Diabetes drugs Flashcards

1
Q

What is the first line management for type 2 diabetes?

A

Metformin

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2
Q

What class of drugs in metformin?

A

Biguanide

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3
Q

Mechanism of action of metformin

A

Reduces hepatic gluconeogenesis by stimulating AMPK
Increase glucose uptake by skeletal muscle
Reduces carboydrate reabsorption
Increases fatty acid oxidation

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4
Q

Side effects of metformin

A

GI upset (start low go slow)
Rarely lactic acidosis
Liver failure
Rash

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5
Q

What is the second line management in type 2 diabetes?

A

Suplhonylureas

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6
Q

Example of sulphonylurea

A

Tolbutamide
Glipizide
Glibendamide

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7
Q

What is the mechanism of action of sulphonylureas?

A

Displace ADP-Mg2+ from the SUR1

Thus closing the Katp channel and stimulating insulin release

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8
Q

Side effects of suplhonylureas

A

Hypo

Weight gain

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9
Q

Who is at most risk of hypo with sulphonylureas?

A

Longer acting agents
Elderly
Reduced hepatic/renal function

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10
Q

What can suplhonylureas be used in conjunction with?

A

Metformin or TZDs

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11
Q

Example of glinides

A

Repaglinide

Nateglinide

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12
Q

How do glinides work?

A

Bind to SUR1 to close Katp channel & stimulate insulin release

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13
Q

Which are glinides less likely then sulphonylureas to cause hypo?

A

Rapid onset

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14
Q

Example of incretin analogue?

A

Extenatide

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15
Q

Mechanism of action of incretin analogues

A

Mimic action og GLP-1 but are longer lasting
Bind to GPCR GLP-1 that increase intracellular cAMP
Causes increase insulin, decreased glucagon, decreased gastric emptying, decreased appetite

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16
Q

Pros of incretin analogues

A

Weight loss

Reduced heaptic fat accumulation

17
Q

How are incretin analogues adinisered?

A

2x daily SC injection

18
Q

Side effects of incretin analogues

A

Nausea
Hypo
Pancreatitis

19
Q

Example of DPPA inhibitor

A

Sitagliptin

20
Q

Mechanism of action of DPP4 inhibitors

A

Rapily terminates actions og GIP + GLP

21
Q

Mechanism of action of TZDs

A

Enhance action og glucose at target site (reduce amount needed to maintain BG)
PPARy-RXR complex binds to DNA to repress genes
Promotes fatty acid uptake and storage in adipocytes rather than skeletal muscle & liver

22
Q

Side effect of TZDs?

A

Weight gain
Fluid retention (don’t use in HF)
Hepatotoxicity
Increased bone fractures (don’t use in osteoperosis)

23
Q

Mechanism of action of SGLT2 inhibitors

A

Selectively block reabsorption of glucose in kidneys to deliberately cause glucosuria

24
Q

Example of SGLT2 inhibitor

A

Dapaglifozin

25
Q

Side effects of SGLT2 inhibitors

A

Thrush

UTI

26
Q

What is a-glucosidase?

A

Brush border enzyme that breaks down starch + dissacharides to absorbable glucose

27
Q

Mechanism of action of a-glucosidase inhibitors?

A

Delay absorption of glucose thus reducing postpradndial increase in BG

28
Q

Side effect of a-glucosidase inhibitors

A

GI - flatulence, loos stools, bloating

29
Q

Example of a-glucosidase inhibitor

A

Acarbose