22. Pharmacology of Diabetes Mellitus Flashcards

1
Q

What are the options for insulin replacement in type 1?

A

Subcutaneous insulin

Islet replacement therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the methods of delivering insulin in type 1?

A

Basal and bolus
Insulin pumps
Artificial pancreas (sensor and pump)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is the amount of insulin required calculated?

A

0.5 x kg/per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between basal and bolus insulin?

A

Basal is long acting: between meals and overnight

Bolus is rapid acting before a meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the complications of an insulin pump?

A

Infection and ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the side effects of insulin?

A

Hypoglycaemia
Weight gain
Oedema
Allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the Hb1AC target in diabetes?

A

7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the first choice treatment for type 2 diabetes?

Why?

A

Metformin

Doesn’t cause weight gain or hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does Metformin work?

A

Reduces hepatic glucose production

Increases sensitivity by increasing glucose uptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the side effects of Metformin?

A

GI
Lactic acidosis in renal impairment (eGFR <30)
B12 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do sulfonylureas work?

A

Stimulate insulin release by B-cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the side effects of sulphonylureas?

A

Hypoglycaemia
Weight gain
Stop responding over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Can sulphonylureas be used in renal failure?

A

Yes but at lower doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name a sulphonylurea

A

Gliclazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 2 thiazolidinediones

A

Pioglitazone

Rosiglitazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do thiazolidinediones work?

A

Bind to PPAR on muscle and regulate gene expression to increase insulin sensitivity

17
Q

What are the side effects of thizolidinediones?

A

Weight gain
Oedema
Increased risk of fractures

18
Q

Why is rosiglitazone no longer used?

A

Increased risk of CV events

19
Q

How does acarbose work?

A

Disaccharidase inhibitor: delays absorption of glucose from the GIT
Ineffective

20
Q

Why is more insulin released in response to oral glucose compared to IV?

A

Incretins GIP and GLP are released in response to oral stimulus

21
Q

What response do incretins cause?

A

Increase insulin release
Lower glucagon
Reduce appetite

22
Q

What enzyme breaks down incretins?

A

DPP4

23
Q

What are the side effects of GLP-1 analogues?

A

Nausea

Increased risk of gallstones

24
Q

Why are GLP-1 analogues useful in obesity?

A

Cause weight loss and reduce CV events

25
Q

When should GLP-1 analogues be avoided?

A

history of pancreatitis, pancreatic malignancy and medullary thyroid cancer

26
Q

Name a DPP4 inhibitor

A

Sitagliptin

27
Q

Name an SGLT-2 inhibitor

A

Dapagliflozin

28
Q

How do SGLT-2 inhibitors work?

A

Inhibit SGLT-2 in the kidney which blocks resorption
Increased glucose excretion
Weight loss and reduced BP as Na+ absorption also blocks

29
Q

What side effects are associated with SGLT-2 inhibitors?

A

UTIs

30
Q

What are the indications for insulin in type 2?

A

Not meeting glycaemic targets on oral drugs
Illness, perioperative
Pregnancy
Hepatic or renal disease (if oral agents contraindicated)
Allergy to oral agents
Glucose toxicity

31
Q

What drugs are used to control blood pressure in diabetes?

A

ACE inhibitors or ARB
Diuretic or calcium channel blocker
B-blocker
a-blocker

32
Q

What order should the diabetic drugs be given in?

A

Metformin
SGLT-2 inhibitor and GLP1 injection
Sulphonylureas
Insulin