Drug Summaries – Humza Ibrahim
3.7.3 Sulphonylureas (Gliclazide, Glipizide,
Chapter 6 Glibenclamide, Glimepiride, Tolbutamide) .......... 6
Endocrine System 3.7.4
3.7.5
Thiazolidinedione (Pioglitazone).......... 6
Meglitinides
(Nateglinide, Repaglinide) ................................... 6
TABLE OF CONTENTS 3.7.6 DPP 4 inhibitors (Alogliption,
Linagliptin, Saxagliptin, Sitagliptin, Vidagliptin) ... 6
Table of Contents ......................................................... 1
3.7.7 SGLT2 inhibitors (Canagliflozin,
1 Antidiuretic hormone disorders ........................... 2
Empagliflozin, Dapagliflozin) ................................ 7
1.1 Diabetes insipidus ........................................ 2
3.7.8 Glucagon-like peptide receptor agonist
1.2 Other uses .................................................... 2 (Exenatide, Albiglutide, Dulaglutide, Liraglutide,
1.3 Desmopressin............................................... 2 Lixisenatide) ......................................................... 7
1.3.1 Common side effects ........................... 2 3.8 Treating Type 2 Diabetes (NICE 2017) ......... 7
1.3.2 Hyponatraemic convulsions ................. 2 4 Osteoporosis ........................................................ 7
1.3.3 Pregnancy............................................. 2 4.1 Bisphosphonates.......................................... 8
2 Corticosteroid responsive conditions .................. 3 4.2 Strontium ranelate....................................... 8
2.1 Corticosteroid replacement therapy............ 3 5 Sex hormone responsive conditions .................... 8
2.2 Glucocorticoid therapy ................................ 3 5.1 HRT ............................................................... 8
2.2.1 Equivalent anti-inflammatory doses of 5.2 Clomifene (anti-oestrogen).......................... 9
corticosteroids ..................................................... 3 5.3 Male sex hormone responsive conditions ... 9
2.3 Corticosteroids (high Risk) .......................... 3 6 Thyroid disorders ................................................. 9
2.3.1 Side effects ........................................... 3 6.1 Carbimazole ................................................. 9
2.3.2 Warning signs ....................................... 4 6.2 Thyroid hormones........................................ 9
2.3.3 Monitoring ........................................... 4
2.3.4 Pregnancy and breastfeeding .............. 4
2.3.5 Drug interactions.................................. 4
3 Diabetes mellitus and hypoglycaemia ................. 4
3.1 Treatment of diabetes ................................. 4
3.2 Preventing diabetic complications ............... 4
3.3 Diabetic nephropathy .................................. 5
3.4 Diabetic neuropathy .................................... 5
3.5 Diabetic Emergencies ................................... 5
3.5.1 Hypoglycaemia (bsl < 3.5mmol/L)........ 5
3.5.2 Diabetic Ketoacidosis (DKA) or
HyperOsmolar Non-Ketosis (HONK)..................... 5
3.6 Insulins (High Risk) ...................................... 5
3.6.1 Warning signs ....................................... 6
3.6.2 Interactions .......................................... 6
3.7 Antidiabetic Drugs ........................................ 6
3.7.1 Alpha glucosidase inhibitor (Acarbose) 6
3.7.2 Biguanide (Metformin)......................... 6
Chapter 6 – Pg 1
Compiled using the British National Formulary
, Drug Summaries – Humza Ibrahim
1.3.1 Common side effects
Chapter 6 fluid retention, hyponatraemia on administration
without restricting fluid intake (in more serious cases
Endocrine System with convulsions), stomach pain, headache, nausea
and vomiting
1 ANTIDIURETIC HORMONE 1.3.2 Hyponatraemic convulsions
Increased risk of hyponatraemic convulsions when
DISORDERS taking desmopressin for nocturnal enuresis. This can
be minimised by avoiding fluid overload and stopping
the medication during an episode of vomiting or
1.1 DIABETES INSIPIDUS
diarrhoea (until fluid balance normal).
