Thuroid & Diabetes Flashcards
MOA thioureylens
Carbimbazine & PTU
Blocks enzyme which synthesise thyroid hormones
PTU also prevent T4-T3 conversion in peripheral tissue
First line agents against hyperthyroidism
Thioureylenes
Carbimazole
Propylthiouracil PTU
What is the drug of choice in hypothyroidism?
Thyroxine T4 (synthetic)
Insulin
2 amino acid chains produced & stored in Beta cell in islet of langerhans in the pancreas
Hyperglycaemia
Elevated glucose levels
HbA1c
Glycated haemoglobin
Diabetes is
A metabolic disorder characterised by chronic hyperglycaemia with disturbance of carbohydrate, fat & protein metabolism resulting from defects in insulin secretion, lack of insulin sensitivity or both
Normal BGL
3.5-8mmol/L
Action of insulin
- Increase glucose and amino acid uptake by muscle, liver and adipose tissue
- increases protein synthesis, glycogenesis, loop genesis RNA &DNA synthesis intracellular action(growth)
- reduces glucose output, glyconeogenesis, proteolysis & lipolysis
First line oral hypoglycaemic agents in type 2 diabetes treatment
Metformin
Biguanides
Second line oral hypoglycaemic agent in the treatment of diabetes 2
Sulfonylureas
Sulfonylureas action
Closes K+ ATP channel stimulates release of insulin from beta cells in pancreas
HbA1C
Below 7% significantly reduces risk of complications
Haemersiderin deposits
Painful, itchy, dry brown iron deposits
Anterior tibia
How do we treat a bacterial infection where MRSA is present?
Vancomycin
When must you give people diabetes education?
Every time they come into clinic
Pharmacological anxiety treatments
Benzodiazepines
Antidepressants
Antipsychotics
Role of GABA
Inhibitory neurotransmitter in the CNS
MOA benzodiazepines
Bind to GABAa receptor –> greater response to GABA –> reduced anxiety
SSRI
Selective serotonin re-uptake inhibitors
SNRIs
Serotonin & noradrenalin re-uptake inhibitors
TCAs
Tricyclic antidepressants
MOA-Is
Monoamine oxidase inhibitors
Non pharmacological treatments of depression
Monitor Educate Supportive counselling Guided self-help Behavioural techniques Psychotherapy Physical exercise & lifestyle change
SSRIs MOA
Selective serotonin re uptake inhibitor: Selectively inhibits presynaptic re-uptake of serotonin into nerve terminal
SNRIs MOA
Serotonin & noradrenalin re-uptake inhibitors: inhibit serotonin and noradrenalin re uptake
TCAs MOA
Tricyclic antidepressants: inhibit noradrenaline & serotonin uptake (to presynaptic terminals)
Also blockcholinergic, histaminic, alpha receptors –> ADRs
MAO-I MOA
Monoamine oxidase inhibitors
Irreversibly inhibit an enzyme MAO-A and MAO-B increasing concentration of all amines
Simvastatin MOA
HMG-CoA reductase inhibitor
Alpha glucose inhibitor example and MOA
(Acarbose) inhibits the enzyme in the small intestine and delays digestion & absorption of polysaccharide carbohydrates
Glitazones examples and MOA
(Thiazoledinediones)
Pioglitazone
Rosiglitazone
Increases sensitivity in peripheral tissues to insulin, regulates glucose and lipid metabolism, decreases glyconeogenesis (liver glucose output)
Gliptins
DPP4 inhibitors
Inhibit DDP enzyme - increase in retain levels & beta cells glucose sensitivity
–> increase glucose dependant insulin secretion –> decrease glucagon & so decrease glucose production –> increase insulin synthesis
Incretin analogues
Example and MOA
Exenatide, litaglutide
- increase glucose dependant insulin secretion
- decrease inappropriate glucagon secretion
- delays gastric emptying, rate of glucose absorption and reduces appetite
Biguanides
Example & MOA
Metformin
- decrease glucose production
- increase glucose uptake by AMP-K activity in cell membrane
- reduce glucose absorption
- increase fatty acid oxidation
- increase sensitivity & binding
First line treatment for diabetes
Biguanides
Metformin
Sulfonylureas
Example and MOA
Glibenclamide, clipzide, gliclazide, glimepiride
Closes K+ATP channel stimulates release of insulin from beta cells in pancreas
Sulfonylureas
Can
Reduce insulin resistance
Or
Increase insulin sensitivity
Cramping is due to
Ischaemia
Intermittent claudication
Clotting factors
Proteolysis proteins made in the liver
Warfarin
Is an anticoagulant/anti thrombotic.
