PPT Metabolic Flashcards
(22 cards)
Thiazalidediones (Pioglitazone) is contraindicated in patients with __________ because __________
Heart failure
It causes fluid retention
Which 2 diabetic medications can cause hypoglycaemia when taken on their own
Sulfonylureas (i.e. gliclazide)
Insulin
Which 2 diabetic medications can cause hypoglycaemia when taken with other hypoglycaemics
Sitagliptin (DPP-4 inhibitor)
Exenatide (GLP-1 mimetic)
There is increased risk of Rhabdomyolysis when combining statins with..
Macrolides (Erythromycin/Clarithromycin)
Statins must be temporarily stopped when a macrolide antibiotic is started
Loop diuretics inhibit
Na/Cl/K co transporter -> excretion of all 3 ions
Can lead to hyponatraemia, hypokalaemia,
Thiazides
NaCl excretion
K+ sparing diuretic (aldosterone) MOA
Na excretion and K+ retention
Loop and thiazide diuretics are known to cause ____kalaemia
Hypokalaemia
With Loop diuretics there is K+ excretion and with thiazide diuretics the Na excretion means increase in distal tubular sodium concentration which stimulates the aldosterone-sensitive sodium pump to increase sodium reabsorption in exchange for potassium and hydrogen ion, which are lost to the urine
-> can lead to metabolic alkalosis (loss of Hydrogen ions)
Side effects of different diabetic drugs
1 - Biguanides e.g. metformin - GI upset, lactic acidosis in those with renal failure
2 - Insulin - hypoglycaemia, weight gain, lipodystrophy
3 - Sulfonylureas e.g. gliclazide - weight gain, hypoglycaemia
5 - SGLT-2 inhibitors - genital infections, diabetic ketoacidosis
AKI =
Increase in serum creatinine >26.5/L within 48 hours
Unrine volume <0.5ml/kg for six hours
Management of AKI
IV fluid Withdrawal of nephrotoxins Withhold hypotensive agents and diuretics Stop K raising drugs Withhold atorvastatin
Spironolactone is used in..
HF
Resistant hypertension
Temp treatment of Conn’s
Liver failure ( ascites and oedema)
Loop diuretics is used for..
Oedema (in HF, hepatic, renal disease)
Hypertension
Pulmonary oedema
ACE inhibitors is used in..
Hypertension HF Prohylaxis after MI Prevention of CV event Diabetic Nephropathy CKD
ACE inhibitor SE
Cough
Hypotension
Headache
Hyperkalaemia
NSAIDs cause AKI by…
Vasoconstriction of afferent arteriole (inhibition of PG) -> reduced GFR
SE of alpha blockers (Tamsulosin)
α-blockers can causepostural hypotension, dizzinessandsyncope
Metformin risks
Lactic acidosis due to accumulation if poor renal function
Risk of carbimazole
Agranulocytosis
Alternative to carbimazole
PTU
Why do we generally pre-treat with carbimazole before giving in thyrotoxicosis?
Small risk of inducing thyroid storm. There may be a transient exacerbation of hyperthyroidism after radioiodine, which is eliminated by pretreatment.
Risk of radioiodine for thyrotoxicosis
Thyroid eye disease