There are two types of diabetes insipidus:
The risk can also be minimised by keeping to the
1. Pituitray (cranial)
recommended doses and by avoiding concomitant
caused by insufficient levels of ADH
use of drugs which increase secretion of vasopressin
2. Nephrogenic
(e.g. paracetamol, nicotine, and tricyclic
caused by kidney defects
antidepressants).
Vasopresssin (antidiuretic hormone, ADH) and its
Increased risk in elderly patients — measure baseline
analoge Desmopressin are used in the treatment of
serum sodium concentration, then monitor regularly
pituitary diabetes insipidus. Doses are tailored to
during treatment; discontinue treatment if levels fall
produce slight diuresis every 24 hours to avoid water
below baseline.
intoxication.
Desmopressin is more potent and has a longer 1.3.3 Pregnancy
duration of action than vasopressin. It is often used in small oxytocic effect in third trimester; increased risk
the differential diagnosis of diabetes insipidus; failure of pre-eclampsia (a disorder characterized by the
to respond to a dose indicates nephrogenic diabetes onset of high blood pressure and a significant amount
insipidus. of protein in the urine).
Both pituitary and nephrogenic diabetes insipidus
patients, can benefit from the paradoxical antidiuretic
effect of thiazide diuretics. Carbamazepine is
sometimes useful in sensitising renal tubules to the
action of remaining vasopressin.
1.2 OTHER USES
Desmopressin is sometimes used in haemophilia and
Von Willebrands disease to boost factor VIII (8)
concentration. It can also be used in the treatment of
nocturnal enuresis.
Vasopressin is used to control variceal bleeding in
portal hypertension due to is vasoconstrictor effects.
Oxytocin is another pituitary hormone indicated in
obstetrics.
1.3 DESMOPRESSIN
Patients are advised to limit fluid intake to minimum
from 1 hour before dose until 8 hours afterwards.
Intranasal desmopressin should not be given for
nocturnal enuresis s there is an increased risk of
hyponatraemic convulsions.
Chapter 6 – Pg 2
Compiled using the British National Formulary
3.7.3 Sulphonylureas (Gliclazide, Glipizide,
Chapter 6 Glibenclamide, Glimepiride, Tolbutamide) .......... 6
Endocrine System 3.7.4
3.7.5
Thiazolidinedione (Pioglitazone).......... 6
Meglitinides
(Nateglinide, Repaglinide) ................................... 6
TABLE OF CONTENTS 3.7.6 DPP 4 inhibitors (Alogliption,
Linagliptin, Saxagliptin, Sitagliptin, Vidagliptin) ... 6
Table of Contents ......................................................... 1
3.7.7 SGLT2 inhibitors (Canagliflozin,
1 Antidiuretic hormone disorders ........................... 2
Empagliflozin, Dapagliflozin) ................................ 7
1.1 Diabetes insipidus ........................................ 2
3.7.8 Glucagon-like peptide receptor agonist
1.2 Other uses .................................................... 2 (Exenatide, Albiglutide, Dulaglutide, Liraglutide,
1.3 Desmopressin............................................... 2 Lixisenatide) ......................................................... 7
1.3.1 Common side effects ........................... 2 3.8 Treating Type 2 Diabetes (NICE 2017) ......... 7
1.3.2 Hyponatraemic convulsions ................. 2 4 Osteoporosis ........................................................ 7
1.3.3 Pregnancy............................................. 2 4.1 Bisphosphonates.......................................... 8
2 Corticosteroid responsive conditions .................. 3 4.2 Strontium ranelate....................................... 8
2.1 Corticosteroid replacement therapy............ 3 5 Sex hormone responsive conditions .................... 8
2.2 Glucocorticoid therapy ................................ 3 5.1 HRT ............................................................... 8
2.2.1 Equivalent anti-inflammatory doses of 5.2 Clomifene (anti-oestrogen).......................... 9
corticosteroids ..................................................... 3 5.3 Male sex hormone responsive conditions ... 9