Works by inhibiting the synthesis of vitamin k dependant coagulation factors
(Coumadin, Marevan)
Miconazole
Daktarin
Lamisil
Active ingredient
Class
MOA
Terbinafine is an allylamine
Broad spectrum antifungal
Blocks the biosynthesis of ergosterol resulting in an accumulation of squalene
What is leukonychia
White marking on the nail
Striata
Punctata
Totalis
Step 1 on the pain ladder
Non-opioid
+/- adjuvant
Step 2 on the pain ladder
Opioid +/- non-opioid +/- adjuvant
Step 3 on the pain ladder
Opioid +/- non opioid +/- adjuvant
Ester and amide LA clinically relevant differences
Esters are metabolised more quickly
Therefore shorter duration of action
3 characteristics of COPD treatment
Improve exercise tolerance
Symptom relief
Maintain or improve
Prevent or treat exacerbation a and complications
3 adjuvants used for pain management
GABA analogues Capsaicin Tricyclics antidepressants Corticosteroids Psychotropic drugs
What are symptom controllers for treatment of asthma?
LABA
Clinical types of pain
Nociceptive pain
Neuropathic pain
Mixed pain
What micro organisms are associated with ecthyma
Streptococcus & pseudomonas
Different types of DMARDS
Gold salts Penicillamine Sulfasalazine Hydrochloroquine TNF-alpha antagonists Immunosuppressants Cytokine modulators
Examples of gold salts
Auranofin & aurothiomalate
Penicillamine
Action
Reduces T-cells activity & reduces rheumatoid factor & immune complexes in blood & joints
Sulfasalazine
MOA
Modifies lymphocyte proliferation
& reduces cytokines
First line treatment in early rheumatoid arthritis
Methotrexate
Antimetabolite antineoplastic agent
Onycholysis possible aetiologies
Idiopathic Systemic (PAD, iron deficiency anaemia) Cutaneous disease(psoriasis, eczema, hyperhidrolosis) Local causes (trauma, infection, exposure to irritants)
In case of a penicillin allergy what is commonly used
Cephalosporins
Allopurinol MOA
Reduces uric acid production by inhibiting a converting enzyme which converts purines to uric acid
(Reduces plasma and urinary irate levels)
Name 3topical antifungal nail lacquer
Amorolfine- loceryl
Bifonazole- canestan nail treatment
Ciclopirox- rejuvenail
What is used to treat Methicillin resistant staphycoccus aureus?
MRSA
Vancomycin- inhibits bacterial cell wall synthesis (glucopeptide)
Prednisone
Corticosteroid
Corticosteroid MOA
Regulate gene expression suppressing inflammation & immune response as well as glucose, protein & lipid metabolism.
Mimic action of body’s own steroids.
Uniform thickening of the nail
Onychauxis
Three types of involuted nails
Tile shaped
Plicatured
Pincer
Onychogryphosis
Nail plate grossly thickened & curved
May have longitudinal or transverse ridges
Onychomycosis
Fungal infection of nail bed and nail plate
Involves dermatophytes metabolising keratin
Causes nail plate to thicken and discolour
Onycholysis
Separation of the nail from the nail bed at distal end &/or lateral margins
Detachment of nail plate leads to greyish-white colour
Spontaneous separation of the nail
From matrix to free edge
Onychomadesis
Nail penetrates dermis in sulci
Onychocyptosis
Tranexamic acid
MOA
Blocks binding plasminogen & plasminogen to fibrin
- inhibits breakdown of clots
Vitamin K antagonists
MOA examples
Inhibit enzymatic synthesis of vitamin K dependent clotting factors & the anti thrombin factors proteins C & S
Warfarin (coumadin, marevan)
Phenindione (dindevan)
Anticoagulants
Heparin
Enoxaparin
Dalteparin
Danaparoid
MOA of heparin
Inactivate thrombin IIa and clotting factor XA by binding to antithrombin III
Antiplatelet agents
Aspirin Dipyridamole Ticagrelor Thienopyridines Glycoprotein IIb/IIIa inhibitor
Aspirin MOA
Irreversibly inhibit cyclo-oxygenase –> inhibit thromboxane A2 production –> blocks platelet aggregation for life of platelet
Thrombolytics
MOA
Converts plasminogen to plasminogen which catalyses breakdown of fibrin
Internal normalised ratio
Time taken for blood to clot using a standardised test.
