endocrinology

Question 1

types of inuslin

Answer 1

rapid acting - insulin aspart- Novorapid

short acting - soluble insulin - Actrapid

intermediate acting - isophane (NPH) - Humulin 1

Long acting - insulin glargine(lantus), insulin determir (levemir)

biphasic insulin preparations - mixture of rapid and intermediate - novomix 30 (aspart + aspart protamine)

Question 2

mode of action of insulin

Answer 2

in diabetes, stimulates glucose uptake from circulation into tissues inc. skeletal muscle and fat and increases use of glucose as energy store

stimulates glycogen, lipid and protein synthesis and inhibits gluconeogenesis amnd ketogenesis

reduces serum K+ short term

Question 3

indications for insulin

Answer 3

insulin replacement with type 1 diabetes and for blood flucose control in type 2 hwere oral hypoglycaemic treatment is inadequate

IV for diabetic emergencies (ketoacidosis, hyperglycaemias hyperosmolar synfrome and for perioperative glycaemic control)

hyperkalaemia - alongisde glucose while other measures initiated

Question 4

contraindications for insulin

Answer 4

renal impairment

insulin clearance reduced = icnreased risk of hypoglycaemia

Question 5

side effects of insulin

Answer 5

hypoglycaemia - severe can lead to coma and death

repeated SC injection at same site = fat overgrwoth (lipohypertrophy)

Question 6

interactions of insulin

Answer 6

other hypoglycaemic agents increase risk of hypoglycaemia

concurrent therapy with systemic corticosteroids increase insulin requirements

Question 7

gliclazide

Answer 7

sulphonylureas

Question 8

gliclazide/sulphonylureas mode of action

Answer 8

lower blood glucose by stimulating pancreatic inuslin secretion

Question 9

indications for sulphonylureas

Answer 9

type 2 DM
contorl blood glucose and reduce complications where metformin is contraindicated

in combo with metofrmin where blood glucose inadequately controlled

Question 10

contra-indications of sulphonylureas

Answer 10

hepatic impairemnt - reduced dose

gluocse monitoring in renal impairment

Question 11

side effects of sulphonylureas

Answer 11

dose related side effects such as GI upset

hypoglucaemia in high doses, or reduced drug metabolims or when in combo with other hypoglycaemics

hypersenstivity reactions are rare but cause hepatic toxicity, drug hypersensitivity syndrome and haematological abnromalities

Question 12

interactions of sulphonylureas

Answer 12

increased risk of hypoglycaemia if prescribed with metformin, thiazolidinediones and insulin

efficacy reduced by drugs that elevate blood glucose - prenisolone, thiazide and loop diuretics

Question 13

metformin

Answer 13

biguanides

Question 14

mode of action of metformin/biguanides?

Answer 14

lowers blood glucose by increasing repsonse to insulin

does not stimulate pancreatic insulin so does not cuasse hypoglycaemia

reduces weight gain and induce wieght loss = prevent worsening of insulin resistance and deterioration of DM

Question 15

indications of metformin/biguanides?

Answer 15

type 2 DM as first choice medication for control of blood glucose, used alone in combination with other hypoglycaemic drugs (sulphonylureas) or insulin

Question 16

contraindications of metformin/biguanides

Answer 16

severe renal impairement
withheld in AKI, acute alcohol intoxication and chronic alcohol intoxication
caution in hepatic impairment

Question 17

side effects of metformin/biguanides

Answer 17

GI upset

lactic acidosis - rare but fatal if untreated

Question 18

interactions of metformin/biguanides

Answer 18

witheld 48hr post injection of IV contrast - increased risk of renal impairment, metformin acuclulation and lactic acidosis

other drugs impairing renal function

prednisolone thiazide, loop diuretics, elevate blood glucose and reduce efficacy

Question 19

levothyroxine

Answer 19

thyroid hormone

Question 20

levothyroxine mode of action

Answer 20

replaces thyroid hormones - liothyronine has shorter half life and quicker onset and offset so reserved for emergency treatment of severe or acute hypothtroidism

