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RBM2202 Pathophysiology and Pharmacology 2 > Diabetes Pharmacology > Flashcards

Diabetes Pharmacology Flashcards

1
Q

What is an OHA?

A

Oral Hypoglycaemic Agent.

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2
Q

What are the classes of OHAs?

A
  • Biguanides
  • Sulfonylureas
  • thiazolidinediones (TZD)
  • Alpha glucosidase Inhibitors
  • Incretin-enhancing drugs
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3
Q

What group does Metformin belong to?

A

Biguanides (1st line treatment)

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4
Q

How does Metformin work?

A
  • slows glucose absorption in the intestines
  • stops glucose production in the liver from lactate molecules
  • increase receptors in muscle and fat cells, this increases the uptake of glucose through enhanced insulin receptor binding.
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5
Q

What is metformin prescribed for?

A

TIIDM that is uncontrolled by lifestyle factors.

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6
Q

True/False: Metformin causes weight gain.

A

False

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7
Q

True/False: Metformin does NOT increase insulin secretion

A

True. So hypoglycaemia is rare with monotherapy.

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8
Q

Metformin affects Vit B12 absorption, what does this mean?

A

Anaemia - can effect brain and nerve function.

Baseline levels should be taken and rechecked periodically.

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9
Q

What is an uncommon, but potentially fatal adverse reaction to Metformin?

A

MALA - Metformin Associated Lactic Acidosis.

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10
Q

What are the risk factors for MALA?

A

Dehydration, alcohol consumption, renal/hepatic impairment, CVD, hypoxemia, elderly

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11
Q

What are the S/S of Acidosis?

A

headache, sleepiness, confusion, LOC, seizures, weakness, diarrhoea, SOB, cough, arrhythmias, tachycardia, N&V

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12
Q

Why should metformin dose be increased slowly?

A

To reduce GI upset.

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13
Q

How long does glucose control take when on Metformin?

A

up to 2 weeks. BGL should be monitored regularly.

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14
Q

If pt is having IV iodinated contrast, what drug should be withheld?

A

Metformin.

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15
Q

Severe renal disease is a contraindication for what OHAs?

A

Biguanide and SFU.

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16
Q

What class of drugs is the 2nd line OHA?

A

Sulfonylureas (SFU) The -ides

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17
Q

What are long acting SFU?

A

Glibenclamide

Glimepiride.

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18
Q

What are short acting SFU?

A

Gliclazide

Glipizide

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19
Q

What is the mode of action for SFU?

A

Stimulate B cells to release insulin.
Block glucose formation in the liver
Increase cellular sensitivity to insulin

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20
Q

SFU can result in weight _____

A

gain.

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21
Q

What are contraindications to SFU?

A

Renal impairment, allergy to other SFU - thiazide, loop diuretics, celecoxib.

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22
Q

True/False: Long acting SFU should not be given to those who are elderly or have renal/hepatic impairment.

A

True.

23
Q

When taking SFU what reduces the chance of a hypo?

A

Taking dose with food.

24
Q

SFU and TZD should be used with caution in those who are ____

A

obese.

25
Q

From what group of drugs is TZD?

A

OHA - Thiazolidinedione or ‘glitazones’ (-zones)

26
Q

What is Pioglitazone?

A

A TZD.

27
Q

What are TZD used for?

A

Those who do not tolerate metformin or SFU.

28
Q

What needs to be monitored when TZD is prescribed?

A

Weight gain (oedema), BGL, CVS, Hb, lipids, liver function.

29
Q

What OHA reduces the effectiveness of oral contraceptive?

A

TZD.

30
Q

What co-morbidities are contraindicated for TZD use?

A

obesity, CHF, HTN, family hx of bladder cancer

31
Q

What can be used when OHAs are not tolerated and if BGL remains high over meals despite OHA use?

A

Alpha-Glucosidase Inhibitors (Acarbose)

32
Q

How does Acarbose work?

A

blocks/slows breakdown of carbs from a meal (reduces postprandial rise of glucose)

33
Q

What drug must be taken with the first bite of food?

A

Acarbose

34
Q

If rescue for a hypo is needed when taking acarbose, what should be used?

A

Pure glucose.

35
Q

Adverse effects of Acarbose use?

A

Bloating, flatulence, abdominal pain.

36
Q

What are the contraindications for Acarbose?

A

Inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, chronic intestinal diseases.

37
Q

What are the 2 incretin-enhancing drugs?

A

GLP-1 analogue (exenatide) and DPP4 inhibitor (saxagliptin)

38
Q

What are the major concerns of GLP-1 analogues?

A

SC only - monitor site

Hx or acute pancreatitis.

39
Q

What are the major concerns of DPP4 inhibitors?

A

URTI

40
Q

What do incretin-enhancing drugs do?

A

Trigger the release of insulin when BGL is high.

41
Q

What are medications that INCREASE BGL?

A

Beta agonists, corticosteroids, thiazides diuretics, OC

42
Q

What are medications that DECREASE BGL?

A

beta-blockers, NSAIDs, ACEI, Alcohol

43
Q

Types of insulin and their duration.

A

Rapid (Aspart, Glulisine, lispro) 4hrs
Short (regular, neutral) 8hrs
Intermediate (NPH, isophane, protamine) 12+hr
Long (glargine, detemir) 24hr

44
Q

What type of insulin is Aspart?

A

Rapid

45
Q

What type of insulin is protamine?

A

Intermediate

46
Q

What type of insulin is detemir?

A

Long

47
Q

What does insulin do?

A

Regulate the uptake and utilization of glucose.

48
Q

When might insulin be needed in TIIDM?

A

temporarily during illness or surgery or if OHA cannot regulate BGL.

49
Q

What are some important points regarding insulin preparation and administration?

A

Mixed by rolling.
Unopened store on side in fridge.
Opened store at room temp for 1 month.
Parental only as if taken orally peptides destroyed in the stomach by digestive enzymes.

50
Q

What can cause a hypo when taking insulin?

A

Eating too little, incorrect dose, increased physical activity.

51
Q

What can cause a hyper when taking insulin?

A

increased caloric intake, incorrect dose, emotional, stress, infections, surgery, pregnancy and illness.

52
Q

Signs of a hyperglycaemic event?

A

vomiting, headache, dehydration, SOB, stomach ache, polyuria.

53
Q

What increases insulin absorption?

A

Injection into massaged/exercised area.

Higher temperature

54
Q

What reduces insulin absorption?

A

Smoking, using an injection site too many times, cold insulin.

RBM2202 Pathophysiology and Pharmacology 2 (11 decks)

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