Pharmacology of Endocrine Disease Flashcards
When does Type 1 diabetes present?
Can present at any age of life
what is the most common insulin to use?
Insulatard - you want a flat level background insulin levels - the problem with it though is that it does peak in the first four hours after injeciton
-used in pregnancy b/c it’s been used the longest so we know it’s safe to use during pregnancy
What insulins are safe to use in pregnancy?
Insulatard, Levemir, or Detemir
What insulins are not safe to use in pregnancy?
Glargine or Lantus
What is a Bolus insulin?
insulin that you inject before you eat or with your food
What is carbohydrate counting?
counting your carbohydrates and taking the amount of bolus insulin appropriate for that amount of carbohydrates
what is the downside of insulin?
Hypoglycaemia and weight gain
insulin pumps contian what form of inuslin?
quick acting ( like novorapid)
pump is preprogrammed to take care of both your background AND bolus insulin - so the pump will automatically give the backroung level and you can determine how much to give in bolus situation
*now we have fancy ones that can detect your blood sugar and will give you the equivalent amount you need- and you can also get ones that detect when your sugar is too low or too high and it will automatically act*
how do we check someone’s diabetes control over many months?
Glycataled Hemoglobin (HbA1c) - uses your red blood cells
- Glucose binds to the valine portion of the hemoglobin side chain
- Reflects glucose control over a 2 month period
- Aim in type 1 diabetes is a HBA1c (IFCC <53mmol/mol) of <7.0%
What do we use to diagnose diabetes?
HBA1c
what is the most common complication of diabetes?
Diabetic retinopathy
Can you immediately fix control of diabetes in patients with a baseline retinopathy?
no - you have to stagger it and start to control it bit by bit- or they have a risk of retinopathy
What are the risk factors for Type 2 diabetes?
- family history
- weight
- age
What is Type 2 diabetes?
progressive failure of the beta cells of the pancreas - overtime the remainder die off - it’s a dynamic condition, so it’s only going to get worse
why does an increased adipose lead to diabetes?
leads to insulin resistance -
fatty acids go to muscle and block the action of insulin
fatty acids go to liver and block action of insulin
fatty acids can go to beta cells in pancreas and cause them to fail
So it’s a combination of insulin resistance and beta cell failure
where does metformin work on?
works on the liver to inhibit hepatic gluconeogenesis
used in overweight pateints with Type 2 diabetes
What is the action of pioglitazone?
used in Type 2 diabetes to inhibit lipolysis and improve insulin sensitivity at the muscle
- has a lot of side effects and is contraindicated in heart failure - it increases weight by 6-7 kg (most of which is fluid)
there is an increased risk of cardiovascular disease and bladder cancer
how does bromocriptine work?
it Works on dopamine pathways and lowers A1C by ½ percent
What is the action of Metformin?
reduces hepatic glucose output - increases insulin mediate glucose utilization in peripheral tissues
- weight loss
- intestinal glucose utilizaiton
anti-lipolytic effect
_side effects include GI upset, do not use in renal failure due to potential lactic acidosis
What are the effects of sulphonylureas?
- Stimulate the beta cell of the pancreas to produce more insulin
- Hypoglycaemia
- Weight gain
- Accelerate the failure of the pancreatic beta cell
Why is oral stimulation better than IV stimulation of insulin release?
Because of GLP1 - which is released in the small intestine
this hormone is reduced in Type 2 diabetes
What are the two types of drugs effecting GLP1?
GLP1 agonist - given as injection to stimulate the pancrease to increase insulin - they lower glucagon levels and the slow down how your stomach empties (people on these injections feel full - therefore people lose weight and it also blocks appetite) - this lowers your blood sugars, and glucagon.
GLP1 enzyme inhibitor - no associated with weight loos
What is the main fuel for the brain?
glucose
What transporter reabsorbs most of the glucose in the kidney?
the SGLT2 transporter
How do SGLT2 inhibitors work?
They inhibit the reabsorption of glucose in the kidneys - and therefore they allow you to pee out more urine - this predisposes you to ketoacidosis b/c you’re making them dehydrated (it’s a diuretic drug)
This also has a risk of kidney infections and UTIs
Do you need to be on aspirin if you’re a Type 2 diabetic?
no, only if you have an increased risk for clotting other than the diabetes
What are common causes of hyperthyroidism?
Grave’s Disease= most likely cause
What is the first line treatment for Grave’s Disease?
Carbimazole
How does carbimazole work?
it inhibits thyroid hormone synthesis - blocks thyroid peroxidase
Do we use Carbimazole during pregnancy?
we prefer not to, but it’s prefered over the PTU during 1st trimester of pregnancy
how do patient’s present with thryoiditis (inflammation of the thyroid) ?
they present with flu-like illness and tenderness around the thyroid area of the neck - potentially with a painful goitre
