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Y3 DRUGS PROFILES > ENDOCRINOLOGY DRUGS > Flashcards

ENDOCRINOLOGY DRUGS Flashcards

1
Q

what kind of hormone is insulin?

A

peptide

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2
Q

what 3 processes does insulin stimulate or inhibit?

A

glucose transport from circulation into fat and muscle cells
Stimulates glycogen, protein and lipid synthesis
inhibits gluconeogenesis and ketoacidosis

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3
Q

What are the uses of insulin?

A

Insulin replacement in DM1
Control of blood glucose levels DM2
IV for diabetic emergencies such as:hyperglycaemic hyperosmotic non-ketotic coma, ketoacidosis and perioperative glycaemic control
emergency hyperkalaemia treatment = moves k into the cells

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4
Q

what 3 forms of insulin are available?

A

short <7hrs
Intermediate 14-22hrs
Long acting >24 hrs

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5
Q

give 2 endocrine side effects of insulin

A

hypoglycaemia leading to coma and death

low plasma potassium (promotes K influx into cells)

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6
Q

give 2 other side effects of insulin

A

weight gain

fat hypertrophy at injection site

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7
Q

why shouldn’t beta blockers be given with insulin?

A

mask warning signs of a hypo

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8
Q

give an example of a sulphonylurea?

When do you use it?

A

Gliclazide, Glibenclamide, Tolbutamide
DMT2 control glucose levels and prevent complications
Single agent when Metformin is not working
Combination therapy with metformin when single agent is not enough.
You need residual pancreatic function ( B cells) for it to work

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9
Q

how do sulphonylureas work? (2 processes)

A

Stimulates pancreatic insulin production by binding to
sulphonylureas receptors &; blocking ATP dependent K channels on Pancreatic B cells= cause depolarisation which opens voltage gated Ca channels leading to increase in Ca level and insulin release

Inhibit glucogensis

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10
Q

what other diabetes meds are often combined with sulphonylureas?

A

metformin

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11
Q

why should sulphonylureas be used with caution in elderly patients or those with adrenal, pituitary, hepatic or renal impairment?

A

susceptible to hypos

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12
Q

why shouldn’t sulphonylureas be used with fluconazole?

A

fluconazole increases plasma conc of sulphonylureas?

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13
Q

give an example of a biguanide.

What is the function of the drug?

A

metformin which increasing insulin sensitivity but requires presence of insulin

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14
Q

how does metformin work? (3 processes)

A

increases peripheral glucose usage
inhibits gluconeogenesis and glycogenolysis ( impairs hepatic glucose production)
inhibits glucose absorption from GI tract

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15
Q

why is metformin good to use in obese patients?

A

suppresses appetite ( Induces weight loss)

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16
Q

give 3 examples of conditions predisposing to lactic acidosis that contraindicate use of metformin

A 
hepatic/renal impairment (AKI)
heart failure/ respiratory failure and Mi (tissue hypoxia)
infection
dehydration
acute alcohol intoxication
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17
Q

What diabetic emergency should metformin not be used in?

A

Keto acidosis

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18
Q

Iv injection of what drug should lead to the stopping of metformin prior and for 48 hours afte the injection?

A

IV injection of iodine contrast= as it can lead to renal impairement and therefore lactic acidosis

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19
Q

When is thyroid hormone used and how does it work?

A

Primary hypothyroidism or secondary hypothyroidism to hypopituitarism
mimics endogenous thyroxine by converting t4 to T3

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20
Q

Give examples of thyroxine and when they are used?

A

Levothyroxine (synthetic T4)= long duration = commonly used

Liothyronine (synthetic T3) = short and fast acting so used in emergencies

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21
Q

What are the side effects of giving thyroxine?

A

Mimics symptoms seen in hyperthyrodism

such as restlessness, sweating, weight loss, cardiac dysrhythmias and tachycardia

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22
Q

why shouldn’t thyroxine be taken in conjunction with warfarin?

A

increases effect of warfarin

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23
Q

give an example of an anti-thyroid drug

A

carbimazole (main choice)
propylthiouracil (alternative)
Iodine and iodide
Propanolol

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24
Q

how do anti-thyroid drugs work?

A

decrease production of T3/T4 in thyroid gland

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25
Q

what enzyme do anti-thyroid drugs inhibit?

A

thyroid peroxidase - necessary for synthesis

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26
Q

how long should Grave’s anti-thyroid treatment last for?

A

more than 1 year

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27
Q

give an example of a bisphosphonate

A

alendronic acid, disodium pamidronate, zoledronic acid

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28
Q

how do bisphosphonates work?

A

inhibit osteoclast mediated bone reabsorption so promote bone development

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29
Q

sufficient levels of what two things are required in the body for bisphosphonates to work?

A

calcium and vitamin D

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30
Q

name 5 conditions that bisphosphonates are used in?

Name the specific drug used for the condiiton

A
  • Osteoporosis = AL
  • Post menopausal osteoporosis =al
  • Corticosteroid induced osteoporosis =al
  • Paget’s disease
  • Hypercalcaemia of malignancy = dis and zol
  • Bone mets from breast cancer and myeloma = dis and zol = to prevent bone fracture and cord compression
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31
Q

give a contraindication for the use of bisphosphonates

A

Upper GI tract problems as they have side effect oesophageal irritation
Hypocalcaemia
Renal impairment

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32
Q

why shouldn’t antacids, calcium or iron salts be used with bisphosphonates?

A

decrease absorption

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33
Q

give 3 examples of when calcium requirements in life increase

A

childhood
pregnancy
lactation

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34
Q

when does calcium absorption decrease?

A

elderly

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35
Q

when is the dose of calcium required to be doubled?

A

osteoporosis

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36
Q

what organ impairments can cause vitamin D deficiency?

A

liver

kidneys

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37
Q

give 2 contraindications of calcium and vitamin D supplements

A

hypercalcaemia

malignant/metastatic calcification

38
Q

What drugs absorption is reduced when given with oral calcium?

A

Iron, bisphosphonates, tetracycline and levothyroxine

39
Q

why should diuretics be used with caution with calcium supplements?

A

increase risk of hypercalcaemia

40
Q

what should happen to the dose of vitamin D if carbamazepine or phenytoin are also being taken?

A

increased - they increase the body’s requirement for Vit D

41
Q

give an example of a mineral corticoid

A

fludrocortisone

42
Q

how do mineral corticoids work?

A

replacement of aldosterone in Addison’s or adrenal hypoplasia
Control the synthesis of proteins

43
Q

how do mineral corticoids work in the kidneys?

A

Act on DCT to inhibit loss of sodium by increasing loss of potassium and hydrogen via urine.

44
Q

give 2 examples of when mineral corticoids are used

A

adrenocorticol insufficiency

salt-losing adrenal syndrome

45
Q

what type of systemic infection contraindicates use of mineral corticoids?

A

fungal

46
Q

give 3 circulatory side effects of mineral corticoids

A

oedema
hypertension
cardiac enlargement
congestive cardiac failure

47
Q

give 3 endocrine side effects of mineral corticoids

A

hypokalemia
cushing’s
growth suppression
menstrual abnormalities

48
Q

give 3 other side effects of mineral corticoids

A 
weakness
papilloedema
vertigo
cataracts
glaucoma
impaired healing
Pancreatitis and peptic ulcers
49
Q

why shouldn’t mineralocorticoids be used with potassium depleting diuretics

A

hypokalaemia

50
Q

why shouldn’t mineralocorticoids be used with digoxin?

A

increases risk of toxicity

51
Q

why shouldn’t mineralocorticoids be used with oral anticoagulants?

A

decrease prothrombin time (reduces efficacy)

52
Q

why shouldn’t mineralocorticoids be used with anti-diabetic drugs?

A

diminish effect

53
Q

why shouldn’t mineralocorticoids be used with aspirin?

A

increase risk of ulcers

54
Q

Besides lactic acidosis what other side effects does metformin have?

A

Diarrohea
Nausea and vomiting
Anorexia

55
Q

How is metformin eliminated?

A

Tublar secretion of renal

56
Q

What are the side effects of carbimazole?

A

Nausea , rash, pruritis, headache, mild GI disturbances, fever and malaise
Rare: Jaundice and BM suppression

57
Q

What side effects do you get with bisphosphonates?

A

GI s/e
Such as abdo pain and disturbance
Oesophageal reaction
Hypophosphataemia

58
Q

What are the S/E of Vit D and Ca on GI?

A

D&V
Conspitation
Weight loss/anorexia

59
Q

What are the calcium supplement side effects?

A

Bradycarida

Arrythmia

60
Q

What are the reanl S/E of supplements?

A

Polyuria, thirst

61
Q

What organ impairment would be contradictory to give insulin?

A

Renal impairement

62
Q

Having systemic corticosteroids does what to the insulin requirement?

A

Increase insulin requirement

63
Q

What diabetic emergency should sulphonylureas be avoided in?

A

Diabetic ketoacidosis

64
Q

What group of people should sulphonylureas not be given to?

A

Obese patients due to side effect of weight gain

65
Q

What affect does chloramphenicol or NSAIDS have on sulphonylureas?

A

Increase the hypoglycaemic effect

66
Q

Why shouldn’t you give sulphonylureas in pregnant ladies or when they are breast feeding?

A

Neonatal hypoglycaemia

67
Q

What drugs reduce the effectiveness of sulphonylureas and metformin?

A

Drugs that have hyperglycaemic effect= Loop and thiazide diuretics and prednisolone

68
Q

What drugs can damage renal function and therefore be used cautiously with metformin?

A

Diuretics
ACE inhibitors
NSAIDS

69
Q

What is a rare but fatal side affect of metformin?

A

Lactic acidosis

70
Q

What cardiovascular condition is contradictive to use of thyroxine and why?

A

CAD due to cardiac iscahemia

71
Q

In hypopituitarism how do you administer corticosteroids and thyroxine?

A

First give corticosteroids and then thyroid hormones as can precipitate addisons crisis

72
Q

What drugs reduce GI absorption of thyroid hormones?

A

Antacids, calcium and iron salts

73
Q

What effect does thyroxine have on diabetes?

A

Need greater insulin and other oral hypoglycaemic drugs

74
Q

Why shouldn’t carbimazole be used in pregnant/breast feeding patients?

A

Cause neonatal goitre or hypothyroidism

75
Q

What is a severe side effect of anti thyroid drugs?

A

Bone marrow suppression causing neutropenia and agranulocytosis

76
Q

What symptom is a complication of agranulocytosis caused by anti thyroid drugs?

A

Sore throat

77
Q

What is the treatment for thyrotoxic crisis? emergency condition

A

Iv fluid, propranolol, hydrocortisone, iodine and carbimazole

78
Q

What is propranolol used for in thyroid treatment?

A

Rapid relief of thyrotoxicosis symptoms

Treatment of neonatal thyrotoxicosis or SVA caused by hyperthyroidism

79
Q

What are two rare side effects of bisphosphonates

A

Osteonecrosis of the jaw

Atypical femoral fracture

80
Q

In which patient should use of bisphosphonates be used cautiously due to increase risk of osteonecrosis of the jaw?

A

Smokers

Patients with dental disease

81
Q

How long should bisphosphonates be used for?

A

3 years

82
Q

When is calcium and vitamin D used?

A

Both for osteoporosis
Both for CKd to treat and prevent secondary hyperparathyroidism and renal osteodystrophy
Calcium for severe hyperkalemia to prevent arrhythmias
Calcium for symptomatic calcium deficiency
VItamin D for prevention and treatment for vitamin D deficiency such as rickets in children and osteomalacia in adults

83
Q

What side effects can you get with oral calcium?

A

Dyspepsia and constipation

84
Q

What does the adrenal gland do?

A

Secretes hydrocortisone (cortisol) which has glucocorticoid affects and weak mineralocorticoid effects. Also secretes aldosterone

85
Q

What is the combination treatment of insufficiency of the adrenal gland?

A

hydrocortisone and fludrocortisone

86
Q

What is a potential side effect of calcium gluconate when given for hyperkalaemia?

A

if given too fast then can cause cardiac collapse

Can cause local tissue damage if given S/C

87
Q

Does metformin cause hypoglycaemia? Explain why?

A

It does not cause hypoglycaemia because it does not have an affect on promoting insulin production from pancreatic B cells

88
Q

Why is calcium essential?

A

For normal function of bones, nerves, muscles and clotting system

89
Q

What controls calcium haemostasis?

A

Parathyroid hormones and vitamin D

90
Q

What vitamin changes occur in CKD?

A

Impared phosphate excretion and reduced activation of vitamin D causes hyperphosphataemia and hypocalcaemia.

91
Q

What does abnormal vitamin levels cause in CKD?

A

Leads to hyperparathyroidism leading to renal osteodystrophy

Y3 DRUGS PROFILES (9 decks)

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