Endocrinology Flashcards
List 3 examples for first generation sulphonylurea anti diabetics?
Chlorpropamide
Tolazamide
Tolbutamide
Main side effects of chlorpropamide
Long t1/2 SIADH Disulfiram like reaction 🥂 Weight gain Hypoglycemia Nausea and GI discomfort CI in renal disease, liver disease and frank jaundice
Mechanism of action of insulin secretagogues ( sulphonyl urea and meglitinides)
Close ATP dependent potassium channel, membrane depolarization,
Open voltage gated Ca channels allow Ca mediated exocytosis of insulin
Main side effects of metformin
Metallic taste Nausea, vomit 🤢, anorexia Lactic acidosis 🥂 Decrease absorption of Vit B 12 Preoperative or before RMI - lactic acidosis esp in patient with renal disease.
What are the main side effects of Thiazolidinediones?
Liver toxicity ( met by CYP )
Weigh gain and fluid retention ( CI in severe heart failure💔)
Bose Osteopenia and increase fracture risk.
Rosiglitazine cause MI
Pioglitazone bladder cancer
Increase risk of pregnancy 🤰🏻
In which conditions is alpha glucosidase inhibitors contraindicated?
IBD
Colonic ulcer
Intestinal obstruction
Examples of DPPI
Sitagliptin
Saxagliptin ( met by CYP 3A4/5 inhibitors)
Linagliptin (no dose adjust in kidney disease)
Alogliptin
Effect of pioglitazone and Rosiglitazone on Lipids
Both increase HDL
Pioglitazone decrease TG
Rosiglitazone increase LDL and TG
Examples of Sodium glucose cotransporter 2 inhibitors
Promote renal secretion of glucose in proximal tubule
Take on EMPTY stomach in the Morning
Canagliflozin
Dapagliflozin
What are the main side effects of SGLT2 inhibitors.
Urinary tract infection Vulvovaginal candidiasis Urinary frequency - osmotic diuretic Dehydration Hypotension Hyperkalemia
Antidiabetic medication should be taken 30 min before food or with first bite?
Meglitinides
Acarbose
Antidiabetic medication associated with increase fracture risk and osteopenia?
Thiazolidindiones
Effect of insulin on potassium level.
Insulin cause the shift of potassium from outside the cell to inside the cell.
Therefore used in treatment of hyperkalemia
Antidiabetic medication causing pancreatitis?
DPPI ( sitagliptin, saxagliptin, alogliptin, linagliptin)
GLP 1 - Incretin mimetics ( Exenatide, Liraglutide) 💉💉
Anti diabetic Cause nasophargitis and upper respiratory tract infection?
DPPI 4 inhibitors
Drugs that cause dysglycemia?
Atypical antipsychotics B antagonist Diuretics thiazides and loop Diazoxide Glucocorticoids Niacin Isoniazid Pentamidine Protease inhibitors Tacrolimus Interferon alpha
Risk for diabetes mellitus
Obesity
Age greater 40
Overweight, dyslipidemia, Hypertension
Vascular disease (coronary, cerebrovascular, peripheral)
Gestational diabetes
Vascular disease -(Coronary, cerebrovascular, peripheral)
History of impaired glucose tolerance or impaired fasting glucose
Schizophrenia
When should we start insulin therapy immediately in diabetic patient at time if diagnosis?
HbAC1 >= 9% عالي اوي. Or I can give 2 Oral medications
Normal 4-6٪
What are the vaccines recommended in Diabetes
Annual influenza vaccine
One time pneumococcal vaccine (2nd if older than 65 and received dose 5 years earlier)
Monitoring in diabetes
Annual- foot exam, serum creatinine, ophthalmologist
3months- HbA1c. If good 6 months
3 months- lipid profile and start statins
What is advantage of adding metformin to insulin?
Dec insulin dose
Less weight gain
Less Hypoglycemia
Avoid adding TZD to insulin-edema and wit gain inc HF
Management of hypoglycemia
Conscious- oral glucose
Unconscious- IM or SC glucagon
OR
IV dextrose (malnutrition or alcohol induced)
Medications for diabetic patients for vascular protection?
