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Endocrine > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

What’s the MoA for metformin / biguanides? (2)

A

Reduce hepatic gluconeogenesis, increase peripheral blood glucose uptake.

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2
Q

What affect does metformin have on weight?

A

Weight neutral / may promote weight loss

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3
Q

Does metformin risk hypoglycaemia?

A

Not as a monotherapy

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4
Q

What are the adverse effects of metformin? (3)

A

GI upset, lactic acidosis, obstruction of B12/folate metabolism

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5
Q

What’s the MoA of SUR drugs? (3)

A

Binds to SUR1 subunit of Katp channel, closing it (depolarising), leading to opening of voltage-gated calcium channels and insulin release.

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6
Q

Do SUR drugs risk hypoglycaemia?

A

Yes

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7
Q

What effect do SUR drugs have on weight?

A

Weight gain

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8
Q

Side effects of SUR drugs?

A

Abnormal LFTs, renal failure, CHD risk

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9
Q

GLP-1 drugs are given orally or by injection?

A

Injection

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10
Q

What effect do GLP-1 drugs have on weight?

A

Weight loss

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11
Q

Are biguanides safe in pregnancy?

A

Yes

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12
Q

Maximum daily dose of metformin

A

2g (1g BD)

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13
Q

Example SUR drug

A

Gliclazide

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14
Q

Do SUR drugs prevent microvascular / macrovascular complications? (2)

A

Microvascular - Yes

Macrovascular - No

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15
Q

Side-effects of GLP-1 includes

A

Nausea, pancreatitis

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16
Q

Examples of GLP1 drugs

A

Exenatide, Liraglutide

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17
Q

DPP-4 drug example

A

Any -gliptin drugs (e.g. vildagliptin)

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18
Q

How do DPP-4 drugs work?

A

Reduce breakdown of GLP-1 (which itself promotes insulin secretion, lowers glucose absorption)

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19
Q

How do GLP-1 agonist drugs work? (4)

A

1) Promotes insulin secretion from pancreas
2) Lower glucose absorption in the gut
3) Suppress glucagon release
4) Delay gastric emptying & lower hunger

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20
Q

Are DPP-4 inhibitors weight-neutral?

A

Yes

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21
Q

Do DPP-4 inhibitors risk hypoglycaemia?

A

No

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22
Q

Do GLP-1 agonists protect against micro and macrovascular complications? (2)

A

Micro- assumed

Macro - unknown (but decreases SBP)

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23
Q

Do DPP-4 inhibitors protect against macrovascular progression?

24
Q

Are DPP-4 inhibitors oral?

Study These Flashcards
A

Yes (they block GLP-1 which is produced in the GI tract)

25
Glitazone/TZD drugs act how? Are they insulin dependent?
Through PPAR-gamma (induction of peripheral glucose uptake & fatty acid synthesis in adipocytes). No
26
Are glitazone/TZD drugs weight neutral?
No, they encourage production of fat.
27
What are the side-effects of glitazone drugs?
Fracture, hepatotoxic, fluid retention (can lead to heart failure)
28
SIGN 154 guidance of glycaemic control in T2DM: give the 1st line therapy (and alternative)
1st line = metformin Alternative* = SUR *if intolerant OR osmotic symptoms present. Both are in addition to lifestyle measures.
29
SIGN 154 guidance of glycaemic control in T2DM: give the 2nd line therapy
Metformin / SUR + (one of) SUR / SGLT2/ DPP-4 / TZD
30
SIGN 154 guidance of glycaemic control in T2DM: give the third line therapy
Metformin / SUR + 2nd line therapy + addition of agent from another class (not used). If patient's BMI is >30 substitute this new drug for GLP-1 injections (weight loss) OR insulin (if <30).
31
If patient's have a history of CVD, what's the standard 2 drugs used in T2DM control?
Metformin + SGLT2
32
DPP-4 drug naming convention....
-Gliptin
33
In T2DM, insulin therapy tends to be basal/bolus focused?
Basal (T1DM tends to be basal and bolus)
34
In T2DM, is the initial insulin therapy used as a monotherapy?
No, combined with metformin
35
Which tricyclic antidepressant is useful in neuropathic pain?
Amitriptyline (off-label)
36
If the patient cannot tolerate oral medication for neuropathic pain, which topical alternative is available?
Capsaicin cream
37
Metoclopramide and domiperidone are examples of what kind of drug?
Promotility agents
38
Ondansetron is an example of which type of drug?
Anti-emetic
39
What's the standard therapy for hypothyroidism & starting dose for young patients?
Levothyroxine (T4) 50-100micrograms per day
40
In elderly, the dosage of levothyroxine is higher/lower than youth?
Lower (25-50micrograms per day versus 50-100 in youth)
41
In pregnancy, how should levothyroxine dose be adjusted in hypothyroidism?
Increase by 25-50%
42
How often should TSH be checked in hypothyroidism if the dosage is changed?
Every 2 months (versus 12-18 months once stabilised)
43
In secondary hypothyroidism, TSH is unreliable and treatment should be titrated to what?
Free T4 level
44
Levothyroxine should be taken at what time & how?
Before breakfast without other tablets
45
T4 is much more potent than T3, true or false?
False - T3 is more potent
46
Carbimazole represents the 1st/2nd line therapy in hyper/hypothyroidism?
1st in hyperthyroidism
47
Why is carbimazole not used in the 1st trimester of pregnancy?
Risk of aplasia cutis
48
What drug is used in the 1st trimester of pregnancy in hyperthyroidism?
PTU
49
PTU is how much less potent than carbimazole?
10x
50
How does PTU work?
Inhibits DIO1 (conversion of T4 to T3) rather than production of T4
51
What's the major risk associated with ATDs?
Agranulocytosis
52
Once agranulocytosis has been treated, ATDs can be resumed. True/false?
False
53
How should suspected agranulocytosis be managed in hyperthyroid patients? (2)
1) Cease ATD immediately | 2) Refer for immediate FBC
54
How do beta-blockers work in hyperthyroid disease?
These work on beta-adrenoceptors which reduce sympathetic nervous activity (excessive in hyperthyroid disease)
55
What's the beta-blocker of choice in hyperthyroidism?
Propanolol
56
The immediate symptoms of thyrotoxicosis can be managed with which drug?
Beta-blocker
57
If a hyperthyroid patient is also asthmatic, how are cardiac symptoms managed?
Use calcium-channel blocker instead

Endocrine (17 decks)

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