2.3 Corticosteroids (high Risk) .......................... 3 6 Thyroid disorders ................................................. 9
2.3.1 Side effects ........................................... 3 6.1 Carbimazole ................................................. 9
2.3.2 Warning signs ....................................... 4 6.2 Thyroid hormones........................................ 9
2.3.3 Monitoring ........................................... 4
2.3.4 Pregnancy and breastfeeding .............. 4
2.3.5 Drug interactions.................................. 4
3 Diabetes mellitus and hypoglycaemia ................. 4
3.1 Treatment of diabetes ................................. 4
3.2 Preventing diabetic complications ............... 4
3.3 Diabetic nephropathy .................................. 5
3.4 Diabetic neuropathy .................................... 5
3.5 Diabetic Emergencies ................................... 5
3.5.1 Hypoglycaemia (bsl < 3.5mmol/L)........ 5
3.5.2 Diabetic Ketoacidosis (DKA) or
HyperOsmolar Non-Ketosis (HONK)..................... 5
3.6 Insulins (High Risk) ...................................... 5
3.6.1 Warning signs ....................................... 6
3.6.2 Interactions .......................................... 6
3.7 Antidiabetic Drugs ........................................ 6
3.7.1 Alpha glucosidase inhibitor (Acarbose) 6
3.7.2 Biguanide (Metformin)......................... 6
Chapter 6 – Pg 1
Compiled using the British National Formulary
, Drug Summaries – Humza Ibrahim
1.3.1 Common side effects
Chapter 6 fluid retention, hyponatraemia on administration
without restricting fluid intake (in more serious cases
Endocrine System with convulsions), stomach pain, headache, nausea
and vomiting
1 ANTIDIURETIC HORMONE 1.3.2 Hyponatraemic convulsions
Increased risk of hyponatraemic convulsions when
DISORDERS taking desmopressin for nocturnal enuresis. This can
be minimised by avoiding fluid overload and stopping
the medication during an episode of vomiting or
1.1 DIABETES INSIPIDUS
diarrhoea (until fluid balance normal).
There are two types of diabetes insipidus:
The risk can also be minimised by keeping to the
1. Pituitray (cranial)
recommended doses and by avoiding concomitant
caused by insufficient levels of ADH
use of drugs which increase secretion of vasopressin
2. Nephrogenic
(e.g. paracetamol, nicotine, and tricyclic
caused by kidney defects
antidepressants).
Vasopresssin (antidiuretic hormone, ADH) and its
Increased risk in elderly patients — measure baseline
analoge Desmopressin are used in the treatment of
serum sodium concentration, then monitor regularly
pituitary diabetes insipidus. Doses are tailored to
during treatment; discontinue treatment if levels fall
produce slight diuresis every 24 hours to avoid water
below baseline.
intoxication.
Desmopressin is more potent and has a longer 1.3.3 Pregnancy
duration of action than vasopressin. It is often used in small oxytocic effect in third trimester; increased risk
the differential diagnosis of diabetes insipidus; failure of pre-eclampsia (a disorder characterized by the
to respond to a dose indicates nephrogenic diabetes onset of high blood pressure and a significant amount
insipidus. of protein in the urine).
Both pituitary and nephrogenic diabetes insipidus
patients, can benefit from the paradoxical antidiuretic
effect of thiazide diuretics. Carbamazepine is
sometimes useful in sensitising renal tubules to the
action of remaining vasopressin.
1.2 OTHER USES
Desmopressin is sometimes used in haemophilia and
Von Willebrands disease to boost factor VIII (8)
concentration. It can also be used in the treatment of
nocturnal enuresis.
Vasopressin is used to control variceal bleeding in
portal hypertension due to is vasoconstrictor effects.
Oxytocin is another pituitary hormone indicated in
obstetrics.
1.3 DESMOPRESSIN
Patients are advised to limit fluid intake to minimum
from 1 hour before dose until 8 hours afterwards.
Intranasal desmopressin should not be given for
nocturnal enuresis s there is an increased risk of
hyponatraemic convulsions.
Chapter 6 – Pg 2
Compiled using the British National Formulary
