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Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Insulins: Indications

A

Type 1 DM
Type 2 DM when oral control has failed
With Glucose to treat hyperkalaemia

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2
Q

Insulins: Mechanism of Action

A

Stimulates glucose uptake from circulation and drives K+ into cells
Rapid acting: novorapid, insulin aspart
Short acting: actrapid, soluble insulin
Intermediate acting: humulin, isophane insulin
Long acting: insulin glargine

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3
Q

Insulins: ADRs

A

Hypoglycaemia, can be serious enough to cause coma to death

Lipid hypertrophy at SC injection site

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4
Q

Insulins: Warnings and Interactions

A

Caution in renal failure as insulin clearance is reduced so increased risk of hypoglycaemia
Risk of hypoglycaemia is also increased with oral hypoglycaemic agents

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5
Q

Insulins: Prescribing

A

Diabetes is generally self administration SC
For emergencies, IV actrapid
MONITORING by HbA1c

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6
Q

Sulfonylureas (Glicazide): Indications

A

Type 2 DM: single agent when metformin is not tolerated or in combination with metformin

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7
Q

Sulfonylureas (Glicazide): Mechanism of Action

A

Stimulates pancreatic B cell insulin secretion. They block K+ channels to depolarise the membrane and opening of VG Ca2+ channels.

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8
Q

Sulfonylureas (Glicazide): ADRs

A

GI upset (N/V/D/C), hypoglycaemia, hypersensitivity is rare (causes hepatic failure)

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9
Q

Sulfonylureas (Glicazide): Warnings and Interactions

A

Metabolised by liver and excreted really, so caution in hepatic or renal failure
Caution in those at risk of hypoglycaemia e.g. hepatic impairment or adrenal insufficiency
Risk of hypoglycaemia with other oral hypoglycaemic dugs.
Efficacy decreased by glucose elevating drugs e.g. prednisone

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10
Q

Sulfonylureas (Glicazide): Prescription

A

They are a long term treatment

Monitor HbA1c

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11
Q

Metformin <3: Indications

A

First choice for Type 2 DM

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12
Q

Metformin <3: Mechanism of Action

A

Increases sensitivity to insulin, suppresses hepatic gluconeogensis, increase glucose uptake
Fortunately, the exact mechanism is understood
Causes weight loss

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13
Q

Metformin <3: Warnings and Interactions

A

IT DOES NOT CAUSE HYPOGLYCAEMIA
However it is excreted unchanged by the kidneys so is contraindicated in renal failure, AKI, shock or anything that might even think about damaging the kidneys (NSAIDs)
Prednisone opposes its action

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14
Q

Metformin <3: ADRs

A

GI upset, lactic acidosis is rare but dangerous and can be precipitated by alcohol

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15
Q

Metformin <3: Prescription

A

Assess by HbA1c
Measure renal function at least annually
Withhold 48hr before X-Ray contrast agents

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16
Q

Thiazolidinediones (Pioglitazone): Indciations

A

Type 2 DM, in overweight patients when metformin is contraindicated, or in combination with other drugs

17
Q

Thiazolidinediones (Pioglitazone): Mechanism of Action

A

They active PPAR gamma, which induced genes to enhance insulin action and reduce hepatic gluconeogenesis.
They do not cause hypoglycaemia

18
Q

Thiazolidinediones (Pioglitazone): ADRs

A

GI upset, anaemia, dizziness

Serious: oedema, slight risk of fx and bladder ca. in women

19
Q

Thiazolidinediones (Pioglitazone): Warnings and Interactions

A

Can cause weight gain and therefore decreased insulin sensitivity.
It is contraindicated in heart failure and known bladder cancer. Caution with risk factors for bladder cancer
Caution in hepatic impairment, as it extensively metabolised there and can cause liver damage

No interactions of note

20
Q

Thiazolidinediones (Pioglitazone): Prescribing

A

Oral
Monitor efficacy by HbA1c
Warn patients to seek medical advice if they develop symptoms of side effects of bladder cancer
Liver enzymes should be measured for safety

21
Q

Corticosteroids (prednisone, dexamethasone): Indications

A

To treat allergic or inflammatory disorders
Suppression of autoimmune disorders
Some cancers: as part of chemotherapy or to reduce tutor related swelling
Hormone replacement in adrenal or pituitary insufficiency

22
Q

Corticosteroids (prednisone, dexamethasone): Mechanism of Action

A

Bind to cytosolic glucocorticoid receptors. they upregulate anti-inflammatory genes and downregulate pr inflammatory genes e.g. TNA-alpha

They also have metabolic effects: they increase gluconeogenesis and stimulate Na+ and water retention

23
Q

Corticosteroids (prednisone, dexamethasone): ADRs

A

Immunosuppression, steroid diabetes, mood and behavioural changes, osteoporosis, ADRENAL ATROPHY

24
Q

Corticosteroids (prednisone, dexamethasone): Warning and Interactions

A

Can increase risk of infection (caution in infected people) and suppress growth in children
Efficacy may be reduced by CYP450 inducers
Enhance hypokalaemia in combination with loop or thiazide diuretics
Reduce immune response to vaccines
Increased risk of bleeding alongside NSAIDs.

25
Q

Corticosteroids (prednisone, dexamethasone): Prescription

A

They all have different potencies, with dexamethasone being the most potent
Use lowest dose possible in long term
Do not stop treatment suddenly

Monitor efficacy by disease progression, check for ADRs with HbA1c or DEXA

26
Q

Levothyroxine: Indications

A

Primary or secondary hypothyroidism

27
Q

Levothyroxine: Mechanism of Action

A

It is a synthetic T4, so targets the same receptors as normal T4 all over the body

28
Q

Levothyroxine: ADRs

A

Usually due to OD, similar to HYPERTHYROIDISM e.g. diarrhoea, vomiting, palpitations, tremor, restlessness…

29
Q

Levothyroxine: Warnings and Interactions

A

Danger of ischaemia in CHD as they increase HR and metabolism

GI absorption is reduced by antacids or iron supplements
CYP450 inducers may mean an increased dose is needed

30
Q

Levothyroxine: Prescribing

A

TFTs (and TSH) to guide dosing

Warn about side effects related to high dose

31
Q

Oestrogen and Progesterones: Indications

A

Hormonal Contraception

Highly effective and reversible

32
Q

Oestrogen and Progesterones: Mechanism of Action

A

COCP functions primarily by suppressing LH/FSH levels so inhibiting ovulation
POP thickens cervical mucus

33
Q

Oestrogen and Progesterones: ADRs

A

Irregular bleeding, mood changes, increased risk of VTE (with oestrogen)

34
Q

Oestrogen and Progesterones: Warnings and Interactions

A

Absolutely contraindicated in breast cancer
COCP should be avoided in patients with heart disease or a higher VTE risk

CYP450 inducers! e.g. rifampacin

35
Q

Oestrogen and Progesterones: Prescription

A

Discuss risks and benefits
Baseline assessment includes history, BP and BMI
3 month review, then yearly check ups

Pharmacology (7 decks)

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