Term
| Diabetes mellitus and the cells of the pancreas |
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Definition
is a inability to synthesise and/or desensitisation of cells to insulin.
The pancrease has three types of endocrine cells. B cells produce insulin. A cells produce glucagon. D cells produce somatastatin (this inhibits secretion of insulin and glucagon). |
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Term
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Definition
| Amylin is a peptide produced by the B cells that delays gastric emptying and opposes insulin by encouraging breakdown of stored glycogen from the striated muscle. |
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Term
| Mechanism of insulin release? |
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Definition
| Insulin is released as a prodrug from the B cells in response to increases in BGL. There are two states of insulin release bolus and basal, reflecting stored release and slower continued release and production. |
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Term
| Three examples of GIT hormones released by eating and their effect on insulin release. |
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Definition
| Cholecystokinin, gastrin, secretin - these increase insulin secretion |
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Term
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Definition
| Insulin increases the glucose uptake by glut-4 receptors in adipose tissue and muscle. It inhibits glycogenolysis and gluconeogenesis but increases glucose utilisation. |
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Term
| Initiation of glucagon release? MoA |
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Definition
| Increased levels of amino acids in the plasma. Glucagon increases blood glucose, it has the opposite effects to insulin. |
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Term
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Definition
| is indicated in the treatment of hypoglycaemia, acute cardiac failure precipitated by B adrenoreceptor antagonists. |
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Term
| Guidelines for DM diagnosis |
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Definition
Random BGL of >7mmol/L
2 hr post meal BGL >11.1mmol/L
Hyperglycemia occurs because of unregulated release of hepatic glucose and inability of skeletal muscle to uptake. |
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Term
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Definition
| Polyuria, polyphagia, weight gain, proteinuria, glycosuria, polydipsia. |
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Term
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Definition
| is a diabetic emergency caused by uncontrolled hyperglycaemia resulting in accelerated breakdown of Acetyle CoA, which in anaerobic metabolism produces acetone (ketone) and acetoacetate (causing acidosis) |
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Term
| Counter insulin hormones? |
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Definition
| Glucagon, adrenalin, glucocorticoids, growth hormone |
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Term
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Definition
Once daily injections with long acting insulin
Twice daily injections with long acting insulin
Multiple daily injections consists of a combination of basal and bonus insulin
Insulin pump is a methods of avoiding confusing and time costly MDI |
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Term
| Clinical scenario of once daily LA injection |
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Definition
| This is only used in very rare cases in which only part of the islet cell function is lost. Alternatively it is a means of treating patients when and if they reach a "honeymoon" phase. This however is not a permanent respite from the disease process and most commonly will relapse and worsen within 12 months. |
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Term
| Clinical scenario of twice daily LA injection |
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Definition
| This attempts to maintain a relatively stable basal insulin level by injecting morning and night. Again this is ineffective for the majority of cases and is only suitable for an extremely strict routine, with predictable exercise, carb (g) and meal times. |
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Term
| Clinical scenarion of MDI |
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Definition
| using both long and short acting can accommodate for a more versatile lifestyle but requires regular BSL monitoring, carb counting and appropriate education. |
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Term
| Clinical scenario of an insulin pump |
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Definition
| A pump is fitted to a patient which releases insulin continuously to mimic the activity of the pancreas. If fitted early it is an effective way of reducing the HbA1C and is becoming the method of choice for newly diagnosed type I diabetics. |
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Term
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Definition
| are short acting insulins (insulin lispro) |
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Term
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Definition
| are long acting insulins (insulin glargine) |
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Term
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Definition
| THe only AE of importance with insulin are hyoglycemic episodes. |
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Term
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Definition
Class- Biguanide: is an oral hypoglycaemic agent. Increase glucose uptake, decreases hepatic production of glucose and increases utilisation in skeletal muscle. Does not cause hypoglycaemia. Reduces VLDL and LDL.
