Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Diabetic agents > Flashcards

Diabetic agents Flashcards

1
Q

What is the first line action given to t2 prediabetic patients

A

Lifestyle modification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the first line drugs offered to patients with t2dm?

A

Metformin or DDP4 if contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What blood glucose level is considered high and requiring treatment?

A

> 48 mmol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

T1DM require insulin, how is this produced?

A

Plasmid vector in bacteria carrying the human insulin gene (recombinant DNA) or enzyme modification of porcine insulin.
There is no C chain produced in artificial insulin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What features are needed to diagnose T1DM?

A

Random plasma glucose >11mmol/L

  • polydipsia
  • polyuria
  • lethargy
  • weight loss

A raised glucose without symptoms is insufficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does metformin work?

A

It decreases gluconeogenesis and glycogenolysis in the liver, decreasing the circulating glucose.
It increases the use of glycogen stored within the muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is meant by a basal bolus regime?

A

Using two formulations of insulin which have different lengths of half life, typically use a long acting insulin once a day and a short acting insulin after meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do sulfonylureas work? Why can’t they be prescribed in T1DM?

A

They work by inhibiting the K ATP channel, causing the release of insulin.
Patients must have a pancreas which is still functionally able to produce and secrete insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If metformin is contraindicated, what is the first line drug of choice?
What is the HB1AC to initiate ?

A

DPP4 inhibitors or sulfonylureas

48mmol/mol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do SGLT2 blockers act?

A

They prevent reabsorption of glucose in the PCT, as a competitive reversible inhibitor, resulting in loss within the urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the likely issues with taking a SGLT2 inhibitor?

A

Increased likelihood of UTI

Thirst and polyurea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Insulin is a hormone of which class and what is it secreted in response to?

A

It is a protein hormone

Secreted in response to:

  • glucose concentration increase
  • incretins concentration increase (GLP-1 & GIP)
  • glucagon
  • parasympathetic activity (M2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What inhibits insulin?

A
  • decreased plasma glucose
  • cortisol
  • sympathetic activity (alpha2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the role of insulin?

A

Promote fat uptake

Inhibit glycogenolysis and gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why must insulin be given parentally?

A

To avoid digestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the signs of diabetic ketoacidosis?

A

Hyperglycaemia, acidosis and ketonaemia

Can present with low blood ketones and hyperglycaemia may not always be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the main treatment of diabetic ketoacidosis?

A

Fluids and then insulin, with glucose and potassium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the contraindications of biguanides?

A

GI upset- Nausea, vomiting, diarrhoea, lactic acidosis

Not used if eGFR <30ml/min (unchanged)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What drugs interact with biguanides?

A

ACEi
Diuretics
NSAIDs
- any drugs which may impair renal function

Thiazide like diuretics increase glucose so can reduce action.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the contraindications of sulfonylureas?

A

Mild GI upset - vomiting, diarrhoea, hypoglycaemia

21
Q

What drugs interact with sulfonylureas?

A

Hypoglycaemic agents
Thiazide like diuretics
Hepatic or renal impairment.

22
Q

Name a sulfonylurea

A

Gliclazide

23
Q

How do Thiazolidinediones work?

A

Increased insulin sensitivity in muscle and adipose, decreasing hepatic glucose production.
Activate PPAR-gamma; takes 6-8 weeks to have an effect and causes increased storage of fatty acids in adipocytes.

24
Q

What are the side effects of glitazones?

A 
GI upset
Fluid retention
Weight gain
Fracture risk 
CVD concerns 
Bladder cancer
25
Q

Name a Thiazolidinedione (glitazone)

A

Pioglitazone or rosiglitazone

26
Q

what drug interactions should be considered when prescribing a SGLT2 inhibitor?

A

Antihypertensive and hypoglycaemic drugs already being taken

27
Q

Name a SGLT-2 inhibitor

A

Dapaglifozin

Canagliflozin

28
Q

What are the physiological effects of GLP-1?

A 
Increase insulin secretion and decrease glucagon secretion 
Increase satiety 
Decrease liver glucose production
Decrease gastric emptying 
Increase muscle glucose uptake
29
Q

Name a DPP-4 inhibitor

A

Sitagliptin

Saxagliptin

30
Q

How do DDP-4 inhibitors work?

A

Prevent incretin degradation and therefore increase plasma level. This inhibits glucagon release.
Causes insulin secretion and delay gastric emptying, reducing blood glucose.

31
Q

Why do DDP-4 inhibitors have a lower risk of hypoglycaemia?

A

They do not stimulate insulin secretion at a normal blood glucose

32
Q

What are the contraindications for DPP-4 inhibitors?

A

GI upset
Pancreatitis
Avoid in pregnancy

33
Q

What drug interactions should you be aware of with use of DPP-4 inhibitors?

A

Hypoglycaemic agents

Thiazide like and loop diuretics - drugs increasing glucose can oppose action

34
Q

How do GLP-1 receptors agonists work?

A

Increased glucose dependant synthesis of insulin, activation of GLP-1 receptors.

35
Q

Name a GLP-1 receptor agonist

A

Exenatide

Liraglutide

36
Q

How is GLP-1 administered?

A

Subcutaneous injection

37
Q

What are GLP-1 contraindications?

A

GI upset
GORD
Stop below <30ml/min

38
Q

What is the half life of insulin and it’s metabolism?

A

5 mins in plasma

Renal and hepatic metabolism

39
Q

When is plasma glucose highest after meals?

A

2-3 hours

40
Q

What two things modify absorption of insulin ?

A

Protamine and zinc

41
Q

Name a rapid insulin and it’s features

A

Insulin aspart
10-20mins onset
Peak @ 40-50 mins
3-5 hr duration

42
Q

Name a short acting insulin and it’s features

A

Soluble insulin ; humulin S or actrapid
30-60 min onset
Peak at 2-5hrs
5-8hr duration

43
Q

Name a intermediate acting insulin and it’s features

A

Isophane insulin
Onset at 60-120 mins
Peak @ 4-12 hrs
18-24hr duration

44
Q

Name a long acting insulin and it’s features

A

Insulin glargine
Onset 60-90 mins
Peak between 2-20hrs (plateau)
20-24 hr duration

45
Q

What are the warnings for insulin’s?

A

Hypoglycaemia
Lipohypertrophy
Lipoatrophy
Renal impairment increasing hypo risk

46
Q

What are the interaction problems with insulin?

A

Increase dose with steroids

Caution with other agents

47
Q

What would make you suspect DKA?

A 
BM > 11mmol/l and ...
Infection 
Trauma\ stress 
Poor adherence 
ADR 
Ketosis
48
Q

For first intensification what is considered treatment and optimal HB1AC?

A

Dual therapy
Rise to 58 mmol/mol
Aim for 53 mmol/mol

49
Q

If second intensification, what is the management and HB1AC aim?

A

Triple therapy or insulin (if metformin contraindicated)

Aim for 53 mmol/mol

Pharmacology (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions