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BM4 Part 1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is a ligand?

A

A molecule/substance that binds to a receptor.

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2
Q

What is an agonist?

A

A ligand that binds to and activates a receptor to stimulate an effect.

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3
Q

What is an antagonist?

A

A ligands that binds to a receptor but does not stimulate an effect.

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4
Q

What are the metabolic effects of insulin?

A

Increases - glucose uptake into cells, glycolysis, glycogen synthesis, lipogenesis.
Decreases - gluconeogenesis, pentose pathway, glycogenolysis, lipolysis, amino acid catabolism, ketogenesis.

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5
Q

What are the effects of glucagon?

A

In general, the opposite to insulin.

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6
Q

What are the main ketone bodies?

A

Acetoacetate and β-hydroxybutyrate.

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7
Q

Where are insulin and glucagon specifically secreted from?

A

Insulin = pancreatic beta cells. Glucagon = pancreatic alpha cells.

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8
Q

What is a hormone?

A

A chemical messenger, made by cells in the body, and allows cells to communicate with each other?

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9
Q

What are the 2 types of hormone receptors?

A
  1. Plasma membrane receptors
  2. Nuclear receptors
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10
Q

Why can’t HbA1c be used to rule out T1DM?

A

Onset of symptoms is usually rapid so a change in 3 month average won’t necessarily be seen.

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11
Q

How can steroids affect individuals with DM?

A

Steroids cause a raise in sugar levels so can lead to hyperglycaemia.

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12
Q

What is the mode of action of metformin?

A

Increases uptake of glucose and glycogen storage in skeletal muscle and adipose tissue.
Suppresses hepatic gluconeogenesis and glycogenolysis.
Reduces glucose absorption in the SI.
May act through AMP kinase activation.

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13
Q

What are examples of rapid-acting insulin?

A

Insulin lispro (humalog) and aspart (novorapid)

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14
Q

What are examples of short-acting insulin?

A

Soluble human insulin (humulin S, actrapid)

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15
Q

What are examples of intermediate-acting insulin?

A

Isophane (humulin I, insuman basal, insulatard)

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16
Q

What are examples of long-acting insulin?

A

Glargine (lantus), determir (levemir), degludec (tresiba)

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17
Q

What is the first line treatment for T1DM?

A

Basal-bolus regime:
Insulin determir - 1-2x daily.
Insulin aspart, lispro or glulisine 15 mins before meals.

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18
Q

Where are insulin and glucagon specifically secreted from?

A

Insulin = pancreatic beta cells.
Glucagon = pancreatic alpha cells.

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19
Q

What are the metabolic effects of insulin?

A

Increases - glucose uptake into cells, glycolysis, glycogen synthesis, lipogenesis.
Decreases - gluconeogenesis, pentose pathway, glycogenolysis, lipolysis, amino acid catabolism, ketogenesis.

20
Q

What are the effects of glucagon?

A

In general, the opposite to insulin.

21
Q

What are the main ketone bodies?

A

Acetoacetate and β-hydroxybutyrate.

22
Q

What is the diagnostic criteria for diabetes?

A

Fasting glucose > 7 mmol/L
Random glucose > 11.0 mmol/L
Hb1ac > 48 mmol/mol
*if symptomatic - 1 for diagnosis, if asymptomatic then 2.

23
Q

What are the presenting features of T1DM?

A

Polyuria/nocturia
Polydipsia
Drowsiness/fatigue
Blurred vision
Weight loss
Muscle wasting
Recurrent infections (particularly fungal)
DKA

24
Q

What are the presenting features of T2DM?

A

Polyuria/nocturia
Polydipsia
Blurred vision
Recurrent infections (particularly fungal)
30% present asymptomatically

25
Q

What are the main insulin regimes?

A

Once/twice-daily intermediate or long acting
Once/twice/three times daily premixed
Basal-bolus therapy
Mealtime rapid acting

26
Q

What is the definition of hypoglycaemia?

A

Low blood sugar levels - < 3.0 mmol/L.

27
Q

What are the symptoms of hypoglycaemia?

A

Shaking, sweating, trembling, palpitations, headache, hunger.
Neuroglycopaenic - double vision, difficulty concentration, slurring speech
Confusion, change in behaviour
Unconsciousness/fits

28
Q

How is hypoglycaemia managed?

A

If conscious - 15 g of glucose orally and re-check levels after 15 mins. If > 4.0 mmol/L, offer 15-20 g of complex carbohydrates.
If unconscious - give 1 mg glucagon SC/IM and 50 mL 50% dextrose IV.

29
Q

What is the mode of action of metformin?

A

Increases glucose uptake and glycogen storage in skeletal muscle and adipocytes.
Suppresses hepatic gluconeogenesis and glycogenolysis and reduces glucose absorption from the small intestine.

30
Q

What are the possible side effects of metformin?

A

GI upset (1 in 10)
Reduces GI vitamin B12 absorption - should be monitored if long term use
Lactic acidosis - rare (0.5 per 1000)
Reduces renal function - eGFR > 30 for use

31
Q

What are the 3 main sulfonylureas?

A

Gliclazide
Glibenclamide
Glimepiride

32
Q

What is the first line treatment for T2DM?

A

Metformin
Sulfonylurea if metformin is contraindicated

33
Q

What are the possible side effects of sulfonylureas?

A

Hypoglycaemia (20%)
Weight gain (1-4 kg)

34
Q

What is the mechanism of action of sulfonylureas?

A

Directly stimulate the release of insulin from pancreatic beta-cells.

35
Q

What is the mechanism of action of thiazolidinedione (e.g. pioglitazone)?

A

Increases glucose uptake of skeletal muscle and reduces liver glucose output.

36
Q

What are the possible side effects of thiazolidinediones?

A

Weight gain (can be significant)
Fluid retention - cardiac failure, anaemia, oedema
Increased fracture
Takes longer than other drugs to give effect.

37
Q

What are the 3 main DPP-4 inhibitors?

A

Sitagliptin
Linagliptin
Alogliptin

38
Q

What are the 3 main GLP-1 receptor agonists?

A

Liraglutide
Dulaglutide
Semaglutide

39
Q

What are the possible side effects of DPP-4 inhibitors?

A

Nausea is the most common side effect but mostly well tolerated

40
Q

What are the possible side effects of GLP-1 receptor agonists?

A

Efficacy differs within class
Promotes weight loss (0.6-4.3 kg
Some show reductions in CV events
2nd/3rd line agents but should not be used with DPP4i

41
Q

What are the 3 main SGLT2 inhibitors?

A

Dapagliflozin
Canaglifozin
Empaglifozin

42
Q

What are the possible side effects of SGLT2 inhibitors?

A

May increase risk of mycotic infection (e.g. thrush)
May precipitate DKA (rare)

43
Q

What is the mode of action of SGLT2 inhibitors?

A

Reduced the rate of glucose reabsorption

44
Q

What effects does insulin have on potassium levels?

A

Lowers serum potassium

45
Q

Juxtracrine Signalling

A

Signalling which requires close contact between cells

46
Q

Paracrine

A

Signalling between nearby cells

BM4 Part 1 (11 decks)

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