pharmacology

Question 1

when is insulin given?

Answer 1

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

Question 2

MOA

Answer 2

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

Question 3

SE

Answer 3

Hypoglycemia can lead to coma and death

when given subcutaneously can cause fat overgrowth -lipohypertrophy

Question 4

warnings

Answer 4

renal impairment due to reduced clearance of insulin can cause hypoglycaemia

Question 5

drug interactions

Answer 5

caution wen given with other hypoglycaemia agents

concurrent corticosteroid therapy can increase insulin requirement

Question 6

what should they look out for?

Answer 6

signs of hypoglycaemia
dizziness
nausea
confusion 
lethargy 
sweating 
agitation

Question 7

what are the different classes

Answer 7

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

Question 8

what is glidazide

Answer 8

it is a suphonyleas

Question 9

what is it used to treat?

Answer 9

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

Question 10

MOA/

Answer 10

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

Question 11

SE

Answer 11

gi upset-nausea, diarrhoea, constipation
hypersensitivity reaction
haemolytic abnormalities
cholestatic jaundice

Question 12

contraindications

Answer 12

elderly
renal impairment
liver impairment
adrenal adenoma/insufficiency 
malnutrition

Question 13

drug interactions

Answer 13

other anti-diabetic drugs

drugs causing elevated blood sugars- thiazide, prednisolone, diuretics

Question 14

what is metformin used for?

Answer 14

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

Question 15

MOA

Answer 15

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

Question 16

SE

Answer 16

gi upset- nausea, diarrhoea,, vomiting, anorexia, change In taste
LACTIC ACIDOSIS

Question 17

warning

Answer 17

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

Question 18

DI

Answer 18

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

Question 19

what can be used to treat hyperthyroidism?

Answer 19

carbimazole

Question 20

MOA?

Answer 20

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

Question 21

ci

Answer 21

blood disorders
severe liver disease/impairment
pregnancy and breasfeeding

Question 22

SE

Answer 22

rash and puritis can be given anti-histamines

bone marrow supression -neutropenia and granulocytosis with fever, ST, ulcer, easy bruising, nausea

Question 23

DI

Answer 23

SWET
steroids-prednisolone
warfarin
erythromycin 
theophylline

Question 24

name an bisphosphonate and wen is it given?

Answer 24

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

Question 25

MOA

Answer 25

inhibits osteoclast activity, which therefore reduces bone reabsorption
and bone mass

Question 26

CI

Answer 26

renal impairment
osteonecrosis of the jaw - in smokers and those with dental disease
active upper GI disease
HYPOCALCEMIA

Question 27

SE

Answer 27

Osphagitis
hypophostphatemia, osteonecrosis
atypical femoral fractures

Question 28

DI

Answer 28

binds to calcium therefore reduced uptake

so do not give or in caution with antacids, iron salts, cal vitamin d supplements

Question 29

bare in mind what with alendronates

Answer 29

dental visits before and during treatment

Question 30

what is thyroxine given for

Answer 30

primary hypothyroidism

seocndayr hypothyroidism due to hypopituataryism

Question 31

moa

Answer 31

it is a replacement hormone of t4- synthetic t4

can give synthetic t3triiodothyronine which has a shorter half life and quicker onset so better for acute situations

Question 32

SE

Answer 32

D and V
tremors restlessness insomnia
weight loss
palpitations arrhythimas angina

Question 33

DI

Answer 33

interact with antacids, iron salts -reduced uptake od thyroxine therefore administer 4 hr apart
increase effects of warfarin
increased dose when taken with phenytoin

Question 34

CI

Answer 34

if given with hypopitutaryism give corticosteroid therapy first to prevent addinson crisis
increases heart rate therefore may trigger ischaemia in coronary artery disease therefore low dose and monitor pts