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Pharamacology, theraputics and prescribing > Endocrinology drugs > Flashcards

Endocrinology drugs Flashcards

1
Q

Name one ultrafast acting inuslin

A

FiAsp (aspartate insulin)

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2
Q

Name one fast acting insulin

A

Actrapid

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3
Q

Name one short acting insulin

A

Novorapid, Humulin S, hypurin bovine or procine insulin

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4
Q

Name home intermediate acting insulin

A

humulin 1- isophane insulin

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5
Q

Name one long acting and ultra long acting insulin

A

Long acting- Glargine

Ultra long acting- Glarudec

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6
Q

Name one combination insulin or rapid and intermediate insluns given together

A

Novomix 30, Humulin M3

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7
Q

What class of drugs does metformin belong to?

A

Biguanides

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8
Q

Give an example of a sulphonylurea used to treat type 2 diabetes?

A

Gliclazide

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9
Q

Give an example of a glitazone which were used to treat type 2 diabetes?

A

poiglitazone

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10
Q

How do acarbose work to treat type 2 diabetes?

A

Inhibit a- glucosidase so inhibit breakdown of carbohydrates to glucose in gut, this lowering blood glucose.

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11
Q

How do glifozins such as dapagliflozin work to treat type 2 diabetes?

A

Inhibits SGLT2 in the PCT of the kidneys, so more glucose is excreted and less is absorbed into blood.

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12
Q

Name 3 classes of drugs which increase insulin release from beta cells of islets of langerhans

A

glucagon like peptide 1, sulphonylureas, gliptins/ DDP-4 inhibitors

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13
Q

Name 2 classes of drugs which decrease resistance to insulin?

A

Biguanide (metformin), glitazones

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14
Q

Ethinyestradiol, mestranol and valerate are examples of synthetic versions of which hormone?

A

oestrogen

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15
Q

Levonorgestrel, Norethindrone and medroxyprogesterone are synthetic versions of which hormone?

A

progesterones (progestins- are synthetic progesterones)

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16
Q

What oestrogen antagonist can be used to treat infertility and how does it work?

A

Clomiphene- inhibits oestrogen and its negative feedback on the anterior pituitary, causing ovulation

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17
Q

Give an example of an oestrogen antagonist used to treat ER+ve breast cancer

A

Tamoxifen

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18
Q

Give an example of an antiprogestin and state its uses

A

Mifepristerone

Inuduces labour and used in abortions

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19
Q

State one drug which can be used to prevent hair loss, treat male pattern balding and BPH, describe how it works

A

Finasteride

Inhibits breakdown of testosterone to dihydrotestosterone, so increases testosterone levels

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20
Q

name two compounds used in HRT

A

oestradiol, medroxyprogesterone

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21
Q

Name two emergency contraceptions

A

Levonorgestrel, ulipristal acetate

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22
Q

Give 3 adverse effects of insulin

A
  • hypoglycaemia (insulin levels inappropriately high)
  • hyperglycaemia
  • lipodystrophy (fat hypertrophy or atrophy at injection site-more so with older insulins)
  • Painful injections (more with long acting insulins as are prepared in acid to help preserve them)
  • allergies
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23
Q

Describe 2 insulin regimes

A
  • long acting insulin (eg glargine) twice a day, with rapid acting insulin (actrapid, aspart) before meal times
  • rapid actin insulin (novorapid) 5-10 mins before meals, maybe delivered by a pump w/ continous low background dose
  • low doses of intermediate insulin and rapid insulin, with higher doses of insulin delivered at night time
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24
Q

What is the Hba1c target in those with T2 diabetes?

A

<7.5%

25
Q

Give 2 non pharmacological treatments of T2 diabetes

A

Bariatric surgery, exercise programmes, dieticians

26
Q

How does metformin work?

A
  • decreases insulin resistance, so more glucose enters tissues
  • decreases hepatic production of glucose
  • limits weight gain
  • decreases CVS events
27
Q

Give 2 side effects of metformin

A
  • Gi upset
  • cant be used in severe CKD
  • hypoglycaemia
  • lactic acidosis rare but possible
28
Q

How do sulphonylureas such as gliclazide treat T2 diabetes?

A

They stimulate beta cells to secrete insulin

29
Q

What are the 2 main side effects of gliclazide?

A
  • weight gain

- hypoglycaemia

30
Q

What are the side effects of acarbose?

A

Flatualance and diarrhoea, so severe that this drug is rarely used now

31
Q

How do the thiazolidinediones (glitazones) eg pioglitazone work?

A
  • increase sensitivity to insulin
  • decrease hepatic gluconeogenesis
  • By binding to one or more of the peroxisome proliferator activated receptors (PPARs)
32
Q

Give 3 side effects of pioglitazone

A
  • weight gain
  • fluid retention
  • heart failure
  • bladder cancer
  • effects on bone metabolism
  • For these reasons theyre hardly used now
33
Q

How do glucagon like peptide 1 analogues work in diabetes?

