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Diabetes Mellitus > Diabetic Drugs > Flashcards

Diabetic Drugs Flashcards

1
Q

Pancreatic hormone preperations

A

Insulin preparation:Insulin lispro,insulin as part, NPH insulin, insulin glargine, insulin detemir, insulin degludec

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2
Q

Hypoglycemic agrnts that reduce insulin resistance

A

Metformin,pioglitazone

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3
Q

Hypoglycemic agents that reduce renal glucose reabsorption

A

Dapagliflozin and empagliflozin

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4
Q

Hypoglycemic agents that potentiate insulin secretion

A

Sulfonylurea derivatives,GLP -1 receptor agonists,DPP 4 inhibitors

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5
Q

Sulfonylurea derivatives

A

Gliclazide

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6
Q

GLP 1 receptor agonist

A

Semaglutide,exenatide

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7
Q

DPP4 inhibitors

A

Sitagliptin

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8
Q

2 parts of tyrosine receptor

A

Extracellular alpha and intracellular beta

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9
Q

Insulin antagonist are

A

Glucagon, Thyroid hormones, growth hormone, glucocorticoids, catecholamines

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10
Q

Glucagon

A

Hyperglycaemic pancreatic alpha cell hormone

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11
Q

Glucagon like peptide

A

Pancreatic beta cell stimulator,is a intestinal peptide hormone or incretins,which increase the prandial (after meal ( release of insulin

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12
Q

Ketoacidosis

A

In absence of insulin,body provide energy from fat metabolism, producing ketones.

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13
Q

Anabolic effect of insulin

A

Increase hepatic glycogen synthesis, lipid synthesis in adipose tissue, protein synthesis in muscle, decrease gluconeogenesis,

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14
Q

Anti catabolic effect of insulin

A

Decrease glycogenolysis,proteinolysis,lipolysis

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15
Q

Membrane bound effect of insulin

A

Increase glucose, potassium as well as amino acid transport into target cells

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16
Q

Type diabetes

A

Autoimmune disorder in pancreas,which destroys pancreatic beta cells and absolute insulin deficiency

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17
Q

Treatment for DM 1

A

Insulin replacement therapy

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18
Q

DM2

A

Metabolic disorder in which hyperglycaemia due to impaired insulin secretion and peripheral insulin resistance

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19
Q

DM 2 therapy done using

A

Hypoglycemic agents and Insulin

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20
Q

What is the criteria for effectiveness of anti-diabetic agents

A

Glycosylated hemoglobin (Hba1c)

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21
Q

In obesity ,number of insulin specific receptors

A

Decreases

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22
Q

Fast and short acting insulin analogue

A

Insulin lispro and insulin aspart

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23
Q

Use of insulin short acting ones

A

Control of prandial glycemia in type 2 and type 2 during decompensate phase, correction of acute hyperglycaemia (including ketoacidosis)

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24
Q

Intermediate acting insulin

A

Insulinum humanum(NPH)

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25
Long acting insulin analogue
Insulin glargine, insulin detemir, insulin degludec
26
Use of medium and long acting insulin
Replacement therapy for basal insulin secretion in type 1 and type 2 during decompensation phase
27
Insulin treatment topicalities
Insulin pump and inhaled insulin formulations
28
For moderate NPH ,due to dawn phenomena
There is difficulty getting blood glucose normal
29
SE of insulin
Hypoglycemia, hypokalemia,weight gain, injection site lipodystrophy, rarely allergic reactions
30
Most common cause of hypoglycemia due to insulin
Inaccurate insulin dosing, missed meal,heavy unplanned physical exertion
31
Interactions with insulin
Oral hypoglycemic agents,salycilates (Acetylsalicylic acid),ACE,ARB,non selective beta adrenoreceptor blocker
32
Pathophysiological condition leading to dev of hypoglycemia
Cirrhosis,progression of CKD, alcohol
33
Below 4 of glucose levels, symptoms
Sweating, tremor, tachycardia, palpitations,nausea,hunger
34
Symptoms of neuro hypoglycemia
Headache, irritability,blurred vision, tiredness, difficulty concentrating and speaking
35
Cardiac symptoms in hypoglycemia are due to
Influx of catecholamines in response to hypoglycemia and rapid change in potassium concentration
36
Mild hypoglycemic treatment
Carbohydrates like glucose tablets, richly sweetened tea, orange/grape juice
37
Moderate to severe hypoglycemic treatment
Immediate IV therapy with hypertonic (20-40% glucose solution (75 g)
38
Due to delayed effect of glucagon,it is not used as
Anti hypoglycemic agent, especially in patients with long standing diabetes, malnourished seniors, oncology patients, alcoholics
39
Insulinotropic hypoglycemic agents action
Stimulate insulin secretion
40
2 types of insulinotropic agents
Sulfonylurea derivatives which increase insulin independent of glucose concentration and GLP 1 and DPP4 inhibitors,which depends on glucose concentration ,also depends on residual function of beta cells
41
Sulfonylurea derivatives has risk of
Hypoglycemia,due to independent work with glucose conc
42
Non insulinotropic hypoglycemic agents eg
Metformin ,thiazolidinediones, SGLT2 inhibitors
43
Sulfonylurea derivatives which works independent of glucose concentration will increase
Body weight
44
GLP 1 receptor agonists which depends on glucose concentration will decrease
Body weight
45
DPP4 (Dipeptidyl peptidase) inhibitors doesn't have any effect on
Body weight
46
Biguanides (non insulinotropic agents) action
Reduce intestinal glucose absorption and hepatic hepatic glucose production and increase in peripheral insulin sensitivity.No influence on bodyweight
47
Thiazolidinediones action
Reduce hepatic glucose production and increase peripheral insulin sensitivity, also increase bodyweight
48
SGLT2 inhibitor action
Reduce glucose reabsorption in kidney, reduce body weight
49
Body weight can be decreased in using
GLP 1 receptor agonists ( insulinotropic )and SGLT2 inhibitor (non insulinotropic)
50
Body weight increase while using
sulfonylurea derivatives (insulinotropic) and Thiazolidinediones ( non insulinotropic)
51
Hepatic glucose production can be decreased by using
Biguanides and Thiazolidinediones
52
Increase peripheral insulin sensitivity can be achieved by