Endocrinology Flashcards
(45 cards)
List 3 examples for first generation sulphonylurea anti diabetics?
Chlorpropamide
Tolazamide
Tolbutamide
Main side effects of chlorpropamide
Long t1/2 SIADH Disulfiram like reaction 🥂 Weight gain Hypoglycemia Nausea and GI discomfort CI in renal disease, liver disease and frank jaundice
Mechanism of action of insulin secretagogues ( sulphonyl urea and meglitinides)
Close ATP dependent potassium channel, membrane depolarization,
Open voltage gated Ca channels allow Ca mediated exocytosis of insulin
Main side effects of metformin
Metallic taste Nausea, vomit 🤢, anorexia Lactic acidosis 🥂 Decrease absorption of Vit B 12 Preoperative or before RMI - lactic acidosis esp in patient with renal disease.
What are the main side effects of Thiazolidinediones?
Liver toxicity ( met by CYP )
Weigh gain and fluid retention ( CI in severe heart failure💔)
Bose Osteopenia and increase fracture risk.
Rosiglitazine cause MI
Pioglitazone bladder cancer
Increase risk of pregnancy 🤰🏻
In which conditions is alpha glucosidase inhibitors contraindicated?
IBD
Colonic ulcer
Intestinal obstruction
Examples of DPPI
Sitagliptin
Saxagliptin ( met by CYP 3A4/5 inhibitors)
Linagliptin (no dose adjust in kidney disease)
Alogliptin
Effect of pioglitazone and Rosiglitazone on Lipids
Both increase HDL
Pioglitazone decrease TG
Rosiglitazone increase LDL and TG
Examples of Sodium glucose cotransporter 2 inhibitors
Promote renal secretion of glucose in proximal tubule
Take on EMPTY stomach in the Morning
Canagliflozin
Dapagliflozin
What are the main side effects of SGLT2 inhibitors.
Urinary tract infection Vulvovaginal candidiasis Urinary frequency - osmotic diuretic Dehydration Hypotension Hyperkalemia
Antidiabetic medication should be taken 30 min before food or with first bite?
Meglitinides
Acarbose
Antidiabetic medication associated with increase fracture risk and osteopenia?
Thiazolidindiones
Effect of insulin on potassium level.
Insulin cause the shift of potassium from outside the cell to inside the cell.
Therefore used in treatment of hyperkalemia
Antidiabetic medication causing pancreatitis?
DPPI ( sitagliptin, saxagliptin, alogliptin, linagliptin)
GLP 1 - Incretin mimetics ( Exenatide, Liraglutide) 💉💉
Anti diabetic Cause nasophargitis and upper respiratory tract infection?
DPPI 4 inhibitors
Drugs that cause dysglycemia?
Atypical antipsychotics B antagonist Diuretics thiazides and loop Diazoxide Glucocorticoids Niacin Isoniazid Pentamidine Protease inhibitors Tacrolimus Interferon alpha
Risk for diabetes mellitus
Obesity
Age greater 40
Overweight, dyslipidemia, Hypertension
Vascular disease (coronary, cerebrovascular, peripheral)
Gestational diabetes
Vascular disease -(Coronary, cerebrovascular, peripheral)
History of impaired glucose tolerance or impaired fasting glucose
Schizophrenia
When should we start insulin therapy immediately in diabetic patient at time if diagnosis?
HbAC1 >= 9% عالي اوي. Or I can give 2 Oral medications
Normal 4-6٪
What are the vaccines recommended in Diabetes
Annual influenza vaccine
One time pneumococcal vaccine (2nd if older than 65 and received dose 5 years earlier)
Monitoring in diabetes
Annual- foot exam, serum creatinine, ophthalmologist
3months- HbA1c. If good 6 months
3 months- lipid profile and start statins
What is advantage of adding metformin to insulin?
Dec insulin dose
Less weight gain
Less Hypoglycemia
Avoid adding TZD to insulin-edema and wit gain inc HF
Management of hypoglycemia
Conscious- oral glucose
Unconscious- IM or SC glucagon
OR
IV dextrose (malnutrition or alcohol induced)
Medications for diabetic patients for vascular protection?
- Antiplatelets ( macrovascular or microvascular complications , long standing diabetes, age greater 45 male , 50 females)
- Statin male greater than 45 , female greater than 55
- Blood pressure less than 130/80
Medications for pregnant women 🤰🏻and diabetic?
Insulin (Lispro, Aspart)
Glyburide
Metformin
