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regular insulin

short acting insulin

regular insulin

(Humulin R)
onset 30-60 minutes
peak 2-4 hours
duration 8 hours

insulin lispro

(Humalog)
onset 5-10 minutes
peak 30 - 90 minutes
duration 2-5 hours

insulin aspart

(NovoLog) - rapid acting insulin
onset 5-10 minutes
peak 1 - 3 hours
duration 3 - 5 hours

isophane insulin suspension (NPH)

intermediate acting insulin

NPH

(Humulin N)
onset 1.5 hours
peak 4 -12 hours
duration 24 hours

Lente

(Humulin L)
onset 1 - 2.5 hours
peak 7-15 hours
duration 24 hours

insulin glargine

(Lantus)long acting insulin
onset 1 hour
peak 5 hours
duration 24 hours

insulin detemir

(Levemir) - long acting insulin
onset 2 hours
peak 3 - 14 hours
duration 24 hours

sulfonylureas - mechanism of action

Insulin secretagogue: stimulate beta cells in pancreas to release insulin. Var

sulfonylureas - generations & examples

first generation (tolbumatide, chlorpropamide) - less potent than second generation sulphonylureas (e.g. glipizide, glimepiride)

meglitinides - mechanism

stimulate beta cells of pancreas to release insulin
more rapid acting and shorter duration than sulfonylureas
bind to an ATP-dependent K+ (KATP) channel on the cell membrane of pancreatic beta cells in a similar manner to sulfonylureas but at a separate binding site

work quickly and do not stay in the body long, so they need to be taken at or just before each meal

insulin lispro (Humalog)

rapid acting insulin

insulin zinc suspension (Lente)

intermediate acting insulin

glipizide (Glucotrol)

second generation sulfonylurea

glyburide (DiaBeta, Micronase)

second generation sulfonylurea

sulfonylurea metabolism

Sulphonylureas are metabolised by the liver to less active metabolites which are subsequently excreted by the kidneys. Care should therefore be taken in both renal and hepatic impairment.

nateglinide (Starlix)

meglitinides

repaglinide (Prandin)

meglitinides

alpha-glucosidase Inhibitors

delay digestion of carbohydrates and absorption of carbs from the intestines

acarbose (Precose)

alpha-glucosidase Inhibitor

miglitol (Glyset)

alpha-glucosidase Inhibitor

biguanides

sensitizes liver to circulating insulin levels and reduces hepatic glucose production

metformin (Glucophage)

biguanide

thiazolidinediones

decrease insulin resistance and increase insulin sensitivity

pioglitazone (Actos)

thiazolidinediones

rosiglitazone (Avandia)

thiazolidinediones

incretin mimetic

enhances and/or mimics secretion of incretin
eg sitagliptin, exenatide

sitagliptin

incretin mimetic

exenatide

incretin mimetic

buprenorphine

opioid - partial agonist activity at the µ-opioid receptor
used to treat opioid addiction and for analgesia

Advantages of buprenorphine for the treatment of chronic pain

relatively long half-life, the option of sublingual and transdermal application

drugs used for opiod dependence

buprenorphine, methadone

oxycodone

second-line alternative to oral morphine for cancer pain. causes less respiratory depression, sedation, pruritus, and nausea

hyoscine butylbromide and hyoscine hydrobromide

hyoscine butylbromide - antispasmodic
hyoscine hydrobromide - Antimuscarinic, Travel sickness, To control secretions in the lungs, nose or throat

transdermal fentanyl 12 microgram patch equates to approximately 45 mg oral morphine daily.

...

pilocarpine mechanism.
When used topically...?

non-selective muscarinic receptor agonist - acts in the parasympathetic nervous system
When used topically in the eyes - acts at M3 receptors found on the iris sphincter muscle, (muscle contraction & miosis) and ciliary muscle (contraction -> opening the trabecular meshwork through increased tension on the scleral spur. -> faster drainage of aqueous humor ->decrease intraocular pressure)

pilocarpine indications

chronic open-angle glaucoma and acute angle-closure glaucoma, xerostomia (dry mouth)
Stimulates saliva and sweat production

treating a vitamin D deficiency

injections,high dose, standard dose - most need maintenance dose for life as risk factors rarely reversible

Amiloride

potassium-sparing diuretic - blocks the epithelial sodium channel (ENaC) thereby inhibiting sodium reabsorption in the late distal convoluted tubules and collecting ducts.
often used in conjunction with thiazide (e.g. co-amilozide) or loop diuretics (e.g. co-amilofruse).

