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DRUGS > endocrinology > Flashcards

endocrinology Flashcards

1
Q

types of inuslin

A

rapid acting - insulin aspart- Novorapid

short acting - soluble insulin - Actrapid

intermediate acting - isophane (NPH) - Humulin 1

Long acting - insulin glargine(lantus), insulin determir (levemir)

biphasic insulin preparations - mixture of rapid and intermediate - novomix 30 (aspart + aspart protamine)

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2
Q

mode of action of insulin

A

in diabetes, stimulates glucose uptake from circulation into tissues inc. skeletal muscle and fat and increases use of glucose as energy store

stimulates glycogen, lipid and protein synthesis and inhibits gluconeogenesis amnd ketogenesis

reduces serum K+ short term

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3
Q

indications for insulin

A

insulin replacement with type 1 diabetes and for blood flucose control in type 2 hwere oral hypoglycaemic treatment is inadequate

IV for diabetic emergencies (ketoacidosis, hyperglycaemias hyperosmolar synfrome and for perioperative glycaemic control)

hyperkalaemia - alongisde glucose while other measures initiated

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4
Q

contraindications for insulin

A

renal impairment

insulin clearance reduced = icnreased risk of hypoglycaemia

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5
Q

side effects of insulin

A

hypoglycaemia - severe can lead to coma and death

repeated SC injection at same site = fat overgrwoth (lipohypertrophy)

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6
Q

interactions of insulin

A

other hypoglycaemic agents increase risk of hypoglycaemia

concurrent therapy with systemic corticosteroids increase insulin requirements

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7
Q

gliclazide

A

sulphonylureas

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8
Q

gliclazide/sulphonylureas mode of action

A

lower blood glucose by stimulating pancreatic inuslin secretion

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9
Q

indications for sulphonylureas

A

type 2 DM
contorl blood glucose and reduce complications where metformin is contraindicated

in combo with metofrmin where blood glucose inadequately controlled

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10
Q

contra-indications of sulphonylureas

A

hepatic impairemnt - reduced dose

gluocse monitoring in renal impairment

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11
Q

side effects of sulphonylureas

A

dose related side effects such as GI upset

hypoglucaemia in high doses, or reduced drug metabolims or when in combo with other hypoglycaemics

hypersenstivity reactions are rare but cause hepatic toxicity, drug hypersensitivity syndrome and haematological abnromalities

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12
Q

interactions of sulphonylureas

A

increased risk of hypoglycaemia if prescribed with metformin, thiazolidinediones and insulin

efficacy reduced by drugs that elevate blood glucose - prenisolone, thiazide and loop diuretics

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13
Q

metformin

A

biguanides

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14
Q

mode of action of metformin/biguanides?

A

lowers blood glucose by increasing repsonse to insulin

does not stimulate pancreatic insulin so does not cuasse hypoglycaemia

reduces weight gain and induce wieght loss = prevent worsening of insulin resistance and deterioration of DM

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15
Q

indications of metformin/biguanides?

A

type 2 DM as first choice medication for control of blood glucose, used alone in combination with other hypoglycaemic drugs (sulphonylureas) or insulin

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16
Q

contraindications of metformin/biguanides

A

severe renal impairement
withheld in AKI, acute alcohol intoxication and chronic alcohol intoxication
caution in hepatic impairment

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17
Q

side effects of metformin/biguanides

A

GI upset

lactic acidosis - rare but fatal if untreated

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18
Q

interactions of metformin/biguanides

A

witheld 48hr post injection of IV contrast - increased risk of renal impairment, metformin acuclulation and lactic acidosis

other drugs impairing renal function

prednisolone thiazide, loop diuretics, elevate blood glucose and reduce efficacy

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19
Q

levothyroxine

A

thyroid hormone

20
Q

levothyroxine mode of action

A

replaces thyroid hormones - liothyronine has shorter half life and quicker onset and offset so reserved for emergency treatment of severe or acute hypothtroidism

