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CPT > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

What is the treatment for type 1 diabetes?

A
  • Insulin therapy
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2
Q

What does insulin therapy consist of?

A
  • SC injection but and IV in emergency

- Insulin dose that is given to try lower the glucose levels in the bloodstream

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3
Q

Why is insulin not given orally?

A
  • Insulin is a protein and would get broken down before absorption can even occur.
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4
Q

Describe basal-bolus loading

A
  • Rapid dose that increases insulin just before meal times = bolus. Rapid acting insulin, e.g. aspart
  • Basal dose is given to maintain a certain level of insulin at all times in the body. This is usually long acting insulin.
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5
Q

Avoid insulin therapy in patients who are:

A
  • Hypoglycaemic

- Have renal impairment

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6
Q

Contraindications with insulin therapy

A
  • Increase dose of insulin with steroids because they cause hyperglycaemia.
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7
Q

What is the benefit of manufacturing the insulin therapy as a soluble preparation?

A
  • Delays absorption and overcomes short plasma half-life. Soluble insulins form hexamers at site of injection, contributing to delay in absorption.
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8
Q

Name a biguanide and what it is used to treat?

A
  • Metformin

- Treats type 2 diabetes

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9
Q

Mechanism of action of metformin

A
  • Suppresses appetite so limits weight gain by decreasing hepatic glucose output (decrease gluconeogenesis and glycogenolysis)
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10
Q

Side effects of metformin

A
  • GI upset
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11
Q

Avoid the use of metformin in

A
  • GFR < 30ml/min as metformin is nephrotoxic
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12
Q

Contraindications of metformin

A
  • ACEi
  • NSAIDs
  • Diuretics: thiazides cause hyperglycaemia

All of these drugs are nephrotoxic.

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13
Q

What is the first line pharmacological treatment for type 2 diabetes?

A
  • Metformin (biguanides)
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14
Q

Name a sulfonylurea and describe it’s mechanism of action

A
  • Glicazide
  • Blocks K+ATP channels so depolarisation occurs and calcium enters the cell causing insulin to be released.
  • Insulin has anabolic effects = weight gain
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15
Q

Side effects of sulfonylureas

A
  • GI upset
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16
Q

Avoid sulfanylureas in

A
  • Hepatic and renal impairment
17
Q

Contraindications of sulfonylureas

A
  • Thiazides

- other hypoglycaemic agents

18
Q

How are sulfonylureas metabolised

A
  • Hepatically
19
Q

Name some thiazolidinediones

A
  • Pioglitazone
  • Rosiglitazone

Glitazones

20
Q

Mechanism of action of thiazolidinediones

A
  • Increases insulin sensitivity

- Activates PPAR-gamma to increase adipogenesis = weight gain.

21
Q

Side effects of thiazolidinediones

A
  • GI upset
  • Oedema
  • CVD risk increases (HF)
  • Fracture risk
22
Q

Contraindications of thiazolidinediones

A
  • Hypoglycaemic agents
23
Q

Name SGLT-2 inhibitors

A
  • Dapagliflozin
  • Canagliflozin

Gliflozins

24
Q

Mechanism of action of SGLT-2 inhibitor

A
  • In PCT

- Decreases glucose in plasma so weight loss due to beta oxidation of fat.

25
Q

Side effects of SGLT-2 inhibitors

A
  • UTI
  • genital infections
  • Thirst
  • Polyuria
26
Q

Contraindications of SGLT-2 inhibitors

A
  • Anti-hypersensitives as they cause hypoglycaemia
27
Q

Name some dipeptidyl peptidase 4 inhibitors

A
  • Sitagliptin
  • Saxagliptin

Gliptins

28
Q

Mechanism of action of DP4 inhibitor

A
  • Prevents incretin degradation so increased insulin release and suppressed appetite.
29
Q

Side effects of DP4 inhibitors

A
  • GI upset

- Pancreatitis

30
Q

Avoid the use of DP4 inhibitors

A
  • Pregnancy
31
Q

Contraindications of DP4 inhibitor

A
  • Hypoglycaemic agents

- Diuretics causing hyperglycaemia

32
Q

When are DP4 inhibitors used?

A
  • First line treatment when metformin is contraindicated.
33
Q

Name some glucagon-like-peptide 1 (incretin) receptor agonists. SC injection.

A
  • Exenatide

- Liraglutide

34
Q

Mechanism of action of glucagon-like-peptide 1 receptor agonist

A
  • Increased insulin release
  • Decreased glucagon release
  • Promotes satiety
35
Q

Side effects of GLP-1 receptor agonists

A
  • GI upset

- GORD from delayed gastric emptying caused by GLP-1

36
Q

Avoid GLP-1 receptor agonists in patients with:

A
  • eGFR < 30ml/min
37
Q

Contraindications of GLP-1 receptor agonist

A
  • Hypoglycaemic agents

CPT (9 decks)

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