Diabetes Drugs Flashcards
Name a biguanide
Metformin
How do biguanides work
Reduces hepatic gluconeogenesis by stimulating AMP-activated protein kinase (AMPK)
What is the first line drug in T2DM normally
Metformin
What is the first line drug in T2DM if there are osmotic symptoms present
Sulphonylurea (Gliclazide)
Does Metformin prevent Micro or Macro -vascular complications
Macro and Micro
What effect does Metformin have on weight
Metformin causes weight loss
Is there a risk of hypoglycaemia with Metformin
No
What GI symptoms can Metformin cause
Diarrhoea, nausea, anorexia
Which T2DM drug can rarely cause lactic acidosis
Metformin
Is Metformin insulin dependent or independent
Insulin-independent
Which drug Increases glucose uptake and utilization by skeletal muscle
Metformin
Is Metformin safe during pregnancy
Yes
What are the contraindications to prescribing Metformin
If eGFR < 30 or serum creatinine > 150
What is a first generation sulphonylurea
Tolbutamide
What are some 2nd generation sulphonylurea’s
Glicazide
Glibenclamide
Glimepiride
How do Sulphonylureas work
Bind to SUR1 subunits (displacing ADP-MG) to close the KATP channel causing depolarisation -> insulin release
Do Sulphonylureas prevent Micro or Macro -vascular complications
Micro only
What effect doe Sulphonylureas have on weight
Weight Gain
Is there a risk of hypoglycaemia with Sulphonylureas
Yes
What are some side effects of Sulphonylureas
GI symptoms A headache Hypersensitivity Blood dyscrasias Liver dysfunction
Are Sulphonylureas insulin dependent or independent
Insulin Dependent
What are the contraindications to prescribing Sulphonylureas
Avoid in severe renal or hepatic failure
What type of drug is Pioglitazone
TZD (Thiazolidinedione)
How do TZD’s work
Exogenous agonists of nuclear receptor PPARY (largely confined to adipocytes)
Decrease insulin resistance and reduce hepatic glucose output
Do TZD’s prevent Micro or Macro -vascular complications
Neither
Do TZD’s cause weight gain or loss
Weight Gain
What are some side effects of TZD’s
Fluid Retention
Hepatotoxicity
Is there a risk of Hypoglycaemia with TZD’s
No
Are TZD’s insulin dependent or independent
Insulin-dependent
What are the contraindications to prescribing TZD’s
Avoid in over 65’s due to bone risk
Avoid in heart failure patients due to fluid retention
Give an example of an SGLT2 Inhibitor
Dapagliflozin
How do SLGT2i’s work
Selectively block reabsorption of glucose by SGLT2 in proximal tubule of kidney _> deliberately causes glucosuria
Is there a risk of hypoglycaemia with SGLT2i’s
Yes, very low risk
Do SGLT2i’s cause weight gain or loss
Weight loss (calorific and osmotic diuresis effect)
What are some side effects of SGLT2i’s
Thrush
Urine Infections
Are SGLT2i’s insulin dependent or independent
Insulin-Independent
Are there any contra-indications to prescribing SGLT2i’s
No
Give examples of GLP-1 receptor agonist
Exenatide
Liraglutide
How do GLP-1 receptor agonists work
Binds to GPCR GLP-1 receptors that increase intracellular cAMP of the pancreatic B cell
Do GLP1 receptor antagonists cause weight loss or gain
Weight loss and reduces hepatic fat accumulation
Is there a risk of hypoglycaemia with GLP-1 agonists
Yes
Are GLP-1 antagonists insulin dependent or independent
Insulin-dependent
Give some examples of DPP-IV inhibitors
“-Gliptins”
Sitagliptin
Saxigliptin
Vildagliptin
How do DPP-IV inhibitors work
Competitively inhibit DPP-4 to prolong the action of GLP-1 and GIP
What effect do DPP-IV inhibitors have on weight
Weight Neutral
Is there a risk of hypoglycaemia with DPP-IV inhibitors
Yes
Give some side effects of DPP-IV inhibitors
Nausea
Pancreatitis
Pancreatic Cancer
Are DPP-IV inhibitors insulin dependent
Yes
Give an example of an a-glucosidase inhibitor
Acarbose
How do a-glucosidase inhibitors work
Inhibit a-glucosidase (a brush border enzyme that breaks down starch and disaccharides to absorbable glucose)
Is there a risk of hypoglycaemia with a-glucosidase inhibitors
No
What are some side effects of a-glucosidase inhibitors
flatulence, loose stool, diarrhoea, abdo pain, bloating
Are a-glucosidase inhibitors insulin dependent
No, they are insulin independent
If a patient is suffering from hypo’s when on a sulphonylurea, what type of drug can they be switched to
Glinides (meglitinides)
Give some examples of Glinides (meglitinides)
Repaglinide
Nateglinide
How do Glinides work
Bind to SUR1 (at a distinct benzamido site) to close the KATP channel causing depolarisation –> insulin release
Is there a risk of Hypoglycaemia with Glinides
Yes but less likely to cause hypoglycaemia than SU’s as have rapid onset/offset kinetics
Are Glinides insulin dependent
Yes
What are the side effects of GLP-1 receptor agonists
Nausea
Pancreatitis
Pancreatic cancer