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Endocrine > Treatments > Flashcards

Treatments Flashcards

1
Q

Metformin MOA

A
  • reduces hepatic gluconeogenesis
  • increases insulin sensitivity
  • causes weight loss and has appetite suppressing effects
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2
Q

Metformin Side Effects

A
  • GI upset e.g. diarrhoea, nausea, anorexia

- lactic acidosis

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3
Q

Sulphonylureas MOA

A
  • bind to SUR-1 subunit of ATP-sensitive K channel, inducing its closure
  • no more K efflux = pancreatic beta cell depolarisation
  • activates voltage gated calcium channels to allow ca in
  • increased intracellular Ca = insulin secretion
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4
Q

Sulphonylureas Side Effects

A
  • weight gain (due to increased insulin)

- hypoglycaemia

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5
Q

DPP-4 Inhibitors (gliptins)

A
  • inhibits dipeptidyl peptidase 4, which breaks down GLP-1, an incretin.
  • GLP-1 is released by L cells of the ileum in response to glucose in the ileum.
  • it enters the circulation and ultimately binds to GLP-1R on pancreatic beta cells
  • they are Gs coupled so increase cAMP and activate PKA
  • increases calcium levels in the cell to increase insulin secretion
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6
Q

DPP4 inhibitor side effects

A

Generally well tolerated, but can increase risk of pancreatitis

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7
Q

Thiazolidendiones MOA

A
  • PPARgamma agonist
  • PPAR gamma is predominantly expressed in adipose tissue, where it increases adipogenesis to decrease FFAs and ultimately increase insulin receptor function.
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8
Q

Thiazolidendione Side Effects

A

Weight gain

Fluid retention

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9
Q

SGLT2 Inhibitors (-glifozins)

A

Inhibits reabsorption of glucose in the kidney to decrease glucose levels in blood

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10
Q

SGLT2 inhibitors Side Effects

A
  • urinary tract infections
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11
Q

GLP-1 Agonists (-tides)

A

Incretin mimetic which inhibits glucagon secretion (because it induces insulin release which inhibits glucagon secretion)

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12
Q

GLP-1 Agonists (-tides) Side Effects

A

Nausea and vomiting

Pancreatitis

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13
Q

Management of PRIMARY HYPERALDOSTERONISM

A
  • adrenal adenoma- surgery

- bilateral adrenocortical hyperplasia - aldosterone antagonist e.g. spironalactone

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14
Q

When to use GLP-1 Agonists? Exenatide and liraglutide

A

When BMI> 35 in someone of European descent and weight is a problem

OR

When BMI <35 and insulin is contraindicated due to occupational implications or weight loss would benefit other comorbidities

NICE like patients to have achieved > 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months to justify the ongoing prescription of GLP-1 mimetice

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15
Q

Metformin Dose

A

500 mg once daily , taken with breakfast for at least one week
THEN
500mg twice daily, taken with breakfast and dinner for at least one week
THEN
500mg 3x daily, taken with breakfast, lunch and dinner
MAXIMUM 2g PER DAY

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16
Q

When would you NOT give pioglitzone to T2DM patients?

A

Do not offer pioglitazone to adults with T2DM if they have any of the following:

  • heart failure or history of heart failure
  • hepatic impairment
  • diabetic ketoacidosis
  • current, or a history of, bladder cancer
  • uninvestigated macroscopic haematuria
17
Q

Beta 1 receptor location & action

A

Found in the heart and kidneys
- positive inotropic, chronotropic and dromotropic effects - this is why beta blockers can cause bradycardia while beta agonists can cause tachycardia

  • increase renin release from JG cells in the kidney (can lead to hypertension, hypokalaemia, and alkalosis due to increased aldosterone)
18
Q

Beta -2 receptors location and action

A

Found in lungs, skeletal muscle, vascular smooth muscle, uterine and bladder smooth muscle

  • causes bronchodilation and vasodilation (beta blockers cause bronchoconstriction and hypertension)
  • increases potassium uptake in skeletal muscle (tremor in beta agonists)
  • increases glycogenolysis in liver (causes hyperglycaemia)
  • increases action of Na/K/ATPase (hypokalaemia in beta agonists treatment)
  • smooth muscle relaxation
19
Q

Side effects of non-selective beta blocker e.g. propranolol

A
  • bradycardia and heart failure
  • hypertension
  • hyperkalaemia
  • bronchoconstriction and dispones
  • hypoglycaemia
  • decreased renin release so hyponatrae is and hyperkalaemia and acidosis
20
Q

Steroids side effects

A
  • secondary diabetes (hyperglycaemia)
  • decreased immune response
  • hypertension
  • centripetal fat distribution (moon face, buffalo hump, truncal obesity)
  • skin thinning
  • osteoporosis
  • ?kidney disease (increased GFR)
  • muscle weakness (due to increased proteolysis)

Endocrine (4 decks)

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