endo

Question 1

what are some examples medication for insulin

Answer 1

insulin aspart
insulin glargine
biphasic insulin
soluble insulin

Question 2

MOA of insulin

Answer 2

stimulate glucose uptake from the circulation into tissues incl skeletal muslce and fat

inc use of glucose as an energy source

stimulate glycogen, lipid and protein synthesis

inhibits glyconeogenesis and ketogenesis

drive K+ into cells

Question 3

what are the different types of insulin

Answer 3

fast - insulin aspart 
slow - soluble insulin 
short 
intermediate acting - Bisphane insulin 
long - insulin glargine

Question 4

which form of insulin is used when IV injection is required for hyperkalameia?

Answer 4

soluble insulin

Question 5

contra-indication for insulin

Answer 5

renal impairment (insulin clearance is reduced)

Question 6

side effect of insulin

Answer 6

hypoglycaemia

fat overgrowth when subcut is injected

Question 7

interaction of insulin

Answer 7

combination of insulin with other hypoglycaemic agents inc risk of hpoglycaemia

use with systemic corticoteriods inc insulin requirement

Question 8

indication for insulin

Answer 8

T1/2 DM

Iv injection for diabetic emergencies eg DKA and hyperglycaemic hyperosmolar syndrome

alongside glucose for hyperkalaemia

Question 9

what drug class is metformin

Answer 9

Biguanide

Question 10

MOA for metformin

Answer 10

inc response to insulin - dec blood glucose

suppress hepatic glucose production

inc glucose uptake and utilisation by skeletal muscle

suppress intestinal glucose absorption

encourage weight loss and prevent worsening of insulin resistance

Question 11

indication for metformin

Answer 11

T2 DM - 1st line

Question 12

contra-indication for metformin

Answer 12

metformin is excreted unchanged by the kidney

kidney impairment
should be stopped when AKI
should be stopped in sepsis, shock or dehydration or severe tissue hypoxia eg cardic or resp failure
hepatic impairment - clearance of excess lactate maybe impaired
stop when acute alcohol intoxication - lactic acidosis
chronic alcohol overuse - risk of hypoglycaemia

Question 13

side effect of metformin

Answer 13

GI upset
excess weight loss
lactic acidiosis - rare and esp in ill pt as it can cause accumulation and inc lactate production

Question 14

interaction of metformin

Answer 14

must be stopp for 48 hrs after injection of Iv contrast media - renal impairment

any other drugs which can cause renal impairment - ACEi, NSAIDs, diuretics

prednisolone, thiazide and loop diuretics - elevate blood glucose and so not work with metformin

Question 15

what is an example of sulphonylureas

Answer 15

gliclazide

Question 16

MOA for gliclazide

Answer 16

stimulate pancreatic insulin secretion - lower blood glucose

only effect in pt with residual pancreatic function

stimulate weight gain too and can worsen DM

Question 17

contrad-indication for gliclazide

Answer 17

metabolised in the liver

hepatic impairment
caution in renal impairment
caution in pt with risk of hypoglycaemia

Question 18

side effect of gliclazide

Answer 18

GI upset
hypoglycaemia
hypersensitivity reaction - hepatic toxicity (cholestatic jaundice)

Question 19

interaction of gliclazide

Answer 19

combination with other blood glucose lower drug - hypoglycaemia eg metformin, thiazolidinediones and insulin

reduced efficacy by prednisolone, thiazide and loop diuretics as they inc glucose

Question 20

what are some examples of thyroid hormones

Answer 20

levothyroxine, liothyronine

Question 21

MOA of thyroid hormone

Answer 21

levothyroxine - synthetic T4
liothyronine synthetic T3

liothyronin shorter short life than levothyroxine and so resevred for emergency

Question 22

indiction for levothyroxine and liothyronine

Answer 22

primary hypothyroidism

secondary hypothyroidism

Question 23

contra-indication for levothyroxine and liothyronine

Answer 23

inc HR - inc coronary artery disease - caution

in hypopituitarism, corticosteriod must be started first or else an Addisonian crisis may occur

