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Flashcards in Endocrine Deck (35)
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1

Insulins: Indications

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

2

Insulins: Mechanism of Action

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

3

Insulins: ADRs

Hypoglycaemia, can be serious enough to cause coma to death
Lipid hypertrophy at SC injection site

4

Insulins: Warnings and Interactions

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

5

Insulins: Prescribing

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

6

Sulfonylureas (Glicazide): Indications

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

7

Sulfonylureas (Glicazide): Mechanism of Action

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

8

Sulfonylureas (Glicazide): ADRs

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

9

Sulfonylureas (Glicazide): Warnings and Interactions

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

10

Sulfonylureas (Glicazide): Prescription

They are a long term treatment
Monitor HbA1c

11

Metformin <3: Indications

First choice for Type 2 DM

12

Metformin <3: Mechanism of Action

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

13

Metformin <3: Warnings and Interactions

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

14

Metformin <3: ADRs

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

15

Metformin <3: Prescription

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

16

Thiazolidinediones (Pioglitazone): Indciations

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

17

Thiazolidinediones (Pioglitazone): Mechanism of Action

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

18

Thiazolidinediones (Pioglitazone): ADRs

GI upset, anaemia, dizziness
Serious: oedema, slight risk of fx and bladder ca. in women

19

Thiazolidinediones (Pioglitazone): Warnings and Interactions

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

Thiazolidinediones (Pioglitazone): Prescribing

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

Corticosteroids (prednisone, dexamethasone): Indications

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

Corticosteroids (prednisone, dexamethasone): Mechanism of Action

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

Corticosteroids (prednisone, dexamethasone): ADRs

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

24

Corticosteroids (prednisone, dexamethasone): Warning and Interactions

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

Corticosteroids (prednisone, dexamethasone): Prescription

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

Levothyroxine: Indications

Primary or secondary hypothyroidism

27

Levothyroxine: Mechanism of Action

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

28

Levothyroxine: ADRs

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

29

Levothyroxine: Warnings and Interactions

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

Levothyroxine: Prescribing

TFTs (and TSH) to guide dosing
Warn about side effects related to high dose