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endocrine > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

who usually gets prescribed insulin

A

T1DM patients

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1
Q

MOA of insulin

A

lowers blood sugar

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1
Q

what insulin regimen are most T1DM patients on

A

basal-bolus
long acting insulin 1-2 times a day and short acting insulin before each meal

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2
Q

what is the preferred short acting insulin and why

A

insulin analogues
disappear from circulation more rapidly than soluble insulin so less likely to cause hypoglycaemia

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3
Q

what is one thing you need to be aware of with injecting insulin

A

rotate injection site to prevent lipohypertrophy

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4
Q

name some adverse effects of insulin

A

can cause weight gain and hypoglycaemia

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5
Q

how can insulin be administered (2)

A

intermittent SC injections or via a pump

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6
Q

what kind of drug is metformin

A

biguanide

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7
Q

indication of metformin

A

first line in all patients with T2DM

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8
Q

MOA of metformin

A

reduces hepatic glucose production and increases gut glucose utilisation and metabolism

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9
Q

is metformin glucose dependent or independent

A

glucose independent

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10
Q

give one non-glucose effect of metformin

A

has a cardiovascular benefit

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11
Q

when is metformin contraindicated (3)

A

renal impairment
cardiac failure
hepatic failure

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12
Q

how to reduce side effects of metformin

A

initiate slowly or use a modified release formulation

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13
Q

name some side effects of metformin

A

diarrhoea, bloating, abdo pain, dyspepsia, metallic taste in the mouth, decrease in appetite

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14
Q

name one complication of metformin use

A

metformin associated lactic acidosis

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15
Q

what should happen to metformin dose as renal function decreases

A

dose should be decreased

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16
Q

name a sulfonylurea

A

glicazide

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17
Q

indication of sulfonylureas

A

alternative first line treatment of T2DM when metformin is too expensive

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18
Q

MOA of sulfonylureas

A

act on the β-cell to induce insulin secretion even when there is no increase in glucose concentration

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19
Q

name the 2 main adverse effects from sulfonylureas

A

weight gain, hypoglycaemia

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20
Q

name one TZD

A

pioglitazone

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21
Q

what is a TZD

A

Thiazolidinediones

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22
Q

what is the only insulin sensitiser used in the treatment of T2DM

A

TZDs

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23
which diabetes drug causes peripheral oedema
TZDs
24
indication for the use of TZDs
as a monotherapy instead of metformin in addition to other drugs
25
MOA of TZDs
selective agonists of PPAR-γ nuclear receptor increased expression of genes involved in glucose uptake and utilisation
26
name 3 adverse effects of TZDs
weight gain increased fracture risk mild anaemia
27
name a GLP1 agonist
semaglutide
28
what should diabetic patients with atherosclerotic CVD be prescribed (2)
metformin + GLP1 receptor agonist
29
what should diabetic patients with HF or CKD be given where SGLT2i are not indicated (2)
metformin + GLP1 agonist
30
MOA of GLP1 receptor agonists
enhance the incretin effect by activating the GLP1 receptors promote insulin secretion and lower glucagon, increase satiety
31
non-glucose effects of GLP1 agonists (4)
reduce appetite reduce gastric emptying lower blood pressure reduction in cardiovasc mortality
32
who can GLP1 agonists be useful for
diabetic patients who want to lose weight
33
contraindication of GLP1 agonists
patients with history of pancreatitis
34
adverse effects of GLP1 agonists
nausea, vomiting, bloating, diarrhoea small increase in incidence of gallstones
35
how are GLP1 agonists administered
SC injection self-administered once a week
36
name 2 DPP4 inhibitors
sitagliptin, alogliptin
37
indication of DPP4 inhibitors
monotherapy when metformin not tolerated or as an addon
38
MOA of DPP4 inhibitors
inhibits the breakdown of GLP1 and GIP increasing insulin secretion and reducing glucagon secretion
39
name 1 non-glucose effect of DPP4 inhibitors
lower blood pressure
40
is there a risk of hypoglycaemia when using DPP4 inhibitors
no- act via the amplifying pathway so are glucose dependent
41
name one SGLT2i
Dapagliflozin
42
first line management of diabetes in a patient with HF or CKF
metformin + SGLT2i
43
non-glucose effects of SGLT2i (3)
mild diuretic action reduces plasma urate protection (beneficial for gout) renal protection
44
MOA of SGLT2i
lowers renal threshold for glucose increasing urinary glucose excretion
45
name 1 complications of SGLT2i
DKA
46
what should happen to your SGLT2i during prolonged fasting or acute illness
STOPPED
47
name the main adverse effects of SGLT2i
genital candidiasis
48
indication for levothyroxine
hypothyroidism
49
what is levothyroxine
a manufactured form of thyroxine
50
name some medications that can impair absorption of levothyroxine (3)
PPIs, iron tablets and calcium tablets
51
dosing levothyroxine in pregnancy
dose requirements may increase by 25-50%
52
when do adverse effects of levothyroxine usually occur
when dose is too high - leading to hyperthyroidism
53
how and when should levothyroxine be taken
PO before breakfast
54
what is the first line treatment for hyperthyroid
carbimazole
55
MOA of carbimazole
Inhibition of TPO thereby blocking thyroid hormone synthesis
56
contraindication of carbimazole
shouldn't be used in the first trimester of pregnancy
57
name a mild adverse effect of carbimazole
allergic type reaction - rash, urticaria, arthralgia
58
name a severe adverse effect of carbimazole
agranulocytosis
59
when is the highest risk of agranulocytosis when taking carbimazole
in the first 6 weeks
60
indication for propylthiouracil
first line for hyperthyroidism in the first trimester of pregnancy
61
how may agranulocytosis present in a patient taking carbimazole
fever, oral ulcer or oropharyngeal infection
62
MOA of propylthiouracil
Inhibits DIO1 which decreases conversion of T4 to T3
63
adverse effects of propylthiouracil
Allergic type reactions, agranulocytosis, cholestatic jaundice
64
main endocrine indication for β-blockers
immediate symptomatic relief of thyrotoxic symptoms
65
what is the main β-blocker used in endocrinology
propranolol
66
caution of using β-blocker in endocrinology
use carefully in patients with asthma
67
name 3 adverse effects of β-blockers
nausea, headaches, tiredness
68
main indication for prescribing testosterone
Hypopituitarism resulting in testosterone deficiency
69
when is testosterone contraindicated (5)
confirmed hormone responsive cancer (breast, prostate) possible prostate cancer haematocrit <50% severe sleep apnoea heart failure
70
name some complications of testosterone
can cause polycythaemia oral tablets can cause hepatitis
71
what are the main 2 ways testosterone is administered
IM injection skin gel
72
main indication of somatostatin analogues
GH-secreting pituitary adenoma resulting in acromegaly/gigantism
73
name some short term adverse effects of somatostatin analogues
flatulence, diarrhoea, abdo pains
74
name a long term adverse effect of somatostatin analogues
gallstones
75
administration of somatostatin analogues
monthly injections
76
name a dopamine agonist
cabergoline
77
main indication for a dopamine agonist
prolactinoma
78
MOA of dopamine agonists
act on D2 receptors
79
name some adverse effects of dopamine agonists
N+V, low mood, may cause fibrosis of heart valves ?
80
give an example of a GH antagonist
pegvisomant
81
main indication of GH antagonists and why they aren't used often
GH-secreting pituitary adenoma resulting in acromegaly/gigantism VERY EXPENSIVE

endocrine (15 decks)

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