Question 21

indications of levothyroxine

Answer 21

primary hypothyroidism

hypothyroidism secondary to hypopituitarism

Question 22

contraindications of levothyroxine

Answer 22

precipitate cardiac ischaemia in those with CAD

corticosteroid therapy to avoid addisonian crisis in hypopituitarism

Question 23

side effcts of levothyroxine

Answer 23

hyperthyroidism in excessive dosage - gastrointestinal (D+V, wt loss) , cardiac (palp, arrhyth., angina) and neurological (tremor, restlessness, insomnia) manifestations

Question 24

possible interactions of levothyroxine

Answer 24

GI absorption reduced by antacids, caclium or iron salts (4hrs diff in admin)

increased dose in cytochromic P450 inducers

can increase insulin or oral hypoglycaemic requirements in DM and enhance warfarin

Question 25

carbimazole

Answer 25

antithyroid

Question 26

how does carbimazole work?

Answer 26

reduces production of thyroid hormones T3 and T4

Question 27

indications for carbimazole

Answer 27

hyperthyroidism

Question 28

contraindications fro carbimazole

Answer 28

early months of pregnancy not ideally when breastfeeding people with severe liver disease or blood disorders

Question 29

side effects of carbimazole

Answer 29

rashes and pruritus are common - treat w antihistamines bone marrow suppression is rare = neutropenia and agranulocytosis

Question 30

possible interactions of carbimazole

Answer 30

warfarin theophylline erythromycin steroids - prednisolone

Question 31

alendronate

Answer 31

bisphosphonate

Question 32

mode of action of bisphosphonate/alendronate

Answer 32

reduce bone turnover by inhibiting the action of osteoclasts (cell responsible for bone resporption) = reduce bone loss and improve bone mass

Question 33

indications for bisphosphate/alendronate

Answer 33

alendronic acid used as first line treatment for those at risk of osteoprootic fragility fractures used as first line treatment of metabolically active pagets disease - reduce bone turnover and pain

Question 34

contraindications of bisphosphonate

Answer 34

avoided in severe renal impairment hypocalcaemia oral contraindicated in upper GI disorders risk of jaw osteonecrosis, avoid in somkers and major dental disease

Question 35

side effects of bsiphosphonate

Answer 35

common side effect - oesophagitis and hypophosphatemia osteonecrosis of jaw atypical femoral fracture

Question 36

interactions of bisphosphonates

Answer 36

bind calcium absorption reduced if taken with calcium salts inc milk as well as antacids and iron salts

Question 37

inidcations for caclium carbonate

Answer 37

osteoporosis chronic kidney disease - prevent hyperparathyroidism and renal osteodystrophy severe hyperkalaemia to prevent arrhythmias severe hypocalcaemia

Question 38

indications for vitamin D

Answer 38

osteoporosis chronic kidney disease - prevent secondary hyperparathyroidism and renal osteodystrophy prevent and treat vit D deficiency (rickets and osteomalacia)

Question 39

contraindications of vit D and calcium

Answer 39

hypercalcaemia

Question 40

side effects of calcium

Answer 40

oral calcium well tolerated but may cuase dyspepsia and constipation Iv can cause cardiovacular collapse if too fast and tissue damage locally if given into SC tissue

Question 41

interactions of calcium

Answer 41

reduces absorption of many drugs - iron, bisphosphonates, tetracycline and levothyroxine IV should not mix with sodium bicarbonate due to risk of precipitation

Question 42

fludrocortisone

Answer 42

mineralcorticoid

Question 43

mode of action of fludrocortisone

Answer 43

mineralcorticoid replacement in adrenocortical insufficiency

Question 44

indications of fludrocortisone

Answer 44

adrenocortical insufficiency

Question 45

contraindications of fludrocortisone

Answer 45

systemic infection | avoid live virus vaccines

Question 46

side effects of fludrocortisone

Answer 46

same as corticosteroids

Question 47

interactions of fludrocortisone

Answer 47

increased risk of peptic ulcers and GI bleeds when used with NSAIDs and enhanced hypokalaemia in patients taking beta2agonists, theophylline, loop or thiazide diuretics efficacy reduced by cytochrome P450 inducers reduce immune response to vaccines