High INR is indicative of
The longer it will take blood to clot
Risk of bleeding
Lower the INR
More likely to form a blood clot
INR normal value
0.8-1.2
Prothrombin time
PT - is also a measure of how long it takes blood to clot
Target INR for people taking warfarin
2-3
Onychophosis
HK or heloma durum in the nail sulcus
Lipitor
Class & MOA
Hypolipidaemic agent - atorvastatin
MOA - HMG-CoA reductase inhibitor
First line treatment for acute gout
Indomethacin (NSAID)
Or
Colchicine (if NSAID is contraindicated)
Recurrent gout treatment
Allopurinol plus either colchicine or NSAID then allopurinol alone
Chronic gout treatment
Difficult to treat
Colchicine and/or indomethacin are introduced slowly
First line treatment of rheumatoid arthritis
Methotrexate as mono therapy OR in combination with DMARDs
Allopurinol
MOA
Inhibits xanthine oxidase which catalyses the conversion of hypoxanthine to xanthine & then xanthine to urate/uric acid
Pale dendritic cells responsible for immunological responses of skin to environmental antigens
Langerhans cells
Melanocytes
Produce pigment & UV protection
Merkel cells
Associated with nerve fibre - play a sensory function
Specialised skin Cell with branching process
Melanocytes
Pacinian corpuscule
Detect pressure & high frequency vibrations; largest of encapsulated nerve endings
Ruffini endings detect
Heavy and continuous touch sensations & pressure
Meissner’s corpuscle
Detect touch and low frequency vibration
Merkel’s disc
Is primarily involved in touch
Nerve supply of the skin
Autonomic nerves supply the blood vessels, sweat glands and arrector pili muscles
Apocrine sweat glands
Larger than eccrine glands
Most numerous around axillae, perineum, areolae
Eccrine sweat gland
Excretory duct spirals upward to open onto skin surface
Most on palms, soles, axillae & forehead
Sweat glands
Tube like, cooled glands, located within the dermis
Produce a watery secretion
Two types: eccrine & apocrine
Sebaceous gland
Form around hair follicle and secrete sebum
What is the process of the entire cell being shed as a secretory product
Holocene process
Papillary dermis
Closer to the surface- highly vascular & has a thin network of collagen fibres
How does penicillin work?
Inhibit cell wall synthesis
How does an ACE inhibitor lower BP
Blocks conversion of angiotensin I to angiotensin II which results in reduce vasoconstriction & reduced BP. Also reduces aldosterone release lowering sodium and water resorption reducing BP
What causes gout?
Hyperuricaemia either
Decreased excretion of uric acid or increased production of uric acid
What would you use to treat Candida albicans and trichopyton rubrum?
Lamisil (terbinafine) or daktarin (azole)
As they are active against both organisms
Terbinafine & azole a work by
Inhibit cell wall synthesis by inhibiting ergosterol synthesis
Yellow pus on a bacterial infection is indicative of
S. Aureus
Mupirocin
Inhibits bacterial protein synthesis
By reversible and specifically binding to transfer RNA synthase
First line treatment for dyslipidemia
Diet
The name given to an infection that occurs during antimicrobial treatment
Superinfection
Causative organisms for tinea pedis
Candida albicans & trichopyton rubrum
Green fruity Purulent exudate, what micro organism would you suspect?
Pseudomonas
What is treatment of choice for mild impetigo on the leg?
Mupirocin (Bactroban)
4 mechanisms of antibiotics
Inhibit bacterial cell wall synthesis
Inhibit protein synthesis
Inhibit DNA synthesis
Disrupt or alter cell membrane permeability
Erythromycin
MOA
Macro life antibiotic
Inhibits protein synthesis
First line pharmacological treatment for congestive heart failure
Ace inhibitor
Glucosamine
Natural supplement derived from shellfish
Thought to inhibit pro-inflammatory mediators in the development of OA
What do you tell a patient who is using Tea tree oils instead of medicament
Has not been demonstrated to be consistently effective
Paracetamol
MOA
Inhibit prostaglandin synthesis in CBS by inhibiting cox-3
