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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
what is the first line drug for type 2 diabetes?
metformin
26
what does metformin need to be taken up by cells and where are these found?
organic cation transporters (OCTs) intestines, liver and kidneys
27
how is metformin excreted?
unchanged, by the kidneys undergoes no metabolism
28
where is the main site of action of metformin?
the liver
29
what effect does metformin have in the liver?
lowers hepatic glucose production
30
what effect does metformin have on the intestines?
increases glucose utilisation and metabolism increases secretion of GLP-1
31
what effect does metformin have on BG?
potent lowering of BG lowers HbA1c by around 18mmol/mol
32
what effect does metformin have on weight?
usually weight neutral weight negative in some patients
33
what is the usual dose of metformin?
50mg twice daily
34
what is the max dose of metformin?
1g twice daily
35
what are the two possible side effects of metformin use?
GI intolerance | metformin associated lactic acidosis (MALA)
36
how can the side effects of metformin be reduced?
initiate the drug slowly give as a modified release formulation
37
what are the two glucose transporters found in the renal tubule?
SGLT2 | SGLT1
38
what happens to the renal glucose transporters in diabetes?
they become overwhelmed glucose is not reabsorbed into the blood, all peed out
39
what is glycosuria?
glucose in urine
40
what effect do SGLT2 inhibitors have on the kidneys?
decrease glucose uptake means some glucose passes straight through and leaves in urine = decreases blood glucose
41
what effect do SGLT2 inhibitors have on weight?
weight negative
42
besides lowering BG, what two effects do SGLT2 inhibitors have?
diuretic effect | increased urate excretion
43
what do SGLT2 inhibitors provide?
some renal protection
44
what effect do SGLT2 inhibitors have on blood glucose?
moderately lower it HbA1c reduction of around 11 mmol/mol
45
what does the glucose lowering effect of SGLT2 inhibitors rely in?
the patients GFR no benefit if <45
46
name three SGLT2 inhibitors?
dapagliflozin canagliflozin empagliflozin
47
name four side possible side effects of SGLT2 inhibitors
thrush gangrene hypovolemia and hypotension increased risk of DKA
48
when should SGLT2 inhibitors be omitted and why?
prolonged fasting or acute illness due to risks of hypovolaemia and DKA
49
what does TZD stand for?
thiazolidinediones
50
what type of drugs are TZDs?
PPARy ligands
51
how do TZDs work?
bind and activate the transcription factor PPARy, regulating genes
52
what do TZDs mainly affect?
adipocytes
53
what effect do TZDs have on the fat stores of the body?
move fat from bad places (around organs) to the subcutaneous area where it is healthier to be
54
what effect do TZDs have on adipocytes?
cause them to mature and release adiponectin
55
what is adiponectin?
an insulin sensitizing peptide
56
what does adiponectin do?
increases insulin sensitivity of the liver
57
what are TZDs also called?
glitazones
58
what effect do TZDs have on BG?
potent 15-20mmol/mol reduction
59
who are TZDs most potent in?
obese women
60
what effect do TZDs have on weight?
increases weight
61
what is the available TZD?
pioglitazone
62
what is the given dose of pioglitazone?
15-30mg once daily
63
what are the two possible side effects of TZDs?
fluid retention | fracture risk
64
name four commonly used sulphonylureas
gliclazide glipizide glimepiride glibenclamide
65
what is the action of sulphonylureas?
act on pancreatic beta cells to increase insulin secretion
66
is there a risk of hypoglycaemia with sulphonylureas?
YES they are glucose independent - so cause insulin secretion even when not needed
67
what effect do sulfonylureas have on BG?
potent glucose lowering reduce HbA1c by around 18mmol/mol
68
what effect do sulphonylureas have on weight?
increase by around 1-2kg
69
what is the most common sulphonylurea in the UK?
gliclazide
70
what is the starting dose of a sulphonylurea?
40-80mg once daily
71
what is the max dose of a sulphonylurea?
160mg bd

Y2 Endocrine (33 decks)

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