Metabolic Flashcards
Insulin
replacement of insulin; glucose into cells;
short/int/long-acting;
basal-bolus, biphasic, once-daily regimens;
more if stress, trauma, infection, puberty, preggo T2/3
less if endocrine (e.g. Addison’s), coeliac, hep/renal impairment
sulphonylureas (glibenclamide, tolbutamide)
block KATP » increased insulin secretion (depol and Ca in);
SEs: weight gain, insulin resistance, risk of hypos (esp meal skip and elderly)
metformin (biguanide)
AMP-K inhibition » decreased gluconeogenesis and increased GLUT; not for renal impairment; may help weight loss
SEs: GI (bloating, distension, flatulence) - not always tolerated
NOT FOR RENAL IMPAIRMENT
meglitinide analogues
indirect inhib of KATP; fast-acting (prandial control)
glitazones (thiazolidinediones)
‘sensitisers’; PPAR-a agonists » GLUT, decreased resistance, decreased hep glucose, increased fat uptake into cells;
monitor LFTs; weight gain, fluid retention, fracture risk, uncover/worsen CHF
statins
stop the production of cholesterol; 10/20 prevention of IHD (‘ASCAB’);
also ^LDL-R
less effective in familial; used for MI and angina; patients with >30% 10y risk or >20% with >5mM cholesterol
fibrates
PPAR-a activators; controversial; decrease TAG (and glucose); can be combined with statins;
SEs: rhabdomyolysis
binding agents (colesystyramine)
reduce bile » reduced fat absorption » reduced cholesterol and TAG synthesis (13-25%); combo with statin;
also ^ LDL-R
SEs: decreased absorption of fat-sol vitamins and drugs (e.g. digoxin, thiazides)
thioamides
block TPO » decreased Tg production » decreased hormone production and thyroid function; delayed onset (long half-life of thyroid hormones)
SEs: agranulocytosis, leucopenia (sore throat, ulcers, bruising)
beta-blockers
non-selective; relieve tremor, anxiety, palpitations
levothyroxine
replacement of thyroid function after high-dose carbimazole » blockade; 25-100mcg start, increase 25-50mcg
SE: may worsen/uncover angina
Diabetes complications (HTN and nephropathy)
HTN: ACEI (also renoprotective) +/- CCB +/- diuretic; aim