Dapagliflozin

23
Q

What are the ADRs of SGLT-2 inhibitors?

A
  • UTI
  • Genital infections
  • Thirst
  • Polyuria
24
Q

What are the DDIs of SGLT-2 inhibitors?

A
  • Antihypertensives

* Other hypoglycaemic agents

25
Q

What are 4 examples of systemic corticosteroids?

A
  • Betamethasone
  • Dexamethasone
  • Hydrocortisone
  • Prednisolone
26
Q

What is the mechanism of action of systemic corticosteroids?

A

Prevent IL-1 and IL-6 production by macrophages. Inhibit all stages of T cell activation

Act like endogenous cortisol (bind to glucocorticoid receptors) - decrease inflammation, reduce immune response, regulate metabolism

27
Q

Give two examples of drug used in HRT?

A
  • Estradiol

* Medroxyprogesterone acetate

28
Q

What is the mechanism of action of estradiol?

A

Oestrogen steroid hormone - stimulates oestrogen receptors

29
Q

What is the mechanism of action of medroxyprogesterone?

A

Synthetic progesterone - stimulates progesterone receptors

30
Q

Why is HRT prescribed at menopause?

A
  • Reduces the symptoms of hot flushes/sweats and dyspareunia
  • Reduces osteoporosis risk
31
Q

What are the risks of using HRT?

A
  • Increased risk of venous thromboembolism (increased if a smoker)
  • Unopposed oestrogen (ERT) - increased risk of endometrial and cervical cancers
  • Opposed oestrogen (HRT) - increased risk of breast cancer
  • Increased risk of stroke
32
Q

What are two examples of anti-oestrogens?

A
  • Clomifene

* Tamoxifen

33
Q

What are clomifene and tamoxifen?

A

Selective oestrogen receptor modulatiors (SERM)

34
Q

When is clomifene used? How does it work?

A

To treat anovulation

Competes with oestrogen for ER binding. Leads to ovulation through increased production of anterior pituitary hormones

35
Q

When is tamoxifen used? How does it work?

A

Breast cancer

A prodrug, metabolised in the liver to an active metabolite - competes with oestrogen for binding to ER. Causes cells to arrest in the cell cycle

36
Q

How does tamoxifen work differently in breast and endometrial tissue?

A

In breast tissue - is an ER antagonist

In endometrial tissue - is an ER agonist

37
Q

What are 3 examples of bisphosphonates?

A
  • Alendronic acid
  • Pamidronate disodium
  • Zoledronic acid
38
Q

What do bisphosphates do?

A

Reduce bone turnover (used to treat and as prophylaxis of osteoporosis) - control osteoclast activity

39
Q

What are the ADRs of bisphosphonates?

A
  • Upper GI effects - oesophagitis - educate patient on remaining seated or standing for 30 mins after taking
  • Hypocalcaemia - check vit D and calcium levels before starting treatment

Must be taken on an empty stomach as absorption affected by food, especially milk

CPT - Other Drugs (11 decks)

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