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endocrine > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

who usually gets prescribed insulin

A

T1DM patients

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2
Q

MOA of insulin

A

lowers blood sugar

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3
Q

what insulin regimen are most T1DM patients on

A

basal-bolus
long acting insulin 1-2 times a day and short acting insulin before each meal

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4
Q

what is the preferred short acting insulin and why

A

insulin analogues
disappear from circulation more rapidly than soluble insulin so less likely to cause hypoglycaemia

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5
Q

what is one thing you need to be aware of with injecting insulin

A

rotate injection site to prevent lipohypertrophy

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6
Q

name some adverse effects of insulin

A

can cause weight gain and hypoglycaemia

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7
Q

how can insulin be administered (2)

A

intermittent SC injections or via a pump

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8
Q

what kind of drug is metformin

A

biguanide

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9
Q

indication of metformin

A

first line in all patients with T2DM

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10
Q

MOA of metformin

A

reduces hepatic glucose production and increases gut glucose utilisation and metabolism

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11
Q

is metformin glucose dependent or independent

A

glucose independent

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12
Q

give one non-glucose effect of metformin

A

has a cardiovascular benefit

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13
Q

when is metformin contraindicated (3)

A

renal impairment
cardiac failure
hepatic failure

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14
Q

how to reduce side effects of metformin

A

initiate slowly or use a modified release formulation

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14
Q

name some side effects of metformin

A

diarrhoea, bloating, abdo pain, dyspepsia, metallic taste in the mouth, decrease in appetite

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15
Q

name one complication of metformin use

A

metformin associated lactic acidosis

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16
Q

what should happen to metformin dose as renal function decreases

A

dose should be decreased

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17
Q

name a sulfonylurea

A

glicazide

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18
Q

indication of sulfonylureas

A

alternative first line treatment of T2DM when metformin is too expensive

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19
Q

MOA of sulfonylureas

A

act on the β-cell to induce insulin secretion even when there is no increase in glucose concentration

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20
Q

name the 2 main adverse effects from sulfonylureas

A

weight gain, hypoglycaemia

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21
Q

name one TZD

A

pioglitazone

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22
Q

what is a TZD

A

Thiazolidinediones

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23
Q

what is the only insulin sensitiser used in the treatment of T2DM

A

TZDs

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24
Q

which diabetes drug causes peripheral oedema

A

TZDs

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25
Q

indication for the use of TZDs

A

as a monotherapy instead of metformin
in addition to other drugs

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26
Q

MOA of TZDs

A

selective agonists of PPAR-γ nuclear receptor
increased expression of genes involved in glucose uptake and utilisation

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27
Q

name 3 adverse effects of TZDs

A

weight gain
increased fracture risk
mild anaemia

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28
Q

name a GLP1 agonist

A

semaglutide

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29
Q

what should diabetic patients with atherosclerotic CVD be prescribed (2)

A

metformin + GLP1 receptor agonist

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30
Q

what should diabetic patients with HF or CKD be given where SGLT2i are not indicated (2)

A

metformin + GLP1 agonist

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31
Q

MOA of GLP1 receptor agonists

A

enhance the incretin effect by activating the GLP1 receptors
promote insulin secretion and lower glucagon, increase satiety

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32
Q

non-glucose effects of GLP1 agonists (4)

A

reduce appetite
reduce gastric emptying
lower blood pressure
reduction in cardiovasc mortality

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33
Q

who can GLP1 agonists be useful for

A

diabetic patients who want to lose weight

34
Q

contraindication of GLP1 agonists

A

patients with history of pancreatitis

35
Q

adverse effects of GLP1 agonists

A

nausea, vomiting, bloating, diarrhoea
small increase in incidence of gallstones

36
Q

how are GLP1 agonists administered

A

SC injection self-administered once a week

37
Q

name 2 DPP4 inhibitors

A

sitagliptin, alogliptin

38
Q

indication of DPP4 inhibitors

A

monotherapy when metformin not tolerated or as an addon

39
Q

MOA of DPP4 inhibitors

A

inhibits the breakdown of GLP1 and GIP increasing insulin secretion and reducing glucagon secretion

