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Abs Endo > Diabetes Drugs > Flashcards

Diabetes Drugs Flashcards

1
Q

example of biguanide

A

metformin

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2
Q

first line treatment

A

metformin

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3
Q

mechanism of action of metformin

A

reduce gluconeogenesis
suppress hepatic glucose output
increase fatty acid oxidation
increase insulin sensitivity

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4
Q

benefits of metformin

A

manages hyperglycaemia
does not cause hypoglycaemia
weight neutral
reduces triglycerides and LDL

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5
Q

complications prevented by metformin

A

microvascular

macrovascular

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6
Q

is metformin safe in pregnancy

A

yes

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7
Q

other conditions which may benefit from metformin therapy

A

PCOS

NAFLD

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8
Q

adverse effects of metformin

A

GI upset
interferes with B12 and folic acid absorption
lactic acidosis

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9
Q

when is lactic acidosis more likely

A

existing renal or hepatic disease

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10
Q

2nd line treatment

A

sulphonylureas

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11
Q

examples of first gen SUs

A

tolbutamide

chlorpropramide

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12
Q

examples of second gen SUs

A

gliclazide
glipizide
glibencamide
glimepride

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13
Q

mechanism of action of SUs

A

close ATP sensitive K+ channels on B cells

promotes Ca2+ influx which signals insulin release

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14
Q

benefits of SUs

A

manages hyperglycaemia

more rapid reduction in hyperglycaemia than insulin sensitisers

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15
Q

adverse effects of SUs

A 
hypoglycaemia 
weight gain 
GI upset 
headache 
avoid in severe renal or hepatic failure
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16
Q

example of thiazolidinediones

A

pioglitazone

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17
Q

mechanism of action of pioglitazone

A

lipophilic so enters cells and binds to PPARy
PPARy complexed with RXR
transcription modulator binds to DNA to promote expression of genes encoding proteins involved in insulin signalling
promote fatty acid uptake in adipocytes
reduce hepatic glucose output
increase insulin sensitivity

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18
Q

benefits of TZDs

A

manages hyperglycaemia

no hypoglycaemia

19
Q

complications prevented by SUs

A

microvascular

20
Q

adverse effects of TZDs

A

weight gain

increased risk of hip fracture (osteoporosis)

21
Q

contraindications to TZDs

A

heart failure

osteoporosis

22
Q

complications prevented by TZDs

A

macrovascular

23
Q

what do incretin hormones do

A

control the effect sugar has on the GI tract
slow gastric emptying to increase satiety
stimulate insulin secretion
reduce hepatic glucose output
decrease glucagon production
make beta cell more sensitive to glucose

24
Q

2 therapies based on incretins

A

GLP 1 receptor agonists

DPP 4 inhibitors

25
Q

examples of GLP 1 agonists

A

exenatide
liraglutide
lixisenatide

26
Q

mechanism of action of GLP 1 agonists

A

mimic action of GLP 1
bind to GPCR which increase intracellular cAMP concentration
acts as incretin hormones do
reduce hepatic fat accumulation

27
Q

benefits of GLP 1 agonists

A

promote insulin secretion from pancreas without hypoglycaemia
modest weight loss
reduce appetite

28
Q

adverse effects of GLP 1 agonists

A

nausea

pancreatitis

29
Q

examples of DPP 4 inhibitors

A

sitagliptin
vildagliptin
saxagliptin
linagliptin

30
Q

mechanism of action of DPP 4 inhibitors

A

also manipulate the incretin pathway but less potent than GLP 1 agonists
inhibits enzyme DPP4, thus prolonging the actions of GLP1 and GIP

31
Q

benefits of DPP4 inhibitors

A

promote insulin secretion without hypoglycaemia
weight neutral
limited side effects as not that potent

32
Q

side effects of DPP4 inhibitors

A

rarely pancreatitis

33
Q

examples of SGLT2 inhibitors

A

dapagliflozin

34
Q

mechanism of action of SGLT2 inhibitors

A

selectively block reabsorption of glucose by SGLT2 in the proximal tubule of the kidney nephron to deliberately cause glycosuria

35
Q

benefits of SGLT2 inhibitors

A

weight loss
no hypoglycaemia
cardiovascular benefit

36
Q

adverse effects of SGLT 2 inhibitors

A

sugar in urine creates ideal conditions for bacterial or fungal overgrowth so thrush is a side effect

37
Q

examples of alpha-glucosidase inhibitors

A

acarbose

38
Q

mechanism of action of acarbose

A

delay absorption of glucose thus reducing postprandial increase in blood glucose
stops the enzyme which mediates the final step in carbohydrate digestion

39
Q

benefits of acarbose

A

no risk of hypoglycaemia

40
Q

adverse effects of acarbose

A

abdominal discomfort, flatulence, diarrhoea

41
Q

drugs which increase secretion of insulin

action is insulin dependent

A

SUs
incretin mimetics
glinides
DPP4 inhibitors

42
Q

drugs which decrease insulin resistance and reduce hepatic glucose output
action is insulin dependent

A

biguanides

TZDs

43
Q

drugs which slow glucose absorption from the GI tract

action is insulin independent

A

alpha-glucosidase inhibitors

44
Q

drugs which enhance glucose excretion by kidneys

action is insulin independent

A

SGLT2 inhibitors

Abs Endo (8 decks)

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