Endocrine

Question 1

gliclazide

Answer 1

this is a sulphonylurea, increases insulin secretion, binding to ATPase sensitive K+ channels, so more Ca2+ goes into the B cells of the pancreas ADRs; weight gain, hyper insulin anaemia, hypoglycaemia. Slow onset

Question 2

Repaglinide

Answer 2

This is a glinide, it increases insulin secretion, binding to ATPase sensitive K+ channels, so more Ca2+ goes into the B cells of the pancreas ADRs; weight gain, hyper insulin anaemia, hypoglycaemia - this is the same as a gliclazide (a sulphonylurea) but has a faster onset, therefore can be used after a meal - short duration

Question 3

Nateglinide

Answer 3

This is a glinide, it increases insulin secretion, binding to ATPase sensitive K+ channels, so more Ca2+ goes into the B cells of the pancreas ADRs; weight gain, hyper insulin anaemia, hypoglycaemia - this is the same as a gliclazide (a sulphonylurea) but has a faster onset, therefore can be used after a meal - short duration

Question 4

Metformin

Answer 4

Weight loss and CVS protective effects make it first line despite not having the best HBa1C reduction. Also, used for PCOS - polycystic ovarian syndrome

Question 5

Acarbose

Answer 5

this is an Alpha-glucosidase inhibitor, it prevents carbohydrates being broken down so you can’t absorb glucose, infrequently used as diarrhoea and flatulance

Question 6

Rosiglitazone

Answer 6

this is a glitazone/Thiazolidinedione, cardiac ADRs - these increase sensitivity to insulin and decrease hepatic gluconeogenesis

Question 7

Pioglitazone

Answer 7

this is a glitazone/Thiazolidinedione these increase sensitivity to insulin, and decrease hepatic gluconeogenesis

Question 8

Sitaglyptin

DPP-4 inhibitor

Answer 8

Glyptins/DPP-4 inhibitors, these inhibit the enzyme DPP-4 which inactivates GLP-1, GLP-1 (a type of incretin hormone) this increases your insulin:glucagon ratio post meals, and is responsible for the feeling of satiety (fullness). ADRs; can get nasopharyngitis - rare, normally well tolerated

Question 9

Dapagliflozin

Answer 9

SGLUT-2 inhibitors cause an osmotic diuresis in the kidneys. ADRs; polyuria, polydipsia, increased risk UTI

Question 10

Treatment pathway of type 2

Answer 10

Metformin, then metformin + sulphonylurea, pioglytiazone + gliptin/DPP-4 inhibitor

If can’t have metformin - either sulphonylurea or a gliptin, then add the other one, if still not working add a pioglitazone

Question 11

HBa1C targets

Answer 11

lifestyle only; 6.5
Drugs to do with this; 7 (higher as it’s not worth the risk of hypo when you’re on medication)

normal = less than 6

Question 12

normal/soluble insulin

Answer 12

classic, rapid acting, 20 mins before eating, used in emergency IV

Question 13

NPH

Answer 13

medium - long acting insulin

Question 14

insulin glargine

Answer 14

longest acting insulin

Question 15

insulin Aspart

Answer 15

rapid acting insulin, unlike regular insulin needs to be given 20min or so before eating - used in insulin pumps

Question 16

insulin lispro

Answer 16

rapid acting insulin, can give after meal, unlike regular insulin needs to be given 20min or so before eating

Question 17

what accounts for the difference in length of action

Answer 17

molecules have different end chains, which affects how long they take to be absorbed into blood from subcut

Question 18

Hyperthyroidism

Answer 18

treated with carbimazole - can be given with thyroxine, or radioactive iodine, this goes into the thyroid and damages it back down to normal - ADRs - cold intolerance

Question 19

hyporthyroidism

Answer 19

levo-thyroxine treatment