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Clinical pharmacology and therapeutics > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Describe how carbohydrates are metabolised

A

Carbohydrates ingested
Carbohydrates digested by enzymes in stomach and intestine to release glucose
Glucose absorbed into blood stream stimulates pancreas to release insulin
Glucose is then stored in fat, muscle and in the liver

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2
Q

What is insulin?

A

Hormone which acts like a key to unlock the body’s cells and let glucose in which is then converted to energy

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3
Q

What is diabetes mellitus?

A

A syndrome of chronic hyperglycaemia due to reactive insulin deficiency, resistance or both

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4
Q

What is the optimum blood glucose level before a meal?

A

4-7 mmol/L

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5
Q

What is the optimum blood glucose level 2 hours after a meal?

A

<10mmol/L

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6
Q

What advice can you give someone with T2DM?

A

Lifestyle interventions

CV risk reduction

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7
Q

When is HBA1C not an appropriate way of measuring diabetic control?

A

Young
Pregnant
T1DM
Diabetes symptoms <2 months
Medication causing a rapid rise in glucose such as steroids and antipsychotics
Acute pancreatic damage including surgery
Genetic and haematological factors

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8
Q

Describe treatment intensification for the management of T2DM

A

Initial drug therapy - Monotherapy - Non insulin blood glucose therapy
First intensification - Dual therapy - Non insulin blood glucose therapy
Second intensification - Triple therapy - Non insulin blood glucose therapy + any combination with insulin

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9
Q

Describe how muscle and fat affect the glucose level in T2DM

A

Insulin resistance

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10
Q

Describe how the pancreas affects the glucose level in T2DM

A

Beta cell dysfunction

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11
Q

Describe how the gut affects the glucose level in T2DM

A

Glucose absorption

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12
Q

Describe how the liver affects the glucose level in T2DM

A

Hepatic glucose overproduction

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13
Q

What T2DM drugs target the pancreas?

A

Sulfonylureas
Meglitinides
DPP4 inhibitors
GLP1 analogs

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14
Q

Which T2DM drugs target the liver?

A

Metformin
Thiazolidinediones
DPP4 inhibitors
GLP1 analogs

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15
Q

Which T2DM drugs target the gut

A

Alpha glucosidase inhibitors
GLP 1 analogs
Pramlintide

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16
Q

Which T2DM drugs target muscle and fat?

A

Thiazolidinediones

Metformin

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17
Q

Which is the most common first line treatment for T2DM?

A

Metformin

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18
Q

List the side effects of metformin

A

Anorexia, GI disturbance, metallic taste, metabolic acidosis, decreased vitamin B12 absorption

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19
Q

What happens to peoples weight as a result of metformin?

A

Remains neutral

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20
Q

Where does metformin target?

A

Liver and muscle

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21
Q

Where do sulfonylureas target?

A

Pancreas

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22
Q

Name some sulfonylureas

A 
Glipizide 
Gliclazide 
Tolbutamide
Glimepiride 
Glibenclamide
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23
Q

List the side effects of sulfonylureas

A

Hypos - inform DVLA
GI disturbance
Weight gain
Deranged LFTS

24
Q

Where do thiazolidinediones act?

A

Liver
Pancreas
Fat cells
Muscle cells

25
Q

Name a thiazolidinedione

A

Pioglitazone

26
Q

What are thiazolidinediones associated with?

A

Increased risk of HF, bladder cancer and fractures

27
Q

How long does it take thiazolidinediones to take full effect?

A

8 weeks

28
Q

List the side effects of thiazolidinediones

A 
GI disturbance
Weight gain
Oedema 
Hypoglycemia 
Altered lipids
29
Q

When should you continue thiazolidinediones?

A

If there is a reduction of at least 0.5% HbA1c in 6 months

30
Q

Name some glucagon like peptide 1 receptor agonists

A

Exenatide
Liraglutide
Lixisenatide

31
Q

When do you continue GLP1 agonists?

A

If beneficial metabolic response in 6 months

32
Q

How are GLP 1 agonists administered?

A

SC injection

33
Q

Who should you be cautious of giving GLP1 agonists to?

A

Elderly and those with renal problems

34
Q

What interactions should patients be aware of when taking GLP1 agonists

A

Take other medications 1 hour before or 2 hours after injections

35
Q

List the side effects of GLP 1 agonists

A 
GI disturbance 
Weight loss
Hypoglycemia 
Pancreatitis 
AKI
36
Q

Name some dipeptidyl peptidase 4 inhibitors

A 
Alogliptin
Linagliptin
Saxagliptin 
Sitagliptin
Vildagliptin
37
Q

When should sitagliptin and vildagliptin be continued?

A

If reduction is at least 0.5% HbA1c in 6 months

38
Q

What must you do when prescribing DPP4 inhibitors in liver and renal impairment?

A

Reduce the dose

39
Q

List the side effects of DPP4 inhibitors?

A

GI disturbance
Peripheral oedema
Pancreatitis

40
Q

Where are sodium glucose co transporter 2s located?

A

Proximal tubule

41
Q

What percentage of filtrate is reabsorbed by SGLT2s

A

90%

42
Q

Name some sodium glucose co transporter 2 inhibitors

A

Canagliflozin
Dapagliflozin
Empagliflozin

43
Q

Describe the mechanism of action of SGLT2 inhibitors

A

Blocks lucose reabsortption in the proximal renal tubule

44
Q

When should you be cautious of prescribing SGLT2 inhibitors

A

Volume depletion
CVD
Liver and renal impairment

45
Q

List the side effects of SGLT2 inhibitors

A

GI disturbance
Dyslipidaemia
Urinary symptoms
Dehydration

46
Q

Which SGLT2 inhibitor is not indicated with pioglitazone?

A

Dapagliflozin

47
Q

Name an alpha glucosidase inhibitor

A

Acarbose

48
Q

Describe the mechanism of action of alpha glucosidase inhibitors

A

Delays glucose absorption from the gut after a carbohydrate meal by blocking glucosidase in the small intestine

49
Q

When should you avoid alpha glucosidase inhibitors

A

Renal and liver impairment

50
Q

List the side effects of alpha glucosidase inhibitors

A

Nausea and vomiting
Diarrhoea
Flatulence
Hypos

51
Q

What must you monitor when prescribing alpha glucosidase inhibitors

A

Liver

52
Q

Name some meglitinides

A

Nateglinide

Repaglinide

53
Q

Describe the mechanism of action of meglitinides

A

Stimulate insulin secretion in the presence of glucose

54
Q

What is the main side effect of meglitinides

A

Hypoglycaemia (less so than SU)

GI disturbance

55
Q

Name a biguanide

A

Metformin

56
Q

Which drug is the only one that can be used to treat gestational diabetes?

A

Metformin

57
Q

Describe the DVLA regulation on diabetes and driving

A

Must inform the DVLA
Insulin, Sulfonylureas, meglitinides
Test blood glucose a maximum of 2 hours before driving and every 2 hours during driving

Clinical pharmacology and therapeutics (27 decks)

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