Diabetes Flashcards
Antiobesity drug of choice?
Orlistat
Orlistat moa?
Pancreatic lipase inhibitor. Reduce breakdown and subsequent absorption of fat from gut.
Name 2 insulin sensitising agents with examples
- Biguanides: metformin
* thiazolidinediones: pioglitazone
Metformin moa? (3)
- Increase peripheral use glucose by increasing uptake and decreasing gluconeogenesis, increase glycogenolysis
- decrease hepatic glucose production by inhibiting mitochondrial respiratory chain complex. Decrease GNG, glycogenolysis, fa oxidation
- reduce carb absorption from intestine
- activate insulin receptors and glut 4
Name 5 advantages metformin
- Weight loss
- No hypoglycaemia
- decrease thrombotic risk: decrease platelet aggregation and pai-1 levels
- beneficial effect lipid profile: decreased LDL, triglycerides, increased HDL
- safe pregnancy
Contraindications metformin?
Egfr <30 and hepatic impairment (risk lactic acidosis)
Pioglitazane moa? (3)
• PPARgamma nuclear receptor agonist: increase transcription proteins that augment post receptor action of insulin
. Increase lipogenesis, uptake fatty acids and glucose
• reduce peripheral insulin resistance therefore increase sensitivity.
Indication pioglitazone?
Combination with metformin or sulfonylurea DM 2.
Name 4 advantages pioglitazone
- Reduce cv risk
- increase HDL, decrease LDL and triglycerides
- Improve Nash (nonalcoholic steatohepatitis)
- improve ovulation PCOS
- no hypoglycemic
Name 5 adverse effects pioglitazone
• Weight gain . Fluid retention • increased risk fractures long term use • increased risk heart failure congestive • increased risk bladder cancer
Moa sulfonylureas? (2)
- Block ATP dependent potassium channels in membrane of pancreatic B cells
- cause depolarisation, calcium influx and insulin release.
Name 3 sulfonylureas.
- Glimepiride
- tolbutamide
- glibenclamide
Name 3 adverse effects sulfonylureas
- Hypoglycaemia
- weight gain
- increased risk CV mortality
Name 2 types incretins and example each.
- GLP-1 agonist: exenatide, liraglutide, dulaglutide, semaglutide
- Gliptins/DPP-4 inhibitors: sitagliptin, saxagliptin, vildagliptin, linagliptin
GLP 1 agonist moa?
Eg exenatide.
• increase insulin secretion
• suppress glucagon secretion
. Slow gastric emptying
Indication glp-1 agonists?
Obese patients with DM 2 after dual therapy fail.
name 2 adverse effects glp-1 agonist
Eg dulaglutide.
• git disturbance
• pancreatitis
Name 2 adverse effects dpp-4 inhibitors
- Heart failure, especially saxagliptin
* pancreatitis
Sglt2 inhibitors moa?
Increased glucose excretion by kidney.
Indication sglt2 inhibitors?
Dual therapy with metformin in patients that can’t tolerate sulphonylareas.
Cause weight loss, CV protection, slow progression DKD
Name 3 SGLT2 inhibitors
• Dapagliflozin
. Canagliflozin
• empagliflozin
Name 3 adverse effects sglt2 inhibitors.
- DKA risk
- genitourinary infections and thrush,polyuria, risk Fournier gangrene
- volume depletion, hypotension
Name 3 principles treatment DKA
- Fluid: resuscitate, ns initially then 5% dextrose when glucose <14
- iv insulin
- K supplement iv
