pharmacology Flashcards
when is insulin given?
to manage type 1 diabetes and can be used in type 2 diabetes when oral medication has not been tolerated/successful
IV in diabetes emergencies or pre-operative procedures
alongside glucose in treatment of hyperkalaemia - only temporary measure
MOA
stimulates glucose uptake by tissue and use of glucose
stimulates glycogen, protein, fat synthesis
in hyperkalaemia stimulates K to enter cells, but the K will leak out when insulin no longer given
inhibits gluconeogenesis and ketogenesis
SE
Hypoglycemia can lead to coma and death
when given subcutaneously can cause fat overgrowth -lipohypertrophy
warnings
renal impairment due to reduced clearance of insulin can cause hypoglycaemia
drug interactions
caution wen given with other hypoglycaemia agents
concurrent corticosteroid therapy can increase insulin requirement
what should they look out for?
signs of hypoglycaemia dizziness nausea confusion lethargy sweating agitation
what are the different classes
Rapid acting -rapid onset, short duration - IV given this way - novorapid
Short acting -early onset, short duration- actrapid
Intermediate acting - intermediate both- humalin
Long acting - flat profile, requires regular supply- levenir, lantus
some solutions are combined such as novomix which is rapid and intermediate
what is glidazide
it is a suphonyleas
what is it used to treat?
diabetes when metformin is not tolerated or not sufficient
reduces risk of diabetic complications
can be used in combo with metformin when blood glucose is not adequately controlled by a single agent
MOA/
increase insulin secretion by blocking ATP K channel of voltage gated ca2 on the beta cell this enables an increase in intracellular ca2 , needed for insulin secretion
however, in the long term it can worsen diabetes as it causes weight gain - anabolic process
relies on functioning pancreas
SE
gi upset-nausea, diarrhoea, constipation
hypersensitivity reaction
haemolytic abnormalities
cholestatic jaundice
contraindications
elderly renal impairment liver impairment adrenal adenoma/insufficiency malnutrition
drug interactions
other anti-diabetic drugs
drugs causing elevated blood sugars- thiazide, prednisolone, diuretics
what is metformin used for?
it is used to treat type 2 diabetes as a first line treatment
it can be given in combo with sulphonyleas if not sufficient alone
MOA
increases glucose sensitivity
does not stimulate increase insulin secretion from beta cells
it supress hepatic glucose production -glycogenolysis
increases uptake by muscle cells and intestinal absorption
does not cause hypoglycaemia and can induce weight loss therefore prevent worsening of resistance
SE
gi upset- nausea, diarrhoea,, vomiting, anorexia, change In taste
LACTIC ACIDOSIS
warning
renal impairment –> can cause tissue hypoxia
caution with heart failure
and AKI caused by sepss, dehydration shock for example
alcohol intoxication
hepatic impairment due to reduce clearance of lactate
DI
beware that prednisolone, diuretics, thiazides increase blood glucose so may reduce efficacy
use caution with other anti-diabetic therapies
to be within 48 hr before and after IV contrast media to prevent renal impairment , metaformin accumulation and lactic acidosis
what can be used to treat hyperthyroidism?
carbimazole
MOA?
when absorped converted into the active form metimazole where it prevents the enzyme thyroid perioxidase from coupling and iodinating the thyrosine residue on the thyroglobulin so reduces production of t3 and t4
ci
blood disorders
severe liver disease/impairment
pregnancy and breasfeeding
SE
rash and puritis can be given anti-histamines
bone marrow supression -neutropenia and granulocytosis with fever, ST, ulcer, easy bruising, nausea
DI
SWET steroids-prednisolone warfarin erythromycin theophylline
name an bisphosphonate and wen is it given?
alendronic acid
alendronate
it is an alendronic acid given for proplyaxis purpose in those at risk of osteoprotic fragility
it is also given for the treatment of pagets disease to reduce pain and bone turnover
