Question

27. Mechanism of action for metformin 28. Action and advantages of gliptins 29. Thyroid replacement meds and monitoring, follow-up measurements for thyroid function when treating with levothyroxine, treatment for patients with hyperthyroidism. 30. Onset and duration of different insulins (reg, lispro, neutral protamine Hagedorn) 31. Considerations of ethnic group risks and presentation of diabetes 32. Treatment considerations for diabetics with known cardiovascular disease 33. There will be multiple questions about antibiotics including appropriate treatment, side effects of antibiotic therapy, allergies and cross-sensitivities, UTI treatment, URI treatment (or not), STD treatments, Otitis media treatment, treatment during pregnancy 34. febuxostat treatment 35. Using prednisone (side effects, tapering) 36. Treatment for migraine headaches 37. Acute and chronic pain treatment

Answer 1

27.Mechanism of action of metformin

It is an antidiabetic drug used to treat type 2 diabetes.When the medication is taken orally it reaches the specific organ like liver and decreases the gluconeogenesis in the liver there by decreasing the glucose production from liver.The intestine has a decreased absorption so it reaches the peripheral circulation where the exchange of glucose from blood vessels enters the cell and energy is produced as a result the glucise are utilised from the blood and maintaining the normal blood sugar level

28. Gliptin is also an antidiabetic agent .It works by raising the increptin level which leads to increase in production of insulin and stops the release of glucagon in the Islets of Langerhans ,simultaneously the gastric emptying is reduced and controlling the blood sugar level

Advantage :

• Decreases the appetite and hence can control blood sugar
• Can be used to control weight in weight management

29.An increased secretion of thyroid hormone leads to hyperthyroidism.

Treatment:

• Oral thyroid tablet
• Radioactive iodine therapy
• Surgical removal of thyroid gland (partial or complete )

The level has to be checked at 3 months after starting the medicine and regular follow up once in 6 months and addressing any complaints

Health educate about disease condition

Diet modifications

Medication replacement to be done once in three months or monthly or as per order

29.

	Onset of action	Duration of action
Regular	fast(half an hour to one hours)	6 to 8 hours
Lispro	starts in 15 minutes ,peak level reaches in half an hour to one and half hour	5 hours
Neutral protamine Hageforn	about 1 to 3 hours Te oak level reaches in about 6 to 8 hours	24 hours