21
Q

indications of levothyroxine

A

primary hypothyroidism

hypothyroidism secondary to hypopituitarism

22
Q

contraindications of levothyroxine

A

precipitate cardiac ischaemia in those with CAD

corticosteroid therapy to avoid addisonian crisis in hypopituitarism

23
Q

side effcts of levothyroxine

A

hyperthyroidism in excessive dosage - gastrointestinal (D+V, wt loss) , cardiac (palp, arrhyth., angina) and neurological (tremor, restlessness, insomnia) manifestations

24
Q

possible interactions of levothyroxine

A

GI absorption reduced by antacids, caclium or iron salts (4hrs diff in admin)

increased dose in cytochromic P450 inducers

can increase insulin or oral hypoglycaemic requirements in DM and enhance warfarin

25
Q

carbimazole

A

antithyroid

26
Q

how does carbimazole work?

A

reduces production of thyroid hormones T3 and T4

27
Q

indications for carbimazole

A

hyperthyroidism

28
Q

contraindications fro carbimazole

A

early months of pregnancy
not ideally when breastfeeding
people with severe liver disease or blood disorders

29
Q

side effects of carbimazole

A

rashes and pruritus are common - treat w antihistamines

bone marrow suppression is rare = neutropenia and agranulocytosis

30
Q

possible interactions of carbimazole

A

warfarin
theophylline
erythromycin
steroids - prednisolone

31
Q

alendronate

A

bisphosphonate

32
Q

mode of action of bisphosphonate/alendronate

A

reduce bone turnover by inhibiting the action of osteoclasts (cell responsible for bone resporption)

= reduce bone loss and improve bone mass

33
Q

indications for bisphosphate/alendronate

A

alendronic acid used as first line treatment for those at risk of osteoprootic fragility fractures

used as first line treatment of metabolically active pagets disease - reduce bone turnover and pain

34
Q

contraindications of bisphosphonate

A

avoided in severe renal impairment
hypocalcaemia
oral contraindicated in upper GI disorders
risk of jaw osteonecrosis, avoid in somkers and major dental disease

35
Q

side effects of bsiphosphonate

A

common side effect - oesophagitis and hypophosphatemia

osteonecrosis of jaw

atypical femoral fracture

36
Q

interactions of bisphosphonates

A

bind calcium

absorption reduced if taken with calcium salts inc milk as well as antacids and iron salts

37
Q

inidcations for caclium carbonate

A

osteoporosis

chronic kidney disease - prevent hyperparathyroidism and renal osteodystrophy

severe hyperkalaemia to prevent arrhythmias

severe hypocalcaemia

38
Q

indications for vitamin D

A

osteoporosis

chronic kidney disease - prevent secondary hyperparathyroidism and renal osteodystrophy

prevent and treat vit D deficiency (rickets and osteomalacia)

39
Q

contraindications of vit D and calcium

A

hypercalcaemia

40
Q

side effects of calcium

A

oral calcium well tolerated but may cuase dyspepsia and constipation

Iv can cause cardiovacular collapse if too fast and tissue damage locally if given into SC tissue

41
Q

interactions of calcium

A

reduces absorption of many drugs - iron, bisphosphonates, tetracycline and levothyroxine

IV should not mix with sodium bicarbonate due to risk of precipitation

42
Q

fludrocortisone

A

mineralcorticoid

43
Q

mode of action of fludrocortisone

A

mineralcorticoid replacement in adrenocortical insufficiency

44
Q

indications of fludrocortisone

A

adrenocortical insufficiency

45
Q

contraindications of fludrocortisone

A

systemic infection

avoid live virus vaccines

46
Q

side effects of fludrocortisone

A

same as corticosteroids

47
Q

interactions of fludrocortisone

A

increased risk of peptic ulcers and GI bleeds when used with NSAIDs and enhanced hypokalaemia in patients taking beta2agonists, theophylline, loop or thiazide diuretics

efficacy reduced by cytochrome P450 inducers

reduce immune response to vaccines

DRUGS (13 decks)

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