Endocrinology Drugs

Question 1

What is the mechanism of action of insulin?

Answer 1

It lowers plasma glucose concentration by:

• stimulating glucose transport into fat and muscle cells
• stimulating glycogen synthesis
• inhibiting glucogenesis and lipolysis

Question 2

What are the indications for insulin?

Answer 2

Type 1/2 diabetes mellitus
Ketoacidosis
Hyperglycaemic hyperosmotic non-ketotic coma
Emergency treatment of hyperkalaemia

Question 3

What are the cautions of insulin?

Answer 3

Renal impairment

Question 4

What are the side-effects of insulin?

Answer 4

Hypoglycaemia
Weight gain

Rare: fat Hypertrophy at injection sites

Question 5

What are the interactions of insulin?

Answer 5

B blockers: mask warning signs of hypoglycaemia which are meditated by sympathetic nervous system

Question 6

What class of drug is gliclazide?

Answer 6

Sulphonylurea

Question 7

What is the mechanism of action of gliclazide?

Answer 7

It stimulates insulin production by binding to sulphonylurea receptors and blocking ATP-dependent potassium channels in pancreatic B cells
Causes depolarisation and insulin release
Also inhibits gluconeogenesis

Question 8

What are the indications for gliclazide?

Answer 8

Type 2 diabetes mellitus

Question 9

What are the contra-indications for gliclazide

Answer 9

Ketoacidosis
Pregnancy/breastfeeding

Cautions:
- elderly and renal and hepatic impairment susceptible to hypoglycaemia

Question 10

What are the side effects of gliclazide?

Answer 10

Hypoglycaemia
Weight gain

Rare: headache, rash, GI disturbance, bone marrow suppression

Question 11

What are the interactions of gliclazide?

Answer 11

Chloramphenicol/cotrimoxazole/sulphonamides: ⬆️ hypoglycaemic effects of gliclazide

Fluconazole: ⬆️ plasma concentration of gliclazide

Question 12

What class of drugs Metformin?

Answer 12

Biguanide

Question 13

What is the mechanism of action of Metformin?

Answer 13

Not fully understood
Requires presence of insulin as it is an insulin sensitising agent
⬆️ peripheral glucose utilisation and ⬇️ gluconeogenesis
Inhibits glucose absorption from GI tract

Does not cause hypoglycaemia

Treatment of choice in obese diabetic pt as it decreases appetite

Question 14

What are the indictions for Metformin?

Answer 14

Type 2 diabetes mellitus

Question 15

What are the contra-indications for Meftormin?

Answer 15

Breastfeeding/pregnancy
Conditions predisposing to lactic acidosis

(Hepatic/renal impairment, severe heart failure, infection, dehydration)

Question 16

What are the side effects of Metformin?

Answer 16

Anorexia
Nausea
Vomiting
Diarrhoea

Rare: lactic acidosis

Question 17

What are the interactions of Metformin?

Answer 17

Alcohol: ⬆️ risk of lactic acidosis

Corticosteroids: antagonise hypoglycaemic effect

Question 18

Where is Metformin eliminated?

Answer 18

It is eliminated in the kidneys - tubular secretion as unchanged

Question 19

What class of drug is thyroxine?

Answer 19

Thyroid hormone

Question 20

What is the mechanism of action of thyroxine?

Answer 20

• mimics endogenous thyroxine

- ⬆️ oxygen consumption of metabolically active tissues

Question 21

What are the indications for thyroxine?

Answer 21

Hypothyroidism

Question 22

What are the side effects of thyroxine?

Answer 22

Rare: cardiac dysthymias, tachycardia, MI, angina pain, restlessness, sweating, weight loss

Question 23

What are the interactions of thyroxine?

Answer 23

Warfarin: ⬆️ effect of warfarin

Question 24

What class of drug is Carbimazole?

Answer 24

Anti thyroid

Question 25

What is the mechanism of action of Carbimazole?

Answer 25

- ⬇️ production of thyroid hormones T3 and T4 in the thyroid | - inhibits the enzyme thyroid peroxidase which is necessary for thyroid hormone synthesis

Question 26

What are the indications for Carbimazole?

Answer 26

Hyperthyroidism

Question 27

What are the cautions of Carbimazole?

Answer 27

Breastfeeding/pregnancy

Question 28

What are the side effects of Carbimazole?

Answer 28

``` GI disturbance Headache Skin rash Pruritis Joint pain ``` Rare: agranulocytosis, jaundice, alopecia

Question 29

What class of drug is Alendronate?

Answer 29

Bisphosphonate

Question 30

What is the mechanism of action of Alendronate?

Answer 30

- inhibits osteoclast- mediated bone reabsorbtion | - for optimal activity enough vitamin D and calcium are needed to promote normal bone development

Question 31

What are the indications for Alendronate?

Answer 31

Post-menopausal osteoporosis Corticosteroid-associated osteoporosis Paget's disease

Question 32

What are the contraindications for Alendronate?

Answer 32

Abnormalities of oesophagus (eg stricture) Hypocalcaemia Renal impairment Pregnancy/breastfeeding

Question 33

What are the side effects of Alendronate?

Answer 33

Oesophageal reactions Abdo pain and distension GI disturbances

Question 34

What are the interactions of Alendronate?

Answer 34

Antacids: ⬇️ absorption of Alendronate

Question 35

What class of drug is calcium?

Answer 35

Mineral

Question 36

What are the indications of Calcium?

Answer 36

Calcium deficiency: - ⬆️ requirements in childhood, pregnancy and lactation - ⬇️ absorption in the elderly - double recommend dose needed in osteoporosis to prevent bone loss

Question 37

What are the contra-indications with calcium?

Answer 37

Conditions associated with hypercalcaemia and hypercalciuria

Question 38

What are the side effects of calcium?

Answer 38

GI disturbances Bradycardia Arrhythmias

Question 39

What are the interactions of calcium?

Answer 39

Ciprofloxacin/tetracycline: ⬇️ absorption with calcium salts Diuretics: ⬆️ risk of hypercalcaemia

Question 40

What class of drug is Vitamin D?

Answer 40

Vitamin

Question 41

What are the indications of Vitamin D?

Answer 41

Vitamin D deficiency; - insufficient exposure to sunlight - insufficient dietary intake - osteoporosis - GI malabsorption - chronic liver disease/renal impairment

Question 42

What are the contra-indications of Vitamin D?

Answer 42

Hypercalcaemia | Metastatic calcification

Question 43

What are the side effects of vitamin D?

Answer 43

Symptoms of overdose including: anorexia, nausea, vomiting, diarrhoea, constipation, weight loss, polyuria, vertigo, headache, sweating, thirst

Question 44

What are the interactions of vitamin D?

Answer 44

Carbamazepine/phenytoin: ⬆️ vitamin D requirements Diuretics: ⬆️ risk of hypercalcaemia

Question 45

What class of drug is insulin?

Answer 45

Peptide hormone