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PPT > DIABETES DRUGS > Flashcards

DIABETES DRUGS Flashcards

1
Q

What type of drugs is alogliptin, sitagliptin and linagliptin?

A

DPP4 inhibitors

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2
Q

What type of drug is metformin?

A

Biguanide

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3
Q

What type of drug is pioglitazone?

A

A thiazolidinedione

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4
Q

What type of drugs are canagliflozin, dapagliflozin, ertugliflozin?

A

SGLT2 inhibitors

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5
Q

What type of drugs are gliclazide, glimeperide, tolbutamide?

A

Sulfonylureas

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6
Q

What type of drugs are dulaglutide, exenatide, Liraglutide?

A

GLP-1 agonists

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7
Q

Whats the suffix for DPP4 inhibitors?

A

-gliptin

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8
Q

Whats the suffix for thiazolidinediones?

A

-glitazone

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9
Q

Whats the suffix for SGLT2 inhibitors?

A

-flozin

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10
Q

Whats the suffix for sulfonylureas?

A

-ide

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11
Q

Whats the suffix for GLP1 agonists?

A

-tide

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12
Q

Whats the MOA of DPP4 inhibitors?

A

Inhibits DPP4 which prevents inactivation of glucagon-like peptide which is an incretin

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13
Q

Whats the MOA of GLP1 agonists?

A

mimic the action of endogenous GLP-1 (incretin) to enhance insulin secretion and inhibit glucagon secretion from pancreatic islet cells.

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14
Q

Whats the MOA of metformin?

A

Decreases gluconeogenesis, intestinal absorption of glucose and increases insulin sensitivity by increasing peripheral glucose uptake and reabsorption.

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15
Q

Whats the MOA of thiazolidinediones?

A

Activate PPARs which are a group of nuclear receptors that when activated, increase insulin sensitivity by acting on adipose, muscle, and, to a lesser extent, liver to increase glucose utilization and decrease glucose production.

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16
Q

Whats the MOA of SGLT2 inhibitors?

A

Inhibit SGLT2 in the PCT to prevent reabsorption of glucose and facilitate its excretion in urine

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17
Q

Whats the MOA of sulfonylureas?

A

close ATP-sensitive K-channels in the beta-cell plasma membrane, and so initiate a chain of events which results in insulin release.

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18
Q

What are the contraindications of thiazolidinediones?

A

HF
Previous or active bladder cancer or uninvestigated macroscopic haematuria

19
Q

Whats the first line drug of choice in type 2 diabetes?

A

Metformin

20
Q

When should SGLT2 inhibitors be given in addition to metformin?

A

If the patient has a high risk of developing CVD, has CVD or has chronic HF

21
Q

If metformin is contraindicated, what drug is first choice for type 2 diabetes?

A

SGLT2 mono therapy if the patient has risk of, has CVD or chronic HF
DPP4 inhibitor or sulfonylureas or pioglitazone if patient doesnt have above

22
Q

When should GLP1 mimetic treatment be considered?

A

If triple therapy with metformin and 2 other oral drugs is not effective, not tolerated or contraindicated then consider triple therapy by switching 1 drug for GLP1 mimetic

NICE like patients to have achieved a > 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months to justify the ongoing prescription of GLP-1 mimetics.

23
Q

When should you consider insulin therapy for type 2 diabetes?

A

When dual therapy has not continued to control HbA1c to below the person’s individually agreed threshold

24
Q

Which antidiabetic drugs cause weight gain?

A

Pioglitazone
Sulfonylureas
Insulin

25
Q

Which antidiabetic drugs cause weight loss?

A

SGLT2 inhibitors
GLP1 mimetics

26
Q

Which antidiabetic drugs are weight neutral?

A

DPP4 inhibitors
Metformin

27
Q

Which antidiabetic drugs carry risk of hypoglycaemia?

A

Insulin
Sulfonylureas - moderate risk

28
Q

Which diabetics should statin be offered in?

A

Only pt with 10 year cardiovascular risk >10%

29
Q

What is the incretin effect?

A

In normal physiology an oral glucose load results in a greater release of insulin than if the same load is given intravenously
This is because L cells of the ileum release GLP1

30
Q

What are incretins?

A

hormones that are secreted from the gastrointestinal tract into the circulation in response to nutrient ingestion that enhance glucose-stimulated insulin secretion

31
Q

What are common side effects of metformin?

A

GI side effects
Lactic acidosis

32
Q

What are common side effects of sulfonylureas?

A

Hypoglycaemic episodes
Increased appetite and weight gain
SIADH - hyponatraemia
Hepatotoxicity
Bone marrow suppression
Peripheral neuropathy

Dont give in breast feeding or pregnancy!

33
Q

What are common side effects of pioglitazone?

A

Weight gain
Fluid retention
Liver impairment
Fracture risk
Increased risk of bladder cancer

34
Q

What are common side effects of DPP4 inhibitors?

A

Pancreatitis

35
Q

What are metformin contraindications?

A

Renal dysfunction
Impaired hepatic dysfunction
Congestive HF
Metabolic acidosis

36
Q

When should you add another drug when a pt is on metformin?

A

If HbA1c rises to 58 mmol/mol (7.5%)
Before this you can titrate metformin up and make lifestyle changes

37
Q

If a pt is not tolerating metformin due to GI side effects, what should you do next?

A

Start metformin modified release
- this has a better GI SE profile. This is also only given once daily

38
Q

Whats the most effective oral antidiabetic agent? Whats the biggest risk with this?

A

Sulfonylureas -gliclazide
Greatest risk of hypoglycaemia

39
Q

Why should you stop metformin when you are sick?

A

Dehydration makes it more likely to develop lactic acidosis

40
Q

Why should you stop sulfonylureas when you are sick?

A

If you are unable to eat and drink then you are more likely to develop hypos

41
Q

Why should you stop SGLT2 when you are sick?

A

Dehydration can make it more likely to develop ketoacidosis

42
Q

What are the major adverse efefcts of GLP-1 mimetics?

A

Nausea and vomiting
Exanatide - pancreatitis

43
Q

What are the adverse side effects of SGLT2 inhibitors?

A

Urinary and genital infections
Normoglycaemic ketoacidosis
Increased risk of lower-limb amputation
Weight loss

44
Q

How are GLP-1 mimetics administered?

A

Subcutaneous injections!

PPT (6 decks)

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