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4TH YEAR - CPTP > Diabetes/Lipid Disorders > Flashcards

Diabetes/Lipid Disorders Flashcards

1
Q

How do biguanides work?

A

Inhibit hepatic gluconeogenesis by increasing AMPK activity

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2
Q

Give an example of a biguanide

A

Metformin

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3
Q

What are the advantages and disadvantaged of metformin?

A

ADV: Weight loss, low cost, long track record
DISADV: GI side effects

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4
Q

In which cases can metformin cause lactic acidosis?

A
  • Renal impairment
  • Heart failure
  • Liver disease
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5
Q

How is metformin administered?

A

Give with meals 2/3x a day

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6
Q

How do sulphonylureas work?

A

Increase insulin secretion by binding to and depolarising beta cell

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7
Q

Give an example of a sulphonylurea

A

Gliclazide

Glimepiride

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8
Q

What are the advantages and disadvantages of sulphonylureas?

A

ADV: low cost, long track record
DISADV: weight gain, risk of hypoglycaemia

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9
Q

How are sulphonylureas administered?

A

Give with meals 2/3x a day

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10
Q

How do thiazolidinodiones work?

A

Enhance lipogenesis and decrease lipolysis by altering gene transcription

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11
Q

Give an example of a thiazo

A

Pioglitazone

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12
Q

What are the advantages and disadvantages of thiazos?

A

ADV: ‘insulin sensitizers’ - improve beta cell function
DISADV: weight gain!!!!!!! fluid retention, fracture risk

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13
Q

How do SGLT2 inhibitors work?

A

Prevent renal glucose reabsorption by inhibiting SGLT2 in proximal tubule

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14
Q

Give an example of an SGLT2 inhibitor

A

Gliflozin

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15
Q

What are the advantages and disadvantages of gliflozin?

A

ADV: weight loss, reduced risk of diabetic nephropathy
DISADV: UTI (from glucose), costly

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16
Q

How do DDP-IV inhibitors work?

A

Inhibition of enzyme that breaks down GLP-1 (an incretin)

17
Q

Give an example of a DDP-IV inhibitor

A

-gliptin

18
Q

What are the advantages and disadvantages of DDPIV inhibitors?

A

ADV: oral, use in renal disease
DISADV: uncertain long term effects, costly

19
Q

How do GLP-1 mimetics work?

A

More potent synthetic form of endogenous GLP-1 which has the following effects:

  • Promotes satiety
  • Reduces hepatic glucose output
  • Slows rate of gastric emptying
  • Enhances insulin secretion
  • Suppresses glucagon secretion
20
Q

Give an example of a GLP-1 mimetic

A

Exenatide

21
Q

What are the advantages and disadvantages of GLP-1 mimetics?

A

ADV: weight loss, no hypos
DISADV: SC injection, GI, costly

22
Q

What are the 3 insulin regimens?

A
  1. Mealtime - rapid acting
  2. Basal-bolus - rapid acting at meals + one long acting
  3. Mixed
23
Q

Name 2 rapid acting insulins

A

Humalog, Novorapid

24
Q

Name 2 long acting insulins

A

Glargine, Detenir

25
Q

How does an insulin pump work? (CSII)

A

Gives a constant infusion of rapid-acting insulin analogue at basal rate with meal time boluses

26
Q

What is the main risk of insulin pumps?

A

Increased risk of DKA

27
Q

Why do diabetic patients often take lipid lowering drugs?

A

Increased risk of CVD - especially effective in people over 40

28
Q

How do statins work?

A

Inhibit HMG-CoA reductase, an enzyme involved in cholesterol synthesis. This stimulates upregulation of LDL receptor in the liver so that less LDL is in the bloodstream.

29
Q

Give an example of a statin

A

Atorvastatin

Simvastatin

30
Q

What are the side effects of statins?

A
  • Hepatic injury (monitor LFTs)
  • Myalgia/myositis (monitor CK)
  • Peripheral neuropathy
31
Q

Which drugs do statins interact with?

A
  • Antibiotics (replace statins with fibrates when on abx)
  • Antihypertensives (CCBs)
  • Grapefruit

These are all CYP3A4 inhibitors so cause increased levels of statin

32
Q

How do fibrates work?

A

Activate PPARa receptors to facilitate lipid metabolism

Much less effective than statins

33
Q

What are the side effects of fibrates?

A

Same as statins

34
Q

How does ezelimibe work, and when is it indicated?

A

Inhibits NPC1L1 to reduce cholesterol production, used in secondary prevention in combo with statins

35
Q

How do PCSK9 inhibitors work?

A

Monoclonal IgG abs promote intracellular degradation of LDL

36
Q

What is the therapeutic algorithm for diabetes? treatment

A
  1. Conservative
  2. Metformin
  3. Sulphonylurea
  4. Others
  5. Insulin
37
Q

What drug could give you a CK in the 1000s?

A

Statins - due to myositis (5% of pts on statin have a raised CK)

38
Q

How is diabetes diagnosed in a symptomatic patient?

A

Fasting glucose >7
Random glucose>11

Only one reading required

39
Q

How is diabetes diagnosed in an asymptomatic patient?

A

Fasting glucose>7
Random glucose>11

Two readings required

4TH YEAR - CPTP (19 decks)

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