Diabetes Pharmacology Flashcards by Jennita Ariaratnam

Insulin for the treatment of T1DM may be done in 2 ways:

Subcutaneous Insulin Administration

2. Islet Replacement Therapy (pancreas or islet transplantation)

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When treating T1DM with the basal/bolus insulin regimine, what is the estimated dosage?

dose = 0.5 units/kg/day

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List some side effects of insulin

hypoglycaemia
weight gain
oedema (it may cause Na+ and water retention)
allergy (to insulin)

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List the possible drugs/meds that may be given to treat T2DM

metformin
sulfonylureas
thiazolidinediones
incretin-based therapy
– GLP-I Analogues
– DDP4 Inhibitors
SGLT2 Inhibitors
insulin (advanced T2DM)
acarbose (least effective - not used that much)

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What is the 1st line drug treatment for T2DM?

Metformin

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What organ does metformin work on?

liver

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What is the MOA of metformin?

reduced hepatic glucose output (gluconeogenesis + glycogenolysis)

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What are the side effects associated with metformin?

GI upset
lactic acidosis (esp. from renal impairment)
vitamin B12 deficiency
renal failure

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What are some benefits of using metformin over other drugs?

anti-lipolytic effect
no weight gain or weight loss
no hypoglycaemia

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What is the second line treatment for T2DM?

Sulfonylureas

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What organ does sulfonylureas work on?

pancreas

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What is the MOA of sulfonylureas?

stimulates insulin release by beta cells of pancreas

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What is the side effects associated with sulfonylureas?

risk of hypoglycaemia
weight gain
patient may stop responding to drug

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Give some examples of drugs that are part of the sulfonylureas class

gliclazide
glimepiride
glibenclimide
glipizide

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Thiazolidinediones may be used in the treatment of T2DM. What is their MOA? Give some examples of drugs in this class

improve insulin sensitivity in adipose tissue + muscle

pioglitazone, rosiglitazone

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What are the side effects of thiazolidinediones?

weight gain
oedema
increased risk of fractures
rosiglitazone has increased risk of CV events*

What is the MOA of acarbose?

delays absorption of glucose after meals

What are the 2 incretin-based therapies to treat T2DM?

GLP-1 Analogues

2. DPP4 Inhibitors

What is the MOA of incretin hormones?

after a meal, they stimulate the pancreas to secrete insulin

Give some examples of GLP-1 Analogues

Exanatide
Liraglutide
Semaglutide
Dulaglutide

What are some side effects of GLP-1 Analogues

GI upset
gallstones
injection site reactions

GLP-1 analogues will be avoided in which patient groups?

pts with history of pancreatitis or pancreatic malignancy or medullary thyroid cancer

Give some examples of DPP 4 Inhibitors

Sitagliptin
Linagliptin
Vildagliptin
Saxagliptin

What is the MOA of DPP 4 Inhibitors

prolong the half-life of ENDOGENOUS incretins

What are the side effects of DPP 4 inhibitors?

- GI upset | - skin rash

DPP 4 Inhibitors will be avoided in which patient groups?

pts with history of pancreatitis or pancreatic malignancy or medullary thyroid cancer

What is the MOA of SGLT2 Inhibitors in the treatment of T2DM?

- inhibit the SGLT2 transporter in PCT | - increase glucose excretion by inhibiting glucose reabsorption

Give some examples of SGLT-2 Inhibitors

``` Empagliflozin Canagliflozin Dapagliflozin Ertugliflozin Sotagliflozin ```

List some of the side effects of SGLT-2 inhibitors

``` UTI genital thrush/infection dehydration/postural hypotension fournier's gangrene euglycaemic DKA ```

What is the name of the common weight loss procedure (surgery) that is done in diabetic patients with a high BMI?

verticle sleeve gastrectomy (gastric sleeve)

What are the indications of administering insulin in a T2DM patient?

- not meeting glycaemic targets - decompensation - uncontrolled weight loss - perioperatively - pregnancy - hepatic or renal disease - allergy (to oral agents)

In a diabetic patient with high blood pressure, what would be blood pressure target be?

< 130

In a diabetic patient with high cholesterol and NO previous vascular event, what would the target LDL cholesterol be?

< 2.6 mmol/L

In a diabetic patient with high cholesterol and a PREVIOUS VASCULAR event, what would the target LDL cholesterol be?

< 1.8 mmol/L

In a diabetic patient with high blood pressure, list the different types of treatment that may be given (1st line to 5th line treatment)

1st Line Treatment: ACEi or ARB 2nd Line Treatment: Diuretic or Calcium Channel Blocker 3rd Line Treatment: Calcium Channel Blocker or Diuretic 4th Line Treatment: Beta Blocker 5th Line Treatment: Alpha Blocker

Aspirin may be given to diabetics with an increased risl of a cardiovascular event. What is the MOA of aspirin in this case?

- aspirin for secondary prevention mainly - aspirin slows clotting and decreases the size of the forming blood clot - the anti-clotting action helps prevent a MI remember: MI occurs due to atherosclerotic plaque rupture and clot formation