Pharmacology Flashcards
who usually gets prescribed insulin
T1DM patients
MOA of insulin
lowers blood sugar
what insulin regimen are most T1DM patients on
basal-bolus
long acting insulin 1-2 times a day and short acting insulin before each meal
what is the preferred short acting insulin and why
insulin analogues
disappear from circulation more rapidly than soluble insulin so less likely to cause hypoglycaemia
what is one thing you need to be aware of with injecting insulin
rotate injection site to prevent lipohypertrophy
name some adverse effects of insulin
can cause weight gain and hypoglycaemia
how can insulin be administered (2)
intermittent SC injections or via a pump
what kind of drug is metformin
biguanide
indication of metformin
first line in all patients with T2DM
MOA of metformin
reduces hepatic glucose production and increases gut glucose utilisation and metabolism
is metformin glucose dependent or independent
glucose independent
give one non-glucose effect of metformin
has a cardiovascular benefit
when is metformin contraindicated (3)
renal impairment
cardiac failure
hepatic failure
how to reduce side effects of metformin
initiate slowly or use a modified release formulation
name some side effects of metformin
diarrhoea, bloating, abdo pain, dyspepsia, metallic taste in the mouth, decrease in appetite
name one complication of metformin use
metformin associated lactic acidosis
what should happen to metformin dose as renal function decreases
dose should be decreased
name a sulfonylurea
glicazide
indication of sulfonylureas
alternative first line treatment of T2DM when metformin is too expensive
MOA of sulfonylureas
act on the β-cell to induce insulin secretion even when there is no increase in glucose concentration
name the 2 main adverse effects from sulfonylureas
weight gain, hypoglycaemia
name one TZD
pioglitazone
what is a TZD
Thiazolidinediones
what is the only insulin sensitiser used in the treatment of T2DM
TZDs
which diabetes drug causes peripheral oedema
TZDs
indication for the use of TZDs
as a monotherapy instead of metformin
in addition to other drugs
MOA of TZDs
selective agonists of PPAR-γ nuclear receptor
increased expression of genes involved in glucose uptake and utilisation
name 3 adverse effects of TZDs
weight gain
increased fracture risk
mild anaemia
name a GLP1 agonist
semaglutide
what should diabetic patients with atherosclerotic CVD be prescribed (2)
metformin + GLP1 receptor agonist
what should diabetic patients with HF or CKD be given where SGLT2i are not indicated (2)
metformin + GLP1 agonist
MOA of GLP1 receptor agonists
enhance the incretin effect by activating the GLP1 receptors
promote insulin secretion and lower glucagon, increase satiety
non-glucose effects of GLP1 agonists (4)
reduce appetite
reduce gastric emptying
lower blood pressure
reduction in cardiovasc mortality
who can GLP1 agonists be useful for
diabetic patients who want to lose weight
contraindication of GLP1 agonists
patients with history of pancreatitis
adverse effects of GLP1 agonists
nausea, vomiting, bloating, diarrhoea
small increase in incidence of gallstones
how are GLP1 agonists administered
SC injection self-administered once a week
name 2 DPP4 inhibitors
sitagliptin, alogliptin
indication of DPP4 inhibitors
monotherapy when metformin not tolerated or as an addon
MOA of DPP4 inhibitors
inhibits the breakdown of GLP1 and GIP increasing insulin secretion and reducing glucagon secretion
name 1 non-glucose effect of DPP4 inhibitors
lower blood pressure
is there a risk of hypoglycaemia when using DPP4 inhibitors
no- act via the amplifying pathway so are glucose dependent
name one SGLT2i
Dapagliflozin
first line management of diabetes in a patient with HF or CKF
metformin + SGLT2i
non-glucose effects of SGLT2i (3)
mild diuretic action
reduces plasma urate protection (beneficial for gout)
renal protection
MOA of SGLT2i
lowers renal threshold for glucose increasing urinary glucose excretion
name 1 complications of SGLT2i
DKA
what should happen to your SGLT2i during prolonged fasting or acute illness
STOPPED
name the main adverse effects of SGLT2i
genital candidiasis
indication for levothyroxine
hypothyroidism
what is levothyroxine
a manufactured form of thyroxine
name some medications that can impair absorption of levothyroxine (3)
PPIs, iron tablets and calcium tablets
dosing levothyroxine in pregnancy
dose requirements may increase by 25-50%
when do adverse effects of levothyroxine usually occur
when dose is too high - leading to hyperthyroidism
how and when should levothyroxine be taken
PO before breakfast
what is the first line treatment for hyperthyroid
carbimazole
MOA of carbimazole
Inhibition of TPO thereby blocking thyroid hormone synthesis
contraindication of carbimazole
shouldn’t be used in the first trimester of pregnancy
name a mild adverse effect of carbimazole
allergic type reaction - rash, urticaria, arthralgia
name a severe adverse effect of carbimazole
agranulocytosis
when is the highest risk of agranulocytosis when taking carbimazole
in the first 6 weeks
indication for propylthiouracil
first line for hyperthyroidism in the first trimester of pregnancy
how may agranulocytosis present in a patient taking carbimazole
fever, oral ulcer or oropharyngeal infection
MOA of propylthiouracil
Inhibits DIO1 which decreases conversion of T4 to T3
adverse effects of propylthiouracil
Allergic type reactions, agranulocytosis, cholestatic jaundice
main endocrine indication for β-blockers
immediate symptomatic relief of thyrotoxic symptoms
what is the main β-blocker used in endocrinology
propranolol
caution of using β-blocker in endocrinology
use carefully in patients with asthma
name 3 adverse effects of β-blockers
nausea, headaches, tiredness
main indication for prescribing testosterone
Hypopituitarism resulting in testosterone deficiency
when is testosterone contraindicated (5)
confirmed hormone responsive cancer (breast, prostate)
possible prostate cancer
haematocrit <50%
severe sleep apnoea
heart failure
name some complications of testosterone
can cause polycythaemia
oral tablets can cause hepatitis
what are the main 2 ways testosterone is administered
IM injection
skin gel
main indication of somatostatin analogues
GH-secreting pituitary adenoma resulting in acromegaly/gigantism
name some short term adverse effects of somatostatin analogues
flatulence, diarrhoea, abdo pains
name a long term adverse effect of somatostatin analogues
gallstones
administration of somatostatin analogues
monthly injections
name a dopamine agonist
cabergoline
main indication for a dopamine agonist
prolactinoma
MOA of dopamine agonists
act on D2 receptors
name some adverse effects of dopamine agonists
N+V, low mood, may cause fibrosis of heart valves ?
give an example of a GH antagonist
pegvisomant
main indication of GH antagonists and why they aren’t used often
GH-secreting pituitary adenoma resulting in acromegaly/gigantism
VERY EXPENSIVE
