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(NovoLog) - rapid acting insulin
onset 5-10 minutes
peak 1 - 3 hours
duration 3 - 5 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
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.
delay digestion of carbohydrates and absorption of carbs from the intestines
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
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
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)
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
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).
centrally acting α2 adrenergic agonist - decreases cardiac output and peripheral vascular resistance, lowering blood pressure. Also used in ADHD
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
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
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.
A copper intrauterine contraceptive device (IUCD).
benzoyl peroxide, topical retinoids (tretinoin), topical antibiotics, Azelaic acid (both comedonal acne and inflammatory acne)
Try oral antibiotics (tetracycline), oral retinoid (isotretinoin)
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
Used in bullous pemphigoid and dermatitis herpetiformis. prophylactically to prevent Pneumocystis pneumonia. An antibacterial, also has has anti-inflammatory and immunomodulatory effects
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
medical management of alcohol withdrawal
reducing dose of chlordiazepoxide over 5-7 days. •Diazepam is an alternative
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