Metabolic

Question 1

Insulin

Answer 1

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

Question 2

sulphonylureas (glibenclamide, tolbutamide)

Answer 2

block KATP » increased insulin secretion (depol and Ca in);

SEs: weight gain, insulin resistance, risk of hypos (esp meal skip and elderly)

Question 3

metformin (biguanide)

Answer 3

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

Question 4

meglitinide analogues

Answer 4

indirect inhib of KATP; fast-acting (prandial control)

Question 5

glitazones (thiazolidinediones)

Answer 5

‘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

Question 6

statins

Answer 6

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

Question 7

fibrates

Answer 7

PPAR-a activators; controversial; decrease TAG (and glucose); can be combined with statins;

SEs: rhabdomyolysis

Question 8

binding agents (colesystyramine)

Answer 8

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)

Question 9

thioamides

Answer 9

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)

Question 10

beta-blockers

Answer 10

non-selective; relieve tremor, anxiety, palpitations

Question 11

levothyroxine

Answer 11

replacement of thyroid function after high-dose carbimazole » blockade; 25-100mcg start, increase 25-50mcg

SE: may worsen/uncover angina

Question 12

Diabetes complications (HTN and nephropathy)

Answer 12

HTN: ACEI (also renoprotective) +/- CCB +/- diuretic; aim