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Pharmacology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the rationale for drug use in T2DM? (3)

A
  • Control symptoms
  • Control BGLs
  • Delay microvasculature and macrovasculature complications
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2
Q

What is the pathophysiology of T1DM?

A

Autoimmune destruction of Beta cells

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3
Q

What is the pathophysiology of T2DM?

A

Resistance to insulin and inadequate secretion of insulin response by the Beta cells

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4
Q

What are 5 symptoms of diabetes?

A

Lethargy, polyuria, polydipsia, blurred vision, dizziness, tremor, loss of sensation, poor wound healing, fungal/bacterial infection, ketosis and ketonuria

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5
Q

How many months might lifestyle alterations be trialled before starting drug treatment for T2DM?

A

2-3 months

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6
Q

What are 4 tests for diabetes?

A

BGLs, fasting BGLs, oral glucose tolerance test, glycosated haemoglobin

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7
Q

What are 2 risk factors of T2DM?

A

CVD, PCOS, being in particular ethnic groups, being overweight, anipsychotics, steroids, and IGT + IFG

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8
Q

What might you give someone with T2DM and atherosclerotic cardiovascular disease, heart failure or CKD? (2 drug classes)

A

SGLT2 inhibitor or GLP-1 analogue

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9
Q

How do you do an oral glucose test?

A

Fast and then do a BGL, have a sugary drink and then have BGLs tested after 1 hour and then 2nd hour.

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10
Q

What are 3 main areas of chronic complications of diabetes relating to microvasculture?

A

Eye disease, nephropathy and neuropathy

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11
Q

What are 2 pros and 2 cons to short acting insulins?

A

Flexible and better control by more of a risk of hypos and more injections

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12
Q

What are 2 pros and 2 cons to split mixed regimens?

A

Simple and convenient but not as flexible and cannot skip meals

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12
Q

What are 2 pros and 2 cons to longer acting insulins?

A

Lower risk of hypos and less injections but less flexible and less control

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13
Q

What are 2 pros and 2 cons to basal bolus injections?

A

They are more flexible and have better BSL control but requires more monitoring, does not cover snacks and higher risk of hypos

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13
Q

How should you treat a conscious vs an unconscious patient with hypoglycaemia?

A

A conscious patient should have oral glucose or sucrose, wait 10-15 minutes and then if responsive, have a longer acting carb. An unconscious patient should have an IM or iV injection of glucagon.

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14
Q

By how much do you bring down insulin if it is too high?

A

2-4 units

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15
Q

What are three chronic complications relating to macrovasculature in diabetes?

A

Coronary artery disease, pulmonary artery disease and cerebrovascular disease

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15
Q

What are 4 other chronic complications of diabetes?

A

Infections, genitourinary complications, dermatologic complications, glaucoma, periodontal disease, gastrointestinal complications.

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15
Q

What are 2 pros of metformin?

A

Low risk of hypos, does not affect weight, cardiovascular and renal benefits

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16
Q

What are 2 pros of SGLT2 inhibitors?

A

Weight loss and low risk of hypos

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17
Q

What are the 2 cons of sulfonylureas?

A

Weight gain and increased risk of hypos

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17
Q

What are two pros and one con for acarbose?

A

Weight loss and low risk of hypos but increased risk of GIT complications

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18
Q

What are the cons of insulin?

A

Weight gain and risk of hypos

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18
Q

What are the 2 pros and 1 con of DPP-4 inhibitors?

A

Weight loss and low risk of hypos but they are cleared by the kidney

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19
Q

After giving an oral administration of glucose or sucrose, what do you do?

A

Response should occur within 10 minutes for glucagon and within 4-5 minutes for glucose. Give longer acting carbohydrates if they respond

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20
Q

If you were commencing insulin for a patient starting with an overnight dose. What type of insulin would you use?


A

Intermediate acting

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20
Q

What are the second line agents to T2DM?

A

GLP1 agonists/ DPP-4 inhibitors and SGLT2 inhibitors

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21
Q

What are 3 signs of lactic acidosis?

A

Anorexia, nausea, vomiting, ab pain, cramps, malaise and weight loss

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21
Q

How does a basal bolus regime work?

A

Three daily short acting before meals and one daily night time insulin injection

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22
Q

If you are having a contrast scan and have metformin what do you need to do?

A

Withhold 24 hours beforehand

23
Q

What is the role of DPP-4 inhibitors in T2DM management?

A

The inhibit DPP-4 which breaks down incretin hormones meaning that they last longer and continue to produce insulin and increase fullness.

