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Endocrinology and Gastrointestinal Pharamacology > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What are four oral hypoglycaemic agents?

A

Thiazolidnediones
Sulfonylureas
Alpha glucosidase inhibitors
Metformin

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2
Q

What are Thiazolidinediones?

A

Drugs that enhance insulin action in peripheral tissues

Drugs that suppress endogenous glucose production

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3
Q

What are sulfonylureas?

A

Drugs that enhance endogenous insulin secretion

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4
Q

What are alpha glucosidase inhibitors?

A

Drugs that delay the absorption of carbohydrate from the GI tract

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5
Q

What are Metformin?

A

Drugs that suppress endogenous glucose production

Drugs that enhance insulin action in peripheral tissues

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6
Q

Give a example of a Metformin?

A

Biguanide

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7
Q

What does Metformin do?

A

↑ Glucose uptake & utilization in skeletal muscle • ↓Hepatic gluconeogenesis • ↓ LDL & VLDL

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8
Q

Give one benefit of Metformin?

A

Food for weight loss and does not stimulate appetite

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9
Q

Give a side effect of Metformin?

A

Causes GI disturbance

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10
Q

Give three example of sulphonylureas?

A

Tolbutamide, Glibenclamide, Glipizide

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11
Q

What does sulphonylureas do?

A

Stimulate insulin secretion from β cell

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12
Q

What are side effects of sulphonylureas?

A

Hypoglycaemia

Appetite stimulation

Drug interactions: NSAID’s, alcohol, MAOI’s & antibiotics & antifungals augment hypoglcaemia

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13
Q

What does Thiazolidinediones (Glitazones) do?

A

Enhance the effectiveness of endogenous insulin

↓ Hepatic glucose output

↑ Glucose uptake into muscle

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14
Q

What are physiological effects of Thiazolidinediones (Glitazones)?

A

↓ Blood glucose

↓ circulating insulin

↓ FFA’s & Triglycerides

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15
Q

What is the mechanism of Thiazolidinediones (Glitazones)?

A

Activate the nuclear receptor Peroxisome Proliferator Activated Receptor γ (PPAR-gamma)

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16
Q

What are side effects of Thiazolidinediones (Glitazones)?

A

Weight gain (1-4 kg)

Monitor for liver tox

Heart failure risk (!)

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17
Q

Give a example of a α-Glucosidase Inhibitor?

A

Acarbose

18
Q

What does α-Glucosidase Inhibitor do?

A

Delays carbohydrate absorption

↓ Postprandial rise in plasma glucose

19
Q

What are side effects of α-Glucosidase Inhibitors?

A

GI disturbance: diarrhoea, flatus, pain & bloating

20
Q

What are incretins?

A

Metabolic hormones (peptides) that increase insulin response before the postprandial rise in glucose signal boosts insulin

21
Q

What do Incretins do?

A

They also slow the rate of absorption of nutrients into the blood stream by reducing gastric emptying and may directly reduce food intake.

22
Q

Give a example of a incretin

A

Glucagon-Like peptide 1 agonist

23
Q

What do Dipeptidyl Peptidase 4 Inhibitors do?

A

Increase incretins (GLP1 & GIP), so inhibit glucagon release • Increase insulin secretion • Decrease gastric emptying • Decrease blood glucose

24
Q

Give a example of a Dipeptidyl Peptidase 4 Inhibitor?

A

Sitagliptin

25
Q

What is atherosclerosis?

A

The formation of lipid deposits in the tunica media associated with damage to the endothelial lining

26
Q

Why is HDL good?

A

HDL accepts cholesterol from cells

HDL also accepts cholesterol from lipoproteins that have lost triglycerides

Cholesterylesters are returned to liver

27
Q

What are some lipid lowering drugs?

A

HMG CoA Reductase Inhibitors (statins)

Anion Exchange Resins
– Colestyramine
– Colestipol

Nicotinic Acid

Fibrates
– Gemfibrozil
– Bezafibrate

Inhibitors of Intestinal Cholesterol Absorption
– Ezetimibe

28
Q

What are statins?

A

3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors

29
Q

What do statins?

A

Decrease hepatic cholesterol synthesis

Induces a compensatory increase in hepatic LDL receptors

↓ Plasma cholesterol

30
Q

Give a example of a statin?

A

Simvastatin

31
Q

What are the side effects of statins?

A

Generally low side effect profile

Myopathy (muscle weakness)

Do not give statins in pregnancy – Cholesterol essential for normal fetal development

32
Q

What does an ion exchange resins do?

A

Cause ↑ excretion of bile acids

More cholesterol converted to bile acids

↓ hepatocyte cholesterol causes compensatory ↑ in HMG CoA reductase activity

↑ LDL receptors

33
Q

What are adverse effects of an ion exchange resins?

A

GI disturbance
Resins not absorbed:
Cause bloating, flatulence, discomfort, diarrhoea & constipation

34
Q

What does nicotinic acid do?

A

Reduces release of VLDL

↓ Plasma triglycerides by 30-50 %

↓ Cholesterol by 10-20 %

35
Q

What do Fibrates do?

A

↓ in HDL (10%)

↓ in plasma triglycerides (30%)

Stimulate lipoprotein lipase activity

36
Q

What are Fibrates?

A

Ligands for nuclear transcription factor peroxisome proliferator-activated receptor alpha (PPAR- α ).

37
Q

What is the first line drug for patients with high triglyceride levels?

A

Fibrates

38
Q

What are adverse effects of Fibrates?

A

Myositis like syndrome (muscle effects)

Rhabdomyolysis

Higher incidence in patients with renal impairment & with combination therapies

39
Q

What is ezetimibe?

A

Inhibitor of intestinal cholesterol absorption

40
Q

What does eztimibe do?

A

Decreases LDL by 18%

41
Q

What has been shown to have cardio-protective effects?

A

Fish oils

Endocrinology and Gastrointestinal Pharamacology (7 decks)

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