A
  • increase insulin secretion from beta cells
  • decrease production of glucagon from alpha cells
  • also increase satiety and gastic emptying–> this leads to weight loss
34
Q

Describe 3 disadvatages and side effects to Glucagon like peptide 1 analogues

A
  • they have to be injected
  • GI uset
  • GORD
  • avoid is CKD
  • generally well tolerated however
35
Q

How do gliptins of DPP- 4 inhibitors work?

A

They increase glucagon like peptide 1 levels, thus having similar effects to synthetic GLP1 analogues, however arn’t as good at causing weight gain and are more expensive

36
Q

How do glifozins like dapaglifozin work? What are the 2 common side effects?

A

inhibits SGLT2 in proximal tubule, so more glucose is excreted however will therefor cause polyuria and increased risk of UTIs and thrush.

37
Q

How does carbimazole work? What is it used for?

A

Used to treat hyperthyroidism, it is converted to methimazole by the liver, which inhibits thyroid peroxidases from coupling iodine and thyroglobulin so inhibits T3 and T4 production

38
Q

give 2 common side effects of carbimazole?

A
  • rashes and pruritis
  • GI upset
  • headaches, joint pain
  • can also get bone marrow surpression but this is rare
39
Q

When is levothyroxine used and how does it work?

A

synthetic T4, used to treat hypothyroidism

40
Q

Give 3 side effects of levothyroxine

A

palpitations, weight loss, heat intolerance, sweating, anxiety, tremour, increased appetite

41
Q

What characteristics of synthetic sex hormones give them a long half life?

A
  • 99% bound to albumin and sex hormone binding globulin

- very lipophilic so large Vd

42
Q

Describe the 3 regimes of COCP you can take?

A
  • monophasic (most common)- O and P taken continiously for 21 days, then 7 day break
  • biphasic- continious conc of O, P will increase gradually in second phase of cycle
  • triphasic- O conc may change, P conc increases in 3 phases
43
Q

How 4 adverse effects of the COCP

A
  • increase coagulability –> increase VTE, PE, MI, Stroke risk
  • hypertension
  • decrease glucose tolerance
  • headaches
  • weight gain (water retention)
  • mood swings
  • gall stones
44
Q

Give 3 absolute and 2 relative contraindications of the COCP?

A

Absolute: age over 35 and smoking >15p/d, migranes, Hx VTE diseases, breast cancer, Major immobility
Relative: overweight, FHx VTE disease in 1st degree relative <45 yrs, breast feeding

45
Q

What effect do carbemazepine and rifamicin have on the COCP?

A

both induce CYP450, so increase COCP metabolism, so decrease efficacy of COCP

46
Q

List 3 adverse effects of the POP

A
  • weight gain
  • fluid retention
  • acne
  • N+ V
  • irritable, PMS, depression
47
Q

What is the advice if one pill is missed?

A

take miss pill immediatly, even if means taking 2 in one day, continue taking rest of pack as normal, you should be fine

48
Q

What is the advice is 2 pills are missed?

A

Take last pill immediatly, even if means taking two in one day, take rest of pack as normal but use extra contraception for next 7 days.
If in last 7 days of pack, miss break and keep taking the pills

49
Q

What are the benefits of HRT?

A
  • can reduce vasomotor symptoms and osteoporosis risk
  • can improve sleep and QoL
  • can improve mood
  • Can improve uro- genital symptoms
50
Q

What are the risks of HRT?

A
  • increase endometrial and ovarian cancer with ERT
  • breast cancer risk with HRT
  • Can increase risk of stroke and IHD
  • Increases risk of VTE
  • breast tenderness, headaches, bloating common side effects
51
Q

What are the two HRT regimes

A
  • O and P continuously for 28 days

- O continuously and P for last 14 days only- if last menstural period >1 yr ago

52
Q

When is HRT indicated?

A
  • when benefits outweigh risks
  • for women with early menopause (before 51), even if asymptomatic
  • women under age of 60 with osteoporotic risk
53
Q

What is raloxifene and when is it used?

A

A selective oestorgen receptor modulator (SERM) used to reduce osteoporsis risk, which doesnt have any effect on breast or endometrium, but may increase hot flushes

54
Q

How can HRT be administered?

A

oral, transdermal, implant, transvaginal, nasal

55
Q

Why may unopposed oestrogens (ERT) be given to pts who have had radial hysterectomy?

A

Theyve had ovaries and uterus removed, so no risk of endometrial or ovarian cancer. This will help delay menopause. However they will have to keep taking ERT until the age of normal menopause at age 51.

56
Q

Describe how insulin release is controlled?

A

More glucose= more atp production, ATP inhibits ATP sensitive K+ channels, so less K+ efflux, so membrane depolarises, so Ca2+ enters and vesicles of insulin can be released.

57
Q

How does gliclazide (sulphonylureas) work?

A

Antagonise ATP sensitive K+ channels so less K+ efflux, so membrane depolarises more so more insulin release

58
Q

How does metformin work?

A

Reduces cellular stores of ATP, this increases AMPK, which stimulates glycogen storage, decreases gluconeogenesis and increases tissue sensitivity to insulin

Pharamacology, theraputics and prescribing (15 decks)

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