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Y2 Endocrine > Diabetes Medication > Flashcards

Diabetes Medication Flashcards

1
Q

what are the two types of incretin drugs?

A

DDP4 inhibitors

GLP-1 receptor agonists

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2
Q

describe the incretin effect

A

when glucose is consumed orally, higher insulin levels are seen than when given IV

shows something else contributing to insulin levels= incretins

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3
Q

when is the incretin effect lost?

A

early in type 2 diabetes

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4
Q

what do incretins cause?

A

intestinal secretion of insulin

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5
Q

what are the two types of incretin peptides?

A

GIP

GLP-1

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6
Q

what breaks down incretin peptides?

A

the enzyme DPP-4

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7
Q

how are incretin peptides cleared from the body?

A

converted into inactive metabolites

cleared by the kidneys

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8
Q

name two DPP-4 inhibitors

A

sitagliptin

alogliptin

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9
Q

how do DPP-4 inhibitors work?

A

inhibit the breakdown of GLP1 and GIP

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10
Q

do DPP-4 inhibitors carry a risk of hypoglycaemia?

A

no

they are glucose dependent

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11
Q

how well do DPP-4 inhibitors lower BG?

A

weak

5-8mmol/mol HbA1c reduction

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12
Q

what effect do DPP-4 inhibitors have on weight?

A

none

they are weight neutral

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13
Q

what are the side effects of DPP-4 inhibitors?

A

generally very well tolerated

slight increased risk of pancreatitis

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14
Q

how do GLP-1 receptor agonists work?

A

modify the shape of the GLP-1 molecule receptor to avoid breakdown by DPP-4

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15
Q

do GLP-1 receptor agonists carry a risk of hypoglycaemia?

A

no

they are glucose dependent

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16
Q

what do GLP-1 receptor agonists also lower?

A

glucagon levels

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17
Q

what effects do GLP-1 receptor agonists have on other tissues?

A

hypothalamus - reduce appetite

intestines - reduce gastric emptying

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18
Q

how well to GLP-1 receptor agonists reduce BG?

A

potent

HbA1c reduction of 11-15mmol/mol

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19
Q

what effect do GLP-1 receptor agonists have on weight?

A

weight loss of around 2-3kg

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20
Q

name two GLP-1 receptor agonists

A

liraglutide

semaglutide

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21
Q

what are the two possible side effects of GLP-1 receptor agonists?

A

N+V

increased risk of gallstones

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22
Q

although they don’t cause pancreatitis, what effect can GLP-1 receptor agonists have?

A

sustained increase in pancreatic lipase and amylase

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23
Q

what effect do GLP-1 receptor agonists have on heart disease?

A

reduce CV mortality

reduce risk of hospitalisation for heart failure

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24
Q

what type of drug is metformin?

A

a biguanide

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25
Q

what is the first line drug for type 2 diabetes?

A

metformin

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26
Q

what does metformin need to be taken up by cells and where are these found?

A

organic cation transporters (OCTs)

intestines, liver and kidneys

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27
Q

how is metformin excreted?

A

unchanged, by the kidneys

undergoes no metabolism

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28
Q

where is the main site of action of metformin?

A

the liver

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29
Q

what effect does metformin have in the liver?

A

lowers hepatic glucose production

30
Q

what effect does metformin have on the intestines?

A

increases glucose utilisation and metabolism

increases secretion of GLP-1

31
Q

what effect does metformin have on BG?

A

potent lowering of BG

lowers HbA1c by around 18mmol/mol

32
Q

what effect does metformin have on weight?

A

usually weight neutral

weight negative in some patients

33
Q

what is the usual dose of metformin?

A

50mg twice daily

34
Q

what is the max dose of metformin?

A

1g twice daily

35
Q

what are the two possible side effects of metformin use?

A

GI intolerance

metformin associated lactic acidosis (MALA)

36
Q

how can the side effects of metformin be reduced?

A

initiate the drug slowly

give as a modified release formulation

37
Q

what are the two glucose transporters found in the renal tubule?

A

SGLT2

SGLT1

38
Q

what happens to the renal glucose transporters in diabetes?

A

they become overwhelmed

glucose is not reabsorbed into the blood, all peed out

39
Q

what is glycosuria?

A

glucose in urine

40
Q

what effect do SGLT2 inhibitors have on the kidneys?

A

decrease glucose uptake

means some glucose passes straight through and leaves in urine = decreases blood glucose

41
Q

what effect do SGLT2 inhibitors have on weight?

A

weight negative

42
Q

besides lowering BG, what two effects do SGLT2 inhibitors have?

A

diuretic effect

increased urate excretion

43
Q

what do SGLT2 inhibitors provide?

A

some renal protection

44
Q

what effect do SGLT2 inhibitors have on blood glucose?

A

moderately lower it

HbA1c reduction of around 11 mmol/mol

45
Q

what does the glucose lowering effect of SGLT2 inhibitors rely in?

A

the patients GFR

no benefit if <45

46
Q

name three SGLT2 inhibitors?

A

dapagliflozin
canagliflozin
empagliflozin

47
Q

name four side possible side effects of SGLT2 inhibitors

A

thrush
gangrene
hypovolemia and hypotension
increased risk of DKA

48
Q

when should SGLT2 inhibitors be omitted and why?

A

prolonged fasting or acute illness

due to risks of hypovolaemia and DKA

49
Q

what does TZD stand for?

A

thiazolidinediones

50
Q

what type of drugs are TZDs?

A

PPARy ligands

51
Q

how do TZDs work?

A

bind and activate the transcription factor PPARy, regulating genes

52
Q

what do TZDs mainly affect?

A

adipocytes

53
Q

what effect do TZDs have on the fat stores of the body?

A

move fat from bad places (around organs) to the subcutaneous area where it is healthier to be

54
Q

what effect do TZDs have on adipocytes?

A

cause them to mature and release adiponectin

55
Q

what is adiponectin?

A

an insulin sensitizing peptide

56
Q

what does adiponectin do?

A

increases insulin sensitivity of the liver

57
Q

what are TZDs also called?

A

glitazones

58
Q

what effect do TZDs have on BG?

A

potent

15-20mmol/mol reduction

59
Q

who are TZDs most potent in?

A

obese women

60
Q

what effect do TZDs have on weight?

A

increases weight

61
Q

what is the available TZD?

A

pioglitazone

62
Q

what is the given dose of pioglitazone?

A

15-30mg once daily

63
Q

what are the two possible side effects of TZDs?

A

fluid retention

fracture risk

64
Q

name four commonly used sulphonylureas

A

gliclazide
glipizide
glimepiride
glibenclamide

65
Q

what is the action of sulphonylureas?

A

act on pancreatic beta cells to increase insulin secretion

66
Q

is there a risk of hypoglycaemia with sulphonylureas?

A

YES

they are glucose independent - so cause insulin secretion even when not needed

67
Q

what effect do sulfonylureas have on BG?

A

potent glucose lowering

reduce HbA1c by around 18mmol/mol

68
Q

what effect do sulphonylureas have on weight?

A

increase by around 1-2kg

69
Q

what is the most common sulphonylurea in the UK?

A

gliclazide

70
Q

what is the starting dose of a sulphonylurea?

A

40-80mg once daily

71
Q

what is the max dose of a sulphonylurea?

A

160mg bd

Y2 Endocrine (33 decks)

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