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CPT > 5. Diabetes Mellitus > Flashcards

5. Diabetes Mellitus Flashcards

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1
Q

What is the biochemical triad in diabetic ketoacidosis?

A

Hyperglycaemia
Ketonaemia
Acidosis

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2
Q

What should be given in DKA?q

A

IV fluids with K+ and then IV soluble insulin

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3
Q

How are insulin preparations made to slow absorption?

A

Protamine and/or zinc complex with natural insulin’s
Soluble insulin forms hexameter
Insulin analogues

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4
Q

What are the adverse effects of insulin prescription?

A

Hypoglycaemia

Lipodystrophy

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5
Q

What are the contraindications of insulin prescriptions?

A

Renal impairment

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6
Q

What are the important drug reactions with insulin prescriptions?

A

Dose needs increasing with systemic steroids

Caution with other hypoglycaemic agents

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7
Q

What is the management of type 2 diabetes?

A 
Lifestyle, education
Weigh loss
Initially non-insulin therapies
Insulin in poorly managed or later stage disease
Treat comorbidities
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8
Q

What is the action of biguanides?

A

Reduce hepatic glucose production by inhibiting gluconeogenesis
Suppress appetite so limit weight gain
Lower risk of hypoglycaemia

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9
Q

Name a biguanide drug

A

Metformin

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10
Q

What are some adverse effects of metformin?

A

GI upset - nausea, vomiting, diarrhoea

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11
Q

What are some contraindications of metformin?

A

Excreted unchanged by kidney - stop in eGFR <30ml/min, alcohol intoxication

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12
Q

What are the important drug interactions with metformin?

A

ACEi
Diuretics
NSAIDs

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13
Q

What is the action of sulfonylureas?

A

Stimulate beta cell pancreatic insulin secretion by blocking ATP-dependent K+ channels
Need residual pancreatic function to work
Weight gain through anabolic effects of insulin

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14
Q

Name a sulfonylurea drug

A

Gliclazide

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15
Q

What are the adverse effects of sulfonylureas?

A

Mild GI upset

Hypoglycaemia

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16
Q

What are the contraindications for sulfonylureas?

A

Hepatic and renal disease

17
Q

What are the important drug interactions with sulfonylureas?

A

Other hypoglycaemic drugs

Loops and thiazide diuretics - oppose actions of SU

18
Q

What are the actions of thiazolidinediones?

A

Insulin sensitisation in muscle and adipose, reduce hepatic glucose output by activation of PPAR-gamma, affects gene transcription
Causes weight gain because of fat cell differentiation

19
Q

Name examples if thiazolidinediones

A

Pioglitazone

Rosiglitazone

20
Q

What are the adverse effects of thiazolidinediones?

A

GI upset
Fluid retention
Fracture risk
Bladder cancer

21
Q

What are the contraindications of thiazolidinediones?

A

Heart failure because of fluid retention

22
Q

What are the important drug reactions with thiazolidinediones?

A

Other hypoglycaemic agents

23
Q

What is the action of SGLT-2 inhibitors?

A

Decrease glucose absorption from tubular filtrate, increase urinary glucose excretion by competitive reversible inhibition of SGLT-2 in PCT
Moderate weight los, hypoglycaemic risk low

24
Q

Name 2 SGLT-2 inhibitors

A

Dapagliflozin

Canagliflozin

25
Q

What are the adverse effects of SGLT-2 inhibitors?

A

UTI
Genital infection
Thirst
Polyuria

26
Q

What are the contraindications of SGLT-2 inhibitors?

A

Risk of DKA in type 1 diabetes, possible hypotension

27
Q

What are the important drug interactions with SGLT-2 inhibitors?

A

Antihypertensive and other hypoglycaemic agents

28
Q

What is the action of dipeptidyl peptidase-4 (DPP-4) inhibitors?

A

Prevent increasing degradation - increase [plasma] incretin levels
Suppress appetite - weight neutral

29
Q

Name 2 DPP-4 inhibitors

A

Sitagliptin

Saxagliptin

30
Q

What are the adverse effects of DPP-4 inhibitors?

A

GI upset

Small pancreatitis risk

31
Q

What are the contraindications of DPP-4 inhibitors?

A

Avoid in pregnancy, history of pancreatitis

32
Q

What are the important drug interactions with DPP-4 inhibitors?

A

Other hypoglycaemic agents

Drugs that increase glucose can oppose gliptin action e.g. thiazide like and loop diuretics

33
Q

What is the action of GLP-1 receptor agonists?

A

Increase glucose dependent synthesis of insulin secretion from beta cells
Activate GLP-1 receptor - resistant to degradation by DPP-4

34
Q

Name 2 GLP-1 receptor agonists

A

Exenatide

Liragutide

35
Q

What are the adverse effects of GLP-1 receptor agonists?

A

GI upset

Decreased appetite with weight loss

36
Q

What are the contraindications of GLP-1 receptor agonists?

A

Renal impairment

37
Q

What are the important drug reactions with GLP-1 receptor agonists?

A

Other hypoglycaemic agents

CPT (30 decks)

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