Question 24

side effect of levothyroxine and liothyronine

Answer 24

overdose - lead to symptoms of hyperthyroidism

inc HR
GI upset
neruological - tremor, restlessness, insomnia

Question 25

interaction of levothyroxine and liothyronine

Answer 25

separation of thyroid hormone (4 hours) should be done with antacid, calcium or iron salts - reduced absorption in the gut inc dose when cytochrome p450 inducers eg phenytoin, carbamazepine can cause change in metabolism and hence should increase insulin or hypoglycaemic agents enhance effect of warfarin

Question 26

what are some examples of anti-thyroid drug

Answer 26

carbimazole

Question 27

MOA for carbimazole

Answer 27

converted to methimazole which inhibits the thyroid peroxidase - less T3/T4 production

Question 28

indication for carbimazole

Answer 28

hyperthyroidism thyroidectomy preparation radio-iodine treatment

Question 29

contra-indication for cabrimazole

Answer 29

severe blood disorder hepatic impairment pregnancy/breast feeding

Question 30

side effect of carbimazole

Answer 30

GI upset | bone suppression

Question 31

interaction of carbizmazole

Answer 31

coumarins

Question 32

what are some examples of bisphosphates

Answer 32

alendronic acid, disodium pamidronate, zoledronic acid

Question 33

MOA for alendronate/alendronic acid

Answer 33

reduce bone turnover by inhibiting the action of osteoclasts bisphosphonats as it has a similar structure to pyrophosphate, it is readily incorporated into bone and into osteolclasts and so they can nto work

Question 34

main indication for alendronate/alendronic acid

Answer 34

1st line for pt at risk of osteporotic fragility fractures pamidronate and zoledronic acid - use in treatment for severe hypercalcaemia of malignancy eg myeloma and breast cancer also 1st line for metabolically active Paget's disease which reduce bone turnover

Question 35

contra-indication of alendronic acid/alendronate

Answer 35

excreted in renal - renal impairment in pt who is hypocalcaemia oral admin - contraindicated with active upper GI disorders caution for smokers and dental disease - risk of jaw osteonecrosis

Question 36

side effect of alendoronic acid/alendronate

Answer 36

oesophagitis hypophosphataemia osteonecrosis of jaw - rare atypical femoral fracture

Question 37

interaction of alendronic acid/alendronate

Answer 37

reduce efficacy whentaken with calcium salt, antacids and iron salts

Question 38

what are some examples of calcium and vit D

Answer 38

Calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

Question 39

physiology of calcium

Answer 39

calcium homestasis is controlled by PTH and vit D - inc serum calcium levels and bone mineralisation) calcitonin - reducs serum calcium levels

Question 40

MOA for calcium and vit D

Answer 40

oral calcium - bind phosphate in the gut aldacalcidol - provide vit D which does not depend on renal activation calcium rias the myocardial threshold potential -reduce excitability and risk of arrhythmias

Question 41

indication for calcium carbonate/gluconae, colecalciferol/alfacalcidol

Answer 41

osteoporosis used in CKD to maintain calcium and phosphate level - prevent secondary hyperparathyroidism and renal osteodystrophy severe hyperkalaemia - prevent life-thretening arrythmia hypoclacaemia vit D deficiecny

Question 42

contra-indication for calcium carbonate/gluconae, colecalciferol/alfacalcidol

Answer 42

hypercalaemia

Question 43

side effect of calcium carbonate/gluconae, colecalciferol/alfacalcidol

Answer 43

dyspepsia constipation CI collapse when IV use if injected too fast

Question 44

interaction of calcium carbonate/gluconae, colecalciferol/alfacalcidol

Answer 44

calcium reduce the absorption of many drugs inclduing iron, bisphosphate, tetracyclines and levothyroxine IV Ca must not be allowed to mix with sodium bicarbonate due to risk of precipitation

Question 45

what is an example of mineralcorticoids

Answer 45

fludrocortisone

Question 46

MOA of fludrocortisone

Answer 46

Binds to aldosterone receptors, inc BP, inc Na+/H2O, less K+

Question 47

indication for fludrocortisone

Answer 47

adrenocorticla insufficency Addisons Cushings

Question 48

contra-indications

Answer 48

adrenal suppression infections corticosteroid withdrawal psychiatric

Question 49

side effect of fludrocortisone

Answer 49

high BP Na/H20 retention potassium & calcium loss