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REGUB > Diabetes Pharmacology > Flashcards

Diabetes Pharmacology Flashcards

1
Q

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

A
  1. Subcutaneous Insulin Administration

2. Islet Replacement Therapy (pancreas or islet transplantation)

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2
Q

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

A

dose = 0.5 units/kg/day

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3
Q

List some side effects of insulin

A
  • hypoglycaemia
  • weight gain
  • oedema (it may cause Na+ and water retention)
  • allergy (to insulin)
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4
Q

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

A
  • 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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5
Q

What is the 1st line drug treatment for T2DM?

A

Metformin

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6
Q

What organ does metformin work on?

A

liver

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7
Q

What is the MOA of metformin?

A
  • reduced hepatic glucose output (gluconeogenesis + glycogenolysis)
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8
Q

What are the side effects associated with metformin?

A
  • GI upset
  • lactic acidosis (esp. from renal impairment)
  • vitamin B12 deficiency
  • renal failure
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9
Q

What are some benefits of using metformin over other drugs?

A
  • anti-lipolytic effect
  • no weight gain or weight loss
  • no hypoglycaemia
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10
Q

What is the second line treatment for T2DM?

A

Sulfonylureas

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11
Q

What organ does sulfonylureas work on?

A

pancreas

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12
Q

What is the MOA of sulfonylureas?

A

stimulates insulin release by beta cells of pancreas

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13
Q

What is the side effects associated with sulfonylureas?

A
  • risk of hypoglycaemia
  • weight gain
  • patient may stop responding to drug
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14
Q

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

A

gliclazide
glimepiride
glibenclimide
glipizide

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15
Q

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

A
  • improve insulin sensitivity in adipose tissue + muscle

pioglitazone, rosiglitazone

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16
Q

What are the side effects of thiazolidinediones?

A
  • weight gain
  • oedema
  • increased risk of fractures
  • rosiglitazone has increased risk of CV events*
17
Q

What is the MOA of acarbose?

A

delays absorption of glucose after meals

18
Q

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

A
  1. GLP-1 Analogues

2. DPP4 Inhibitors

19
Q

What is the MOA of incretin hormones?

A

after a meal, they stimulate the pancreas to secrete insulin

20
Q

Give some examples of GLP-1 Analogues

A

Exanatide
Liraglutide
Semaglutide
Dulaglutide

21
Q

What are some side effects of GLP-1 Analogues

A
  • GI upset
  • gallstones
  • injection site reactions
22
Q

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

A

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

23
Q

Give some examples of DPP 4 Inhibitors

A

Sitagliptin
Linagliptin
Vildagliptin
Saxagliptin

24
Q

What is the MOA of DPP 4 Inhibitors

A

prolong the half-life of ENDOGENOUS incretins

25
Q

What are the side effects of DPP 4 inhibitors?

A
  • GI upset

- skin rash

26
Q

DPP 4 Inhibitors will be avoided in which patient groups?

A

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

27
Q

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

A
  • inhibit the SGLT2 transporter in PCT

- increase glucose excretion by inhibiting glucose reabsorption

28
Q

Give some examples of SGLT-2 Inhibitors

A 
Empagliflozin
Canagliflozin
Dapagliflozin
Ertugliflozin
Sotagliflozin
29
Q

List some of the side effects of SGLT-2 inhibitors

A 
UTI
genital thrush/infection
dehydration/postural hypotension
fournier's gangrene
euglycaemic DKA
30
Q

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

A

verticle sleeve gastrectomy (gastric sleeve)

31
Q

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

A
  • not meeting glycaemic targets
  • decompensation
  • uncontrolled weight loss
  • perioperatively
  • pregnancy
  • hepatic or renal disease
  • allergy (to oral agents)
32
Q

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

A

< 130

33
Q

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

A

< 2.6 mmol/L

34
Q

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

A

< 1.8 mmol/L

35
Q

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

A

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

36
Q

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

A
  • 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

REGUB (22 decks)

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