Diabetes Drugs Flashcards
What is the MOA of metformin?
Activates AMP dependent protein kinase (hepatically)
Reduces glucogenic processes
Increases insulin action
Increases glucose uptake, inhibits hepatic GNG and carb absorption
What are ADRs of Metformin?
Abdominal pain and bloating
Diarrhoea
Anorexia
B12 deficiency
When is Metformin contraindicated?
Renal impairment - CKD3
Can provoke lactic acidosis
What are important things that Metformin does NOT do?
Does not induce hypoglycaemia
Does not promote weight gain
What are examples of Sulphonylureas?
Gliclazide
What is the MOA of Gliclazide?
Enhances secretion of insulin in the pancreas
Blocks B cell K+ effluxer channels
Depolarisation
Ca2+ influx and IP3 mediated insulin secretion
What are ADRs of Gliclazide?
Hypoglycaemia
Rarely can cause haematological disorders
Weight gain
When is Gliclazide contraindicated?
Severe hepatic impairment
Renal impairment
Be careful when pregnant
What is the problem with Sulphonylureas?
Need good B cell mass
Goof for few years then after 3years, begins to wear off
How do DDP4 inhibitors work?
Increase the incretin effect by blocking DDP4 receptors
What is an example of a DDP4 inhibitor?
Saxagliptin?
What is the MOA of Saxagliptin?
Inhibits DDP4
Increases half life of incretin and this increases insulin secretion
What are points to note about DDP4 inhibitors?
2nd line
Moderate effect of decreasing blood sugars and keep weight neutral
Only good if insulin secretion is preserved
What are ADRs of Saxagliptin?
Dizziness Dyspepsia Headache Fatigue Gastritis and gastroenteritis Hypoglycaemia
When is Saxagliptin contraindicated?
Severe hepatic impairment
Sensitivity
What is Exenatide?
Injectable
Analogue of GLP-1 s increases incretin effect
Long acting
Promotes insulin release (decreasing glucagon), reduces appetite and delays gastric emptying
Weight loss and decrease in blood sugars
What are ADRs of Exenatide?
Hypoglycaemia
Injection site reactions
Weight loss
Abdominal pain
When is Exenatide contraindicated?
Ketoacidosis
Severe GI pathologies
What are Thiazolidinediones?
Reduce insulin resistance by interaction with PPAR-y
Regulates many genes
Decreases hepatic GNG, increases glucose uptake and increases insulin effect
What is an example of a Thiazolidinedione?
Pioglitazone
What are ADRs of Pioglitazone?
Weight gain
Fluid retention
Heart failure