Co-amilozide

combination of amiloride and hydrochlorothiazide

Clonidine

centrally acting α2 adrenergic agonist - decreases cardiac output and peripheral vascular resistance, lowering blood pressure. Also used in ADHD

Triamterene

potassium-sparing diuretic - blocks ENaC
commonly prepared in combination with hydrochlorothiazide - used for hypertension and oedema

treatment for hyperkalaemia

IV calcium gluconate - 10ml of 10% over 2 mins
IV glucose with insulin - 50ml of 50% glucose with 10 units of short acting insulin)
Potassium binding calcium resonium, dialysis

what is the problem of giving folic acid alone in subacute combined degeneration of the cord

may exacerbate teh neurological deficit

Vitamin B12

present in meat and animal protein foods
Absorption occurs in the terminal ileum and requires intrinsic factor (secreted by parietal cells)

pernicious anaemia causes

Parietal-cell antibody and antibodies to intrinsic factor
Also associated with gastric atrophy

symptoms of pernicious anaemia

onset - symptoms of anaemia, ie lethargy and breathlessness
glossitis
neurological involvement - peripheral neuropathy. later subacute degeneration of the cord

The Schilling test

to determine the cause of a B12 deficiency - ie pernicious anaemia or malabsorption

Subacute combined degeneration of the cord

degeneration of the posterior and lateral columns of the spinal cord as a result of vitamin B12 deficiency
peripheral neuropathy (progressive weakness of legs, arms, tingling and numbness) -> dorsal column loss (sensory ataxia) -> corticospinal tract damage (paraplegia - Bilateral spastic paresis ) Vision changes and and cognitive impairment may also be present. A positive Babinski sign may be seen
If someone is deficient in vitamin B12 and folic acid, the vitamin B12 deficiency must be treated first to avoid precipitating subacute combined degeneration of the cord (giving folic acid first will turn the remaining B12 into methylcobalamin which will not be able to participate in fatty acid metabolism).

New emergency contraception

ulipristal acetate - Selective progesterone receptor modulator
AKA ellaOne - 30 mg tablet - take within 120 hours

types of SPRM

ulipristal acetate - second generation
mifepristone - first-generation SPRM
inhibits or delays ovulation
later in the cycle affects changes in the endometrium which make implantation less likely

the three types of emergency contraception used

An oral progestogen-only emergency contraceptive (POEC) - levonorgestrel (LNG).
A selective progesterone receptor modulator (SPRM) - ulipristal acetate.[1]
A copper intrauterine contraceptive device (IUCD).

progesterone only emergency contraception

levonorgestrel 1.5 mg - Levonelle

acne treatments

benzoyl peroxide, topical retinoids (tretinoin), topical antibiotics, Azelaic acid (both comedonal acne and inflammatory acne)
Dianette
Try oral antibiotics (tetracycline), oral retinoid (isotretinoin)

topical retinoids example and uses

isotretinoin
Acne, psoriasis

azelaic acid uses

acne, rosacea, melasma

Benzoyl peroxide side-effect

photosensitivity

guttate psoriasis - what does guttate mean

from the Latin word for drop

PUVA

PUVA therapy - psoralen + UVA treatment for eczema, psoriasis, graft-versus-host disease, vitiligo, mycosis fungoides, large-plaque parapsoriasis and cutaneous T-cell lymphoma. psoralen is applied or taken orally to sensitize the skin, then the skin is exposed to UVA. Psoralens are photosensitizing agents found in plants

treatment of varicose veins

compression stockings, ligation and stripping, endovenous laser therapy, radioablation, sclerotherapy

dapsone

Used in bullous pemphigoid and dermatitis herpetiformis. prophylactically to prevent Pneumocystis pneumonia. An antibacterial, also has has anti-inflammatory and immunomodulatory effects

Rituximab

monoclonal antibody against the protein CD20, primarily found on the surface of B cells -> destroys B cells -> useful in lymphomas, leukemias, transplant rejection, and some autoimmune disorders

leprosy MDT

rifampicin, dapsone, and clofazimine

medical management of alcohol withdrawal

reducing dose of chlordiazepoxide over 5-7 days. •Diazepam is an alternative

pilocarpine

chronic open-angle glaucoma and acute angle-closure glaucoma . It acts on a subtype of muscarinic receptor (M3) found on the iris sphincter muscle, causing the muscle to contract and engage in miosis

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