- Antiplatelets ( macrovascular or microvascular complications , long standing diabetes, age greater 45 male , 50 females)
- Statin male greater than 45 , female greater than 55
- Blood pressure less than 130/80
Medications for pregnant women 🤰🏻and diabetic?
Insulin (Lispro, Aspart)
Glyburide
Metformin
What is meant by metabolic syndrome?
Central obesity, hypertension, dyslipidemia, insulin resistance, glucose abnormalities.
Short term diabetes risk
Long term cardiovascular risk
Management of Diabetic ketoacidosis?
Fluids
Potassium
Insulin IV
Bicarbonate
Thyroid hormone interact with?
Calcium Antacid Fe supplement Sucralfate -2hrs separate Cholestrylamine; Colestipol-separate 6hrs Soya fiber Raloxifene (Separate 12 hours)
Pregnant 🤰🏻 thyroxine requirement
Elderly 👴🏽thyroxine requirement
Patient with coronary disease requirement 💔
Pregnant 🤰🏻- Inc dose due to inc in thyroid binding globulin.
Elderly 👴🏽thyroxine requirement -
Patient with coronary disease requirement 💔-
Both start low dose 12mcg/day and titrate every 4 weeks
Conditions associated with hyperthyroidism
Grave’s disease 👀protrusion of eye ball
Plummer disease
Diffuse toxic goiter
Toxic nodular goiter
DOC for woman with hyperthyroidism and pregnant 🤰🏻
Polythiouracil
More agranulocytosis
Are corticosteroids used in hyperthyroidism ?
Yes
Adjuvant in treatment of resistant hyperthyroidism
Dexamethasone-Thyroid storm
Hydrocortisone- Myxedema Coma
How to inhibit prolactin secretion 🍼
Bromocriptine/Cabergoline activate D2 receptor in Pituitary -> Inhibit prolactin secretions
Where is prolactin secreted from?
Anterior pituitary
Where is Oxytocin and vasopressin secreted from?
Posterior pituitary VO
Management of thyroid storm
B blocker to stop sympathetic stimulation (CCB if pt asthma or HF)
PTU stop hormone production
Iodides inhibit hormone release
Glucocorticoids
What are the secretions of the hypothalamus?
Thyrotropin Releasing Hormone-TRH Prolactin Releasing Hormone-PRH Corticotropin Releasing Hormone-CRH Growth Hormone Releasing Hormone -GHRH Gonadotropin Releasing Hormone - Gn RH
Secretions from anterior pituitary?
Prolactin Thyrotropin Stimulating Hormone TSH Adrenocorticotropic hormone ACTH - Corticotropin LH FSH
Growth hormones inhibiting hormones
Octreotide- Somatostatin analogue that binds to somatostatin receptors in pituitary and decrease Growth hormone ( ttt of acromegaly) and dec TSH ( ttt of thyrotropinoma in pituitary) and in secretory diarrhea due to Vipoma.
Pegvisomat 🐷🐷 GH receptor Antagonist
What is the mechanism of Raloxifen and side effects?
Agonist on bones (ttt of osteoporosis)
Antagonist on breast and uterine 🙂
Hot Flashes
DVT, PE
Retinal vein Thrombosis
Leg cramps
Androgens Examples
Danazol
Stanozolol
Nandrolone
Oxandrolone
Fluoxymesterone
OF - Oral
Examples of antiandrogens?
Inhibit androgen synthesis -5a reductase inhibitors
Dutasteride
Finasteride
Block androgen receptor - BNF
Bicalutamide
Nilutamide
Flutamide
Gonadotropin Releasing Hormone - Gonadorelin
Synthetic analogues act on GnRH receptors
Leuprolide
Goserelin 👨🏻جوزي
Nafarelin 🤧 نف
Histrelin
Gonadotropin
Gonadotropin are glycoproteins from posterior pituitary
Menotropin (HMG) - LH + FSH
Chorionic gonadotropin hCG - LH
Urofollitropin -FSH
Follotropin
Managment of hyperaldosteronism
Due to inc in aldosterone Cause: -Alkalosis -Hypokalemia -retention of Na and water - Loss of K and H
Treatment
Spironolactone
Eplerenone
Diagnosis of Cushing syndrome
Treatment of Cushing syndrome
Diagnosis-Dexamethasone
Treatment-Ketoconazole or surgery
