3.1 and 3.2 Diabetes Drugs Flashcards
What are the general names of drugs given to type 2 diabetics?
Metformin Sulphonylurea Glitazone Acarbose Incretin Based Drugs SGLT2 Inhibitors
What is the first line treatment of T2D?
Diet and Lifestyle Changes
Exercise and Weight Loss
What is the first Pharmacological treatment of T2D?
How does it work?
Metformin (biguonide)
It increases insulin sensitivity (skeletal and adipose)
It decreases gluconeogenesis
Can also reduce V/LDLs
What are the advantages of Metformin?
Can cause weight loss
It is cheap
It is effective
It is oral and can be taken long term, take 2-3 times a day before meals
What side effects are common with Metformin
Hypoglycaemia
GI Effects
B12 Deficiency
When should you NOT use Metformin?
CKD
<30ml/min
What is the next drug you add to metformin in poor control?
Sulphonylurea
How do Sulphonylureas work?
They stimulate insulin secretion from Beta Islet Cells
They are antagonists of the K+ATPase channel which leads to K+ increasing in the cell which increases Ca2+ entry.
Stimulates vesicle release of insulin
What are the general mechanisms drugs take to treat diabetes?
Which drugs act in which way?
Insulin Sensitisers (Metformin and Glitazones)
Insulin Release Stimulators (sulphonylureas, glipizides)
Inhibit uptake of carbohydrate (acarbose)
Inhibit reabsorption in kidneys (SGLT2 inhibitors)
Increase action of GLP1 (incretin based therapy)
What are some side effects of Sulphonylureas?
Weight Gain (insulin anabolic)
Risk of Hypo (due to increased half life/potency of some agents)
GI disturbance
How does Acarbose work?
It inhibits alpha-glucosidase which normally breaks down complex carbohydrates
What are the side effects of acarbose?
Flatulence
Diarrhoea
Loose Stools
Abdo Pain
What are the risks of glitazones?
Bladder cancer
GI symptoms
Fluid retention
Weight Gain
What are the types of incretin based therapy?
DPP4 Inhibitors
GLP1 receptor agonists
GLP1 agonists
Why do incretin based therapies work?
They act on either the breakdown or action of GLP
GLP is a peptide which is released from intestinal L cells after a meal. It suppresses appetite, slows gastric emptying and gluconeogenesis and increases uptake into muscles and insulin secretion
How do SGLT2 Inhibitors work?
They block SGLT2 in the PCT of the kidney
Prevent reabsorption in the kidney
What are the side effects of SGLT2 Inhibitors?
UTIs (thrush due to glucose in urine)
Polyuria
What are some advantages of SGLT Inhibitors?
Low risk of hypoglycaemia
Promote weight loss
What are some pros and cons of GLP agonists?
Weight Loss
GI symptoms (reflux, loose stools, nausea, diarrhoea)
Expensive
Have to inject- pain
What part of insulin is changed to affect the pharmacokinetics?
The B chain
Between regions 26-30
Helps change its absorption
What are the types of insulin?
Rapid Acting Short acting Intermediate acting Intermediate/Long Acting very Long acting
Why do you take long acting insulin?
To keep basal levels of insulin to prevent hyperglycaemia
What are the risks of long acting insulin?
Hypoglycaemia at night
How long do rapid acting insulin and short acting last?
How long to take effect?
30 mins, 10 Hours with peak at 2-3 Hours
15 mins, 4-6 Hours
Take just before eating