40
Q

name 1 non-glucose effect of DPP4 inhibitors

A

lower blood pressure

41
Q

is there a risk of hypoglycaemia when using DPP4 inhibitors

A

no- act via the amplifying pathway so are glucose dependent

42
Q

name one SGLT2i

A

Dapagliflozin

43
Q

first line management of diabetes in a patient with HF or CKF

A

metformin + SGLT2i

44
Q

non-glucose effects of SGLT2i (3)

A

mild diuretic action
reduces plasma urate protection (beneficial for gout)
renal protection

44
Q

MOA of SGLT2i

A

lowers renal threshold for glucose increasing urinary glucose excretion

45
Q

name 1 complications of SGLT2i

A

DKA

46
Q

what should happen to your SGLT2i during prolonged fasting or acute illness

A

STOPPED

47
Q

name the main adverse effects of SGLT2i

A

genital candidiasis

48
Q

indication for levothyroxine

A

hypothyroidism

49
Q

what is levothyroxine

A

a manufactured form of thyroxine

50
Q

name some medications that can impair absorption of levothyroxine (3)

A

PPIs, iron tablets and calcium tablets

51
Q

dosing levothyroxine in pregnancy

A

dose requirements may increase by 25-50%

52
Q

when do adverse effects of levothyroxine usually occur

A

when dose is too high - leading to hyperthyroidism

53
Q

how and when should levothyroxine be taken

A

PO before breakfast

54
Q

what is the first line treatment for hyperthyroid

A

carbimazole

55
Q

MOA of carbimazole

A

Inhibition of TPO thereby blocking thyroid hormone synthesis

56
Q

contraindication of carbimazole

A

shouldn’t be used in the first trimester of pregnancy

57
Q

name a mild adverse effect of carbimazole

A

allergic type reaction - rash, urticaria, arthralgia

58
Q

name a severe adverse effect of carbimazole

A

agranulocytosis

59
Q

when is the highest risk of agranulocytosis when taking carbimazole

A

in the first 6 weeks

60
Q

indication for propylthiouracil

A

first line for hyperthyroidism in the first trimester of pregnancy

61
Q

how may agranulocytosis present in a patient taking carbimazole

A

fever, oral ulcer or oropharyngeal infection

62
Q

MOA of propylthiouracil

A

Inhibits DIO1 which decreases conversion of T4 to T3

63
Q

adverse effects of propylthiouracil

A

Allergic type reactions, agranulocytosis, cholestatic jaundice

64
Q

main endocrine indication for β-blockers

A

immediate symptomatic relief of thyrotoxic symptoms

65
Q

what is the main β-blocker used in endocrinology

A

propranolol

66
Q

caution of using β-blocker in endocrinology

A

use carefully in patients with asthma

67
Q

name 3 adverse effects of β-blockers

A

nausea, headaches, tiredness

68
Q

main indication for prescribing testosterone

A

Hypopituitarism resulting in testosterone deficiency

69
Q

when is testosterone contraindicated (5)

A

confirmed hormone responsive cancer (breast, prostate)
possible prostate cancer
haematocrit <50%
severe sleep apnoea
heart failure

70
Q

name some complications of testosterone

A

can cause polycythaemia
oral tablets can cause hepatitis

71
Q

what are the main 2 ways testosterone is administered

A

IM injection
skin gel

72
Q

main indication of somatostatin analogues

A

GH-secreting pituitary adenoma resulting in acromegaly/gigantism

73
Q

name some short term adverse effects of somatostatin analogues

A

flatulence, diarrhoea, abdo pains

74
Q

name a long term adverse effect of somatostatin analogues

A

gallstones

75
Q

administration of somatostatin analogues

A

monthly injections

76
Q

name a dopamine agonist

A

cabergoline

77
Q

main indication for a dopamine agonist

A

prolactinoma

78
Q

MOA of dopamine agonists

A

act on D2 receptors

79
Q

name some adverse effects of dopamine agonists

A

N+V, low mood, may cause fibrosis of heart valves ?

80
Q

give an example of a GH antagonist

A

pegvisomant

81
Q

main indication of GH antagonists and why they aren’t used often

A

GH-secreting pituitary adenoma resulting in acromegaly/gigantism
VERY EXPENSIVE

endocrine (15 decks)

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