Pharmacology of Endocrine Disease

Question 1

When does Type 1 diabetes present?

Answer 1

Can present at any age of life

Question 2

what is the most common insulin to use?

Answer 2

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

Question 3

What insulins are safe to use in pregnancy?

Answer 3

Insulatard, Levemir, or Detemir

Question 4

What insulins are not safe to use in pregnancy?

Answer 4

Glargine or Lantus

Question 5

What is a Bolus insulin?

Answer 5

insulin that you inject before you eat or with your food

Question 6

What is carbohydrate counting?

Answer 6

counting your carbohydrates and taking the amount of bolus insulin appropriate for that amount of carbohydrates

Question 7

what is the downside of insulin?

Answer 7

Hypoglycaemia and weight gain

Question 8

insulin pumps contian what form of inuslin?

Answer 8

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*

Question 9

how do we check someone’s diabetes control over many months?

Answer 9

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%

Question 10

What do we use to diagnose diabetes?

Answer 10

HBA1c

Question 11

what is the most common complication of diabetes?

Answer 11

Diabetic retinopathy

Question 12

Can you immediately fix control of diabetes in patients with a baseline retinopathy?

Answer 12

no - you have to stagger it and start to control it bit by bit- or they have a risk of retinopathy

Question 13

What are the risk factors for Type 2 diabetes?

Answer 13

• family history
• weight
• age

Question 14

What is Type 2 diabetes?

Answer 14

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

Question 15

why does an increased adipose lead to diabetes?

Answer 15

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

Question 16

where does metformin work on?

Answer 16

works on the liver to inhibit hepatic gluconeogenesis

used in overweight pateints with Type 2 diabetes

Question 17

What is the action of pioglitazone?

Answer 17

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

Question 18

how does bromocriptine work?

Answer 18

it Works on dopamine pathways and lowers A1C by ½ percent

Question 19

What is the action of Metformin?

Answer 19

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

Question 20

What are the effects of sulphonylureas?

Answer 20

• Stimulate the beta cell of the pancreas to produce more insulin
• Hypoglycaemia
• Weight gain
• Accelerate the failure of the pancreatic beta cell

Question 21

Why is oral stimulation better than IV stimulation of insulin release?

Answer 21

Because of GLP1 - which is released in the small intestine

this hormone is reduced in Type 2 diabetes

Question 22

What are the two types of drugs effecting GLP1?

Answer 22

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

Question 23

What is the main fuel for the brain?

Answer 23

glucose

Question 24

What transporter reabsorbs most of the glucose in the kidney?

Answer 24

the SGLT2 transporter

Question 25

How do SGLT2 inhibitors work?

Answer 25

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

Question 26

Do you need to be on aspirin if you’re a Type 2 diabetic?

Answer 26

no, only if you have an increased risk for clotting other than the diabetes

Question 27

What are common causes of hyperthyroidism?

Answer 27

Grave’s Disease= most likely cause

Question 28

What is the first line treatment for Grave’s Disease?

Answer 28

Carbimazole

Question 29

How does carbimazole work?

Answer 29

it inhibits thyroid hormone synthesis - blocks thyroid peroxidase

Question 30

Do we use Carbimazole during pregnancy?

Answer 30

we prefer not to, but it’s prefered over the PTU during 1st trimester of pregnancy

Question 31

how do patient’s present with thryoiditis (inflammation of the thyroid) ?

Answer 31

they present with flu-like illness and tenderness around the thyroid area of the neck - potentially with a painful goitre