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Pharmacology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the half Life of insulin?

A

5 mins

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2
Q

How long before a meal should you inject insulin?

A

15-30mins prior

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3
Q

What are the warnings and contraindications associated with insulin?

A

Hypoglycaemia
Lipohypertrophy
Lipoatrophy
Renal impairment

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4
Q

What is Aspart?

A

A rapid acting bolus of insulin

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5
Q

What is a Glargine?

A

A long acting dose of insulin - basal

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6
Q

Name a biguanide

A

Metformin

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7
Q

How does the biguanide metformin work?

A

It decreases hepatic glucose output
Increases glucose utilisation in skeletal muscle
Suppresses appetite

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8
Q

What warnings and contraindications are associated with metformin?

A

Nausea and vomiting
Diarrhoea
Lactic acidosis

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9
Q

What interactions should be taken into consideration when prescribing biguanides such as metformin?

A

ACEi
Diuretics
NSAIDs
Any drug that impairs renal function

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10
Q

What is Gliclazide

A

A Sulfonylureas

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11
Q

Name a sulfonylureas

A

Gliclazide

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12
Q

Gliclazide stimulates what cells and to what effect?

A

B cells of the pancreas to stimulate insulin secretion

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13
Q

Gliclazide, a sulfonylureas blocks what type of channel

A

ATP dependent K+ channel

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14
Q

What is a side effect of sulfonylureas?

A

Weight gain

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15
Q

What are the warnings and contraindications associated with sulfonylureas?

A

Mild GI upset - nausea and vomiting
Diarrhoea
Hypoglycaemia
Hypersensitivity

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16
Q

What interactions and considerations are associated with Gliclazide, a sulfonylureas

A

Other hypoglycaemic agents
Hepatic impairment
Renal impairment
Thiazide diuretics

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17
Q

Name 2 Glitazones

A

Pioglitazone

Rosiglitazone

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18
Q

What are pioglitazone and rosiglitazone?

A

Glitazones

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19
Q

What is the mechanism of action for Glitazones such as pioglitazone?

A

Insulin sensitisation

Activation of PPAR - gene transcription

20
Q

What is a side effect of Glitazones?

A

Weight gain

21
Q

What warnings and contraindications are associated with Glitazones?

A 
GI upset
Fluid retention
Fracture risk
CVD concerns
Bladder cancer
22
Q

What are the interactions and considerations associated with Glitazones?

A

Other hypoglycaemic agents

23
Q

Dapagliflozin and canagliflozin belong to which class?

A

Gliflozins

24
Q

Name the gliflozins

A

Dapagliflozin

Canagliflozin

25
Q

Which drug class are SGLT-2 inhibitors ?

A

Gliflozins

26
Q

What is the activity of Gliflozins?

A

Competitive reversible inhibition of SGLT-2 in the proximal convoluted tubule
There is decreased glucose absorption from tubular filtrate, increased excretion

27
Q

What are the warnings and contraindications associated with Gliflozins such as Dapagliflozin?

A

UTI
Genital infection
Thirst
Polyuria

28
Q

What interactions and considerations are associated with Gliflozins such as Canagliflozin?

A

Anti-hypertensives and other hypoglycaemic agents

29
Q

GLP-1 receptor agonists are what type of mimetic?

A

Incretin mimetics

30
Q

What are incretins?

A

A group of metabolic hormones that stimulate a decrease in blood glucose levels. They are released after eating.

31
Q

Why is weight gain a side effect of gliclazide, a sulfonylureas?

A

It stimulates the secretion of insulin and insulin has anabolic effects

32
Q

Why do thiazide like diuretics reduce the action of sulfonylureas?

A

Because thiazide like diuretics increase the blood glucose

33
Q

What body tissues become sensitised to insulin when taking Glitazones?

A

Muscle and adipose tissue

34
Q

What is unusual about the half life of Glitazones?

A

It’s not related to its duration of action

35
Q

What can be used to modify the absorption of insulin

A

Protamine
Zinc
Protamine with zinc

36
Q

Why does the injection site of insulin require rotation?

A

To avoid lipodystrophy

37
Q

Why must insulin be given parentally?

A

To avoid digestion in the gut as it is a protein

38
Q

What is a problem associated with porcine and bovine derived insulins?

A

Immunogenicity

39
Q

What drug is often first line in diabetes treatment?

A

Metformin

40
Q

Why is it important to stop taking metformin if eGFR is <30ml/min?

A

Because it gets excreted unchanged by the kidneys

41
Q

How do Glitazones cause weight gain?

A

Due to fat cell differentiation

42
Q

When are Gliflozins used in diabetes, Tye 1 & 2?

A

Type 1 - when there is a diabetic ketoacidosis risk.

Type 2 - as an add on therapy

43
Q

Why do Gliptins have a low hypoglycaemic risk?

A

Their actions are glucose dependent so works post prandially. They do not stimulate insulin secretion at normal blood glucose

44
Q

What classes of drugs oppose the action of Gliptins and why?

A

Thiazide like drugs and loop diuretics as these increase blood glucose

45
Q

How are GLP-1 receptor agonists (incretin mimetics) administered?

A

Subcutaneous injection

46
Q

What is triple therapy for diabetes?

A

Giving the patient 3 drugs when struggling to control their blood sugar, e.g.
Metformin
Pioglitazone
Sulfonylureas

47
Q

Why would metformin be contraindicated?

A

If risk factors for acute metabolic acidosis are present

If renal impairment is present - eGFR <30L/min

Pharmacology (11 decks)

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