AEs: dose related GI upset. CI in renal or hepatic impairment, pregnancy and shock. Decrease appetite. |
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Term
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Definition
| Class - Sulfonylureas. second generation. are hypoglycaemics which act on B cell to stimulate insulin release. CI in pregnancy and breast feeding. Can cause hypoglycaemia and accumulate in renal failure. Stimulate appetite. Interactions with antibacterials, alcohol, NSAIDs, diuretics and corticosteroids |
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Term
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Definition
| Non-Sulfonylurea pro insulin secretion drugs. |
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Term
| Ciglitazone, Rosiglitazone |
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Definition
| Glitazones. These drugs decrease BGL long term (2-3 months) They increase the efficiency of endogenous insulin, decrease hepatic output and increase skeletal muscle uptake. Commonly AES weight gain and fluid retention. Wary with combination. |
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Term
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Definition
| Reduces carbohydrate absorption and causes flatulence and diarrhea. |
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Term
| Action and target of Leptin? |
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Definition
| Leptin is an important hormone in regulation of body weight. It acts on the hypothalamus. Rising leptin increases energy expenditure, decreases intake. Falling levels increase intake, synthesis and storage of fat. Released in pulsatile fashion and inversely related to hydrocortisone. |
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Term
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Definition
| Inhibits the reuptake of serotonin and dopamine at the appetite centers of the hypothalamus. Increasing satiety and decreasing food intake. Indicated in those who have actively tried to lose weight. AEs p450 interactions, anticholinergic effects and increased HR and BP. Good for weight maintenance. |
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Term
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Definition
| Prevents the breakdown of dietary fats dose related effect. Increased fecal fat excretion. AEs are gastric disturbances, abdo cramps, flatus, steatorrhea. |
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Term
| Two parts of the pituitary and the hormones each secretes? |
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Definition
Anterior - FSH (ovum growth), LH (ovulation), TSH (T3 T4 production), GH (protein synthesis), ACTH (adrenal cortex hormones), Prolactin (milk production)
Posterior - Oxytocin and ADH |
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Term
| Hypothalamic hormones and how they work? |
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Definition
| Hypothalamic hormones are secreted into the blood which drains into the hypophyseal vessel network which runs through the anterior pituitary and has local effects. GnRH, TRH, CRH, GHRF, GHIF, PRIF, PRF, Melanocyte stimulating releasing factor. |
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Term
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Definition
| Is an effective diagnostic test for growth hormone secretion, it forces anterior pituitary to produce peak plasma concentration of GH in 60 min. |
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Term
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Definition
| Long actine somatostatin analogue (inhibits release of GH, insulin, glucagon and TSH and most gastric hormones) Indicated in secreting carcinoid tumours and pituitary adenomas. Lanreotide is also indicated in thyroid tumours. |
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Term
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Definition
| is synthetic TSH used to diagnose thyroid activity. NOrmal will raise thyroxine conc. Hyperthyroidism will decrease because of negative feedback. Hypothyroidism will increase thyroxine conc. |
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Term
| Bromocriptine in the endocrine system? |
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Definition
| Bromocrptine is a dopamine antagonist which can be used to inhibit the release of prolactin indicated in prolactinomas. AEs vomiting, nausea, OH, dizzyness and constipation. |
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Term
| Action of ACTH and its synthetic compound Tetrasactide? |
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Definition
| Stimulation of glucocorticoid production by the adrenal cortex. USed in the diagnosis of adrenal cortical insufficiency. |
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Term
| Mineralo- Gluco- corticoids and androgens? |
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Definition
| aldosterone, hydrocortisone, and testosterone. Produced by the adrenal cortex. |
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Term
| Stimulus for ADH release? |
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Definition
| Increasing plasma osmalality. Secreted by post. pit. Hypovolemia. |
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Term
| Vasopressin, Desmopressin, Terlipressin, Felypressin. |
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Definition
ADH analogues indicated in lengthening action of ADH i.e. diabetes insipid us.
Vaso - short DOA, weak selectivity given IM, SC, IV. anti bleeding.
Desmo - increased DOA, selective, nasal spray. Nocturnal enuresis
Terli - increased DOA, low but protracted. Esophogeal varices.