24
Q

If a drug ends in gliptin what does it mean?

A

It is a Dpp-4 inhibitor

25
Q

Why don’t incretin hormones cause hypos?

A

Because insulin is released wth meals

26
Q

If a drug ends with -tide, what are they?

A

GLP-agonists

27
Q

Which DPP-4 inhibitor is cleared by the liver?

A

Linaglyptin

28
Q

What is a con to GLP-analogues?

A

Eliminated by kidney and may cause nausea and vomiting

29
Q

Do GLP-1 agonists cause hypos?

A

No

30
Q

Which 2 GLP analogues reduce strokes and renal disease risks?

A

Semaglutide and Dulaglutide

31
Q

Name 2 SGLT2 drugs?

A

Answer includes Dapagliflozon, Empagliflozin and Ertugliflozin

32
Q

What do SGLT2 drugs do?

A

Reduce reabsorption of glucose in the kidney and excretion of glucose

33
Q

Diabetes is the number one reason for which disease?

A

Kidney disease

34
Q

What drug may cause euglycaemic DKA?

A

SGLT2 inhibitors

35
Q

If a drug starts with gli, what are they?

A

Sulfonylureas

36
Q

What is the Moa of sulfonylureas?

A

Increase pancreatic insulin secretion

37
Q

If a drug ends with glitazones what is it?

A

Thiazolidinediones

38
Q

Why are Thiazolidinediones not used very much?
 (3 reasons)

A

associated with heart failure, osteoporosis and bladder cancer

39
Q

What is the MOA of Acarbose?

A

Inhibits carb digestion in the GIT thus increasing rate of glucose delivery in the blood.

40
Q

When starting insulin, how do you do it?

A

10 units at bedtime (intermediate acting) in addition to oral medications

41
Q

What is the MOA of Thiazolidinediones?

A

Increases insulin sensitivity

42
Q

What is the MOA of Metformin?

A

Reduces hepatic glucose production and increases insulin use. Thereby increasing insulin sensitivity

43
Q

What are two adverse effects to Thiazolidinediones?

A

MI, bone fracture, macular oedema and bladder cancer

44
Q

What are two adverse effects to Acarbose?

A

Flatulence and bloating

45
Q

What is the effect of DPP-4s? (3)

A

Increases glucose dependent insulin secretion, reduces glucagon production and delays gastric emptying.

46
Q

What are 2 side effects of Metformin?

A

Nausea, vomiting, anorexia, ab pain, cramps, malaise and weight loss.

47
Q

What are 2 adverse effects of GLP-1 analogues?

A

Nausea and vomiting, CKD, CVD and stroke

48
Q

What is the MOA of GLP-1 analogues?

A

Mimics the effect of GLP-1

49
Q

What is the MOA of SGLT2 inhibitors?

A

Inhibits glucose resorption in the kidney

50
Q

What are 2 side effects of SGLT2 inhibitors?

A

Urinary and genital infections and euglycaemic DKA

51
Q

If a drug ends in tide what class is it?

A

GLP-1 agonist

52
Q

if a drug ends in flozin what class is it?

A

SGLT2

53
Q

if a drug starts with gli what class is it?

A

sulfonylureas

54
Q

if a drug ends in glitazone what class is it?

A

thiazolidinones

55
Q

if a drug ends in glyptin what class is it?

A

DPP-4Is

56
Q

Name 2 GLP-1 agonists?

A

Semaglutide and dulaglutide

57
Q

Name 2 sulfonylureas

A

glibenclamide and glipizide

58
Q

Name 2 DPP-4Is

A

linaglyptin and aloglyptin

59
Q

Name 2 SGLT2Is?

A

dapagliflozin and empagliflozin

60
Q

Name 1 thiazolidinones

A

pioglitazone

61
Q

What drug class is acarbose?

A

alpha glucosidase inhibitor

62
Q

What are two drug classes and 1 examples of them which can increase BSLs?

A

Atypical antipsychotics (olanzapine and clozapine)
Glucocorticoids (prednisone and prednisolone)

63
Q

Why do people with diabetes experience symptoms?

A

Hyperosmolar effects of excessive glucose in the bloodstream

64
Q

What are 3 symptoms are specific to T1DM?

A

Ketosis/ketonuria, polyuria, polydypsia, weight loss, rapid onset of symptoms and family history

65
Q

What are 3 signs of insulin resistance?

A

Acanthosis nigricans, skin tags, hyperpigmentation of the skin, central obesity, menstrual irregularities and hirsuitism

66
Q
A

Pharmacology (23 decks)

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