Diabetes drugs Flashcards
What is the first line management for type 2 diabetes?
Metformin
What class of drugs in metformin?
Biguanide
Mechanism of action of metformin
Reduces hepatic gluconeogenesis by stimulating AMPK
Increase glucose uptake by skeletal muscle
Reduces carboydrate reabsorption
Increases fatty acid oxidation
Side effects of metformin
GI upset (start low go slow)
Rarely lactic acidosis
Liver failure
Rash
What is the second line management in type 2 diabetes?
Suplhonylureas
Example of sulphonylurea
Tolbutamide
Glipizide
Glibendamide
What is the mechanism of action of sulphonylureas?
Displace ADP-Mg2+ from the SUR1
Thus closing the Katp channel and stimulating insulin release
Side effects of suplhonylureas
Hypo
Weight gain
Who is at most risk of hypo with sulphonylureas?
Longer acting agents
Elderly
Reduced hepatic/renal function
What can suplhonylureas be used in conjunction with?
Metformin or TZDs
Example of glinides
Repaglinide
Nateglinide
How do glinides work?
Bind to SUR1 to close Katp channel & stimulate insulin release
Which are glinides less likely then sulphonylureas to cause hypo?
Rapid onset
Example of incretin analogue?
Extenatide
Mechanism of action of incretin analogues
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