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Semester 5- Pharmacology > 3.1 + 3.2 Insulin and Other Hypoglycaemic Agents > Flashcards

3.1 + 3.2 Insulin and Other Hypoglycaemic Agents Flashcards

1
Q

Give 3 reasons why diabetes is a strain on the NHS

A

Lots of diagnosed cases
Many complications arise
Need regular check ups
Growing problem due to increased obesity

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2
Q

Why does blood glucose rise in a Type 1 diabetic?

A

Lack of insulin due to autoimmune damage of the pancreas

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3
Q

Why does blood sugar rise in a Type 2 diabetic?

A

Lack of production of insulin and a reduced sensitivity to insulin

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4
Q

What is the normal range of glucose concentration in the blood?

A

3.8-6.5 mmol/L

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5
Q

What is the first stage of treatment for a Type II diabetic?

A

Exercise
Healthy diet
Smoking cessation
Reduced alcohol

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6
Q

What type of drug is Metformin?

A

Biguanide

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7
Q

What is the mechanism of metformin?

A

Increases sensitivity of cells to insulin
Enhances skeletal and adipose tissue glucose uptake
Inhibits hepatic gluconeogenesis

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8
Q

When is metformin ideally taken?

A

Prior to meals

2-3 times a day

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9
Q

What ADRs are common with Metformin?

A

GI disturbances eg. diarrhoea

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10
Q

When should Metformin not be given to a patient?

A

GFR <30ml/min

Suffering from heart, liver or respiratory disease

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11
Q

What is the mechanism of action of a Thiazolidinedione?

A

Bind to a nuclear hormone receptor site (PPAR-y)
Binds to another nuclear receptor (RXR)
PPAR-y/RXR complex then upregulates genes which control insulin signalling

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12
Q

What ADRs are common with Thiazolidinediones?

A

Weight gain
Osteoporosis
Increases LDLs and VLDLs
Increased risk of bladder cancer

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13
Q

Give an example of a sulphonylurea?

A

Glipizide

Gliclazide

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14
Q

What is the mechanism of action of a sulphonylurea?

A

Antagonise K+-ATPase channels in B cells in the pancreas.
Less K+ results in depolarisation and therefore increased Ca2+ entry into a cell
More insulin containing vesicles fuse with the membrane and are released into the bloodstream

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15
Q

What ADRs are common with sulphonylureas?

A

Risk of hypoglycaemia leading to diabetic coma
Weight gain
GI disturbances

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16
Q

What is the mechanism of action of Acarbose?

Give 2 common ADRs

A

Inhibits alpha glucosidase so carbohydrates cannot be broken down
ADRs: flatulence and diarrhoea

17
Q

What is the mechanism of action of Glifozins?

Give 2 common ADRs

A

Stop kidney from reabsorbing glucose by blocking glucose reabsorption channels in the PCT
ADRs: polyuria, increased risk of UTIs

18
Q

List the 6 types of insulin analogues

A

Bovine or porcine insulin

Rapid-acting insulin 
Short-acting insulin 
Intermediate insulin 
Long-acting insulin 
Very long-acting insulin
19
Q

Why is a patient given a mixture of insulins to treat diabetes?

A

Giving various acting insulins allows a more realistic blood sugar control.
Short-acting given before meals
Long-acting given overnight

20
Q

Give 3 factors that may cause blood glucose control to vary

A

Stress
Exercise
Over/under eating

21
Q

What is Type 2 combination theory?

A 
Start with exercise and diet 
Move to Metformin 
HbA1c >7% --> sulphonylurea added
HbA1c >7.5% --> start insulin therapy 
If HbA1c continues to rise the insulin dose is titrated upwards
22
Q

Give some ADRs of insulin

A 
Hyperglycaemia
Hypoglycaemia
Lipodystrophy 
Painful injections 
Insulin allergies
23
Q

Explain why sulphonylureas may cause DDIs

A

Binds heavily to plasma proteins so may displace other drugs in the body and force the competing drug above the therapeutic window.

24
Q

Describe the mechanism of action of the anti-obesity drug Orlistat

A

Gastric and pancreatic lipase inhibitor

Reduces dietary fat conversion to fatty acids and glycerol

25
Q

Give 3 side effects of the anti-obesity drug Orlistat

A

Soft fatty stools
Flatulence
Faecal incontinence

26
Q

How does the anti-obesity drug Sibutramine work?

A

Noradrenaline and serotonin re-uptake inhibitor

Suppresses appetite and increases glucose metabolism

Semester 5- Pharmacology (12 decks)

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