Diabetes drugs Flashcards
Very weight gaining
diabetic medications
- Insulin ( anabolic effects)
- Sulfonylureas
- Pioglitazone
Metformin MOA
Decreasing gluconeogenesis
Increases peripheral utilisation of glucose.
it acts only in the presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells (T2D)
Sulfonylureas MOA
MOA: Stimulate insulin release
Drugs: glibenclamide, gliclazide, glimepiride, glipizide, tolbutamide
Side effects Sulfonylureas
Can cause hypoglycemia (as it stimulates insulin release)
Weight gain
GI side effects
If taken in overdose, has really long life, need a glucose prolonged drip
Multiple daily dosing, eventually stop working so need other drugs
Do not prescribe to people who are very edlery or hypoglycaemia would be catastrophic to profession
Thiazolidinediones MOA
Drug: Pioglitazone
MOA: PPARY agonist. It takes a while to work because of changing transcription in the nucleus . Making newer fat cells to increase the number of glucose transporters on the outside of the cell. Make insulin work better.
Thiazolidinedione side effects
Side effect: Weight gain good fat , tends not to be visceral, Oedema/fluid retention
liver impairment: monitor LFTs
Adverse effects:
Heart failure (esp when given alongside insulin, insulin makes you retain sodium and water)
Small bone fractures (esp women)
Small increased risk of bladder cancer ( makes it prescribed less)
Acarbose MOA
ɑ-Glucosidase inhibitors
T2D
inhibits carbohydrates absorption in the gut.Slowing food digestion helps keep blood glucose from rising very high after meals.
not well tolerated, undigested CHO in large bowel causes bacteria to proliferate and cause bloating
sodium glucose co-transporter 2 inhibitors
Drugs: canagliflozin, dapagliflozin, and empagliflozin
MOA: Work by allowing the kidney to spill more sugar into urine
SGLT2 inhibitor side effects
Increase in Urinary infections + candidiasis,thrush (all the glucose in the urine)
Hypovolaemia (uncommon- you lose sodium and water with it acting like a diuretic)
DKA (rare- so it isn’t used in t1d)
Fournier’s gangrene (rare) rapidly fatal
Being investigated for treatment of heart failure
GLP1 analogues/mimetics MOA
Drugs: dulaglutide, exenatide, liraglutide and lixisenatide,Injectable
MOA: glp1 mimics glucagon from alpha cell. Lowers Blood glucose by making you feel fuller because it slows gastric emptying, by stimulating release of insulin from pancreas only in response to food, suppress appetite by interacting with satiety centre in brain
GLP1 mimetic SIde effects
No hypoglycaemia as monotherapy because only works when there is high glucose , Weight loss, GI side effects – N & V
Increased Risk of pancreatitis
Avoid in medullary Ca thyroid
DPP4 inhibitors MOA
Drugs: alogliptin, linagliptin, sitagliptin, saxagliptin, and vildagliptin, tablet form
MOA: Based on incretin , inhibit breakdown of natural glucagon like peptide 1, therefore have natural GLP around for longer, Low potency
Rapid acting insulin
Flasp, Novorapid, Humalog, Apidra
Quick acting insulin
Actrapid, Humulin S(human), Insulin Lispro( analogue) , Insulin aspart (analogue), Insuman Rapid, Heparin Neutral
Mixed insulin
Novomix 30, Humalog Mix 23/50(analogue) /M3(human) , Inhuman comb 15/25/50