Fely - Short DOA. vasoconstrictor
Cause angina. |
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Term
| Zones of the adrenal cortex and products? |
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Definition
Zona GFR
MGA
M - water and electrolyte balance
G - regulation of metabolism |
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Term
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Definition
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Term
| Excessive glucocorticoids? |
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Definition
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Term
| Metyrapone, Trilostane, Aminoglutethimide |
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Definition
| Prevents the formation of the glucocorticoids |
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Term
| Compare and contrast corticosteroid therapies? |
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Definition
Hydrocortisone (cortisol) - minimal antiinflam, minimal sodium retention, short DOA, good for replacement therapy.
Cortisone - cheap, similar profile, not for systemic antiinflamm
Prednisolone/ Methylprednisolone - systemic anti inflamm and immunosuppresive, intermediate DOA
Dexamethasone/ Betamethasone - potent antiinflamm, minimal water retention, long DOA, antiinflam and immunosuppression, used for ACTH suppression.
Fludrocortisone - high mineralocorticoid effects i.e. fluid retention. |
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Term
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Definition
| osteoporosis, hyperglycemia, central obesity, thinning of skin, hypertension, poor wound healing, buffalo hump, moon face |
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Term
| Thyroid secretes three hormones? |
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Definition
T3, T4 (thyroxine) - critical fro growth and metabolism
calcitonin - controls plasma calcium concentration |
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Term
| Which element is essential in thyroid hormone synthesis and storage? |
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Definition
| Iodine, iodination activates thyroid hormones. |
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Term
| Describe the effect on the size and vascularity of the thyroid of high and low plasma iodide concentration? |
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Definition
High iodide concentration results in decreasing size and vascularity.
Low iodide results in an increase in size and vacs --> goitre, caused by lack of thyroid hormone production and loss of negative feedback --> increased TSH |
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Term
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Definition
| Both are bound to thyroxine binding globulin when transported in the blood, but T3 is metabolised 20 x faster due to T4s stronger binding. The liver is the site of metabolism of the hormones resulting in the excreteing of free and conjugated forms in bile. To be used the mut be unbound, deiodinised etc. |
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Term
| Symptoms of thyroxicosi? (hyperthyroidism) |
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Definition
| high metabolic rate, sweating, tremor, anxiety, tachycardia. |
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Term
| Why is amiodirone implicated in thyrotoxicosis? |
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Definition
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Term
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Definition
| is first line treatment in hyperthyroidism. Absorbed by the thyroid and has cytotoxic effects on the thyroid follicles.half life of 8 days. |
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Term
| Carbimazole, Methimazole, Propylthiouracil |
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Definition
| Class - thioureylenes. decrease the output of thyroid hormones. May take long time because it only stops production of new hormones and cant rid of long lived T4. ++ reduces activation at peripheral tissues. (Prop) Causes granulocytopenia. and rashes. |
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Term
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Definition
| Has short term quick onset reduction in size and vascularity indicated in preparation for thyroid resection. |
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Term
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Definition
| is the first line treatment of uncomplicted hypothyroidism. it is a replacement therapy. (T4) |
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Term
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Definition
| is faster onset but shorter action and is reserved for acute emergencies. AEs cardiac (T3) myxodema coma. |
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Term
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Definition
| class: bisphosphonates. inhibit bone reabsorption by binding to bony matrix and on absorption by osteoclasts inducing apoptosis. given orally but poorly absorbed. Impaired by milk and food. GI disturbances. Indicated in pagers, hypercalcemia of malignancy, osteoporosis. |
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Term
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Definition
| estrogen receptor agonist in bones increasing osteoblast activity and reducing osteoclasts. Hot flushes and leg cramps. |
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Term
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Definition
| PTH peptide fragment, anabolic effect on bone mass and integrity. normal AEs + mild hypercalcemia and leg cramps. |
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Term
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Definition
| inhibits bone reabsorption and stimulates bone formation used in osteoporosis. well tolerated. |
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Term
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Definition
| is a vit D preparation often given with calcitriol. It increases calcium concentration and is indicated in osteoporosis prevention. |
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Term
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Definition
| calcium preparation. nausea and vomiting and tingling in hands funny taste.. |
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Term
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Definition
| used is the emergency treatmet of hyperkalemia, NO IM causes LOCAL NECROSIS. |
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