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Yr 4 - Drugs > Diabetes Drugs > Flashcards

Diabetes Drugs Flashcards

1
Q

Mechanism of metformin?

A

1) increases insulin sensitivity

2) decreases glucose production by the liver (gluconeogenesis)

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2
Q

Key side effects of metformin?

A

1) GI upset: abdo pain, diarrhoea, N&V

2) Lactic acidosis (e.g. 2ary to AKI)

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3
Q

Is metformin safe in pregnancy?

A

Yes

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4
Q

What can be tried in patients with GI side effects from standard-release metformin?

A

Modified release metformin

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5
Q

Does metformin cause hypoglycaemia?

A

No

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6
Q

What class of drug is metformin?

A

Biguanide

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7
Q

Does metformin cause weight gain?

A

No - may cause weight loss.

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8
Q

Contraindications to metformin?

A

1) Acute metabolic acidosis (including lactic acidosis and DKA)

2) Stop if serum creatinine >150

3) Stop during periods of suspected tissue hypoxia (for example, due to myocardial infarction, sepsis).

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9
Q

Give some examples of SGLT-2 inhibitors

A

-gliflozin

Empagliflozin, canagliflozin, dapagliflozin and ertugliflozin.

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10
Q

Mechanism of SGLT-2 inhibitors?

A

1) SGLT-2 inhibitors block action of the sodium-glucose co-transporter 2 protein (found in the proximal tubules of the kidneys).

2) The sodium-glucose co-transporter 2 protein usually acts to reabsorb glucose from the urine back into the blood.

3) By blocking this, more glucose is excreted in the urine.

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11
Q

Can SGLT-2 inhibitors cause hypoglycaemia?

A

Yes - when used with insulin or sulfonylureas.

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12
Q

When can SGLT-2 inhibitors cause hypoglycaemia?

A

When used with insulin or sulfonylureas.

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13
Q

Indications for SGLT-2 inhibitors?

A

1) T2DM:
- monotherapy if metformin inappropriate
- in combination with insulin or other antidiabetic drugs

2) Symptomatic HF (empagliflozin and dapagliflozin)

3) CKD (dapagliflozin)

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14
Q

Impact of SGLT-2 inhibitors on the heart?

A

Reduce the risk of CVS disease.

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15
Q

Which SGLT-2 inhibitor is licensed for use in CKD?

A

Dapagliflozin

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16
Q

Which SGLT-2 inhibitor is licensed for use in HF?

A

Empagliflozin and dapagliflozin

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17
Q

Notable side effects of SGLT-2 inhibitors?

A

1) Glycosuria (glucose in urine(

2) Increased urine output and frequency

3) Genital and urinary tract infections (e.g., thrush)

4) Weight loss

5) DKA (notably with only moderately raised glucose)

6) Lower-limb amputation may be more common in patients on canagliflozin (unclear if this applies to the others)

7) Fournier’s gangrene (rare but severe infection of the genitals or perineum)

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18
Q

Which diabetic drug can cause DKA?

A

SGLT-2 inhibitors - patients are counselled about the features of DKA and when to seek emergency medical input.

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19
Q

Which diabetic drug can increase the risk of lower limb amputation?

A

SGLT-2 inhibitors

20
Q

Do SGLT-2 inhibitors cause weight gain?

A

No - cause weight loss

21
Q

What class of drug is pioglitazone?

A

A thiazolidinedione

22
Q

Mechanism of pioglitazone?

A

1) increases insulin sensitivity

2) decreases liver production of glucose

23
Q

Does pioglitazone cause hypoglycaemia?

A

Not typically

24
Q

Notable side effects of pioglitazone?

A

1) weight gain

2) fluid retention

3) liver dysfunction

4) increased risk of bone fractures

5) a small increase in the risk of bladder cancer

6) visual impairment

25
Q

What is the most common sulfonylurea?

A

Gliclazide

26
Q

Mechanism of gliclazide?

A

Sulfonylureas stimulate insulin release from the pancreas.

27
Q

What are the 2 notable side effects of gliclazide?

A

1) weight gain and increased appetite
2) hypoglycaemia

28
Q

What are incretins?

A

Hormones produced by the GI tract that are secreted in response to a large meal.

29
Q

Role of incretins?

A

Act to reduce blood sugar by:

1) Increasing insulin secretion

2) Inhibiting glucagon production

3) Slowing absorption by the gastrointestinal tract

30
Q

What is the main incretin?

A

Glucagon-like peptide-1 (GLP-1).

31
Q

What are incretins inhibited by?

A

An enzyme called dipeptidyl peptidase-4 (DPP-4).

32
Q

Role of DPP-4 inhibitors in diabetes?

A

Block action of DPP-4 (usually inhibits incretin), allowing increased incretin activity (which works to reduce blood glucose).

33
Q

Give 2 examples of DPP-4 inhibitors

A

1) sitagliptin
2) alogliptin

34
Q

What are the 2 notable side effects of DPP-4 inhibitors (-gliptins)?

A

1) headaches
2) acute pancreatitis

35
Q

Which diabetic medication can cause acute pancreatitis?

A

DPP-4 inhibitors e.g. sitagliptin

36
Q

Role of GLP-1 mimetics in diabetes?

A

Mimic action of GLP-1 (incretin).

37
Q

Give 2 examples of GLP-1 mimetics

A

1) exanatide

2) liraglutide

38
Q

How are GLP-1 mimetics given?

A

SC injections

39
Q

Which GLP-1 mimetic may also be used for weight loss in non-diabetic obese patients?

A

Liraglutide

40
Q

What are the notable side effects of GLP-1 mimetics?

A

1) Reduced appetite

2) Weight loss

3) Gastrointestinal symptoms, including discomfort, nausea and diarrhoea

41
Q

Give the a) onset, b) peak and c) duration of rapid-acting insulins

A

a) 5 mins
b) 1 hour
c) 3-5 hours

42
Q

Give the a) onset, b) peak and c) duration of short-acting insulins

A

a) 30 mins
b) 3 hours
c) 6-8 hours

43
Q

Give the a) onset and b) duration of long-acting insulins

A

a) 1-2 hours
b) up to 24 hours

44
Q

Give 2 examples of rapid acting insulins

A

NovoRapid, Humalog

45
Q

Which diabetic drug is associated with fractures?

A

Pioglitazone

46
Q
A

Yr 4 - Drugs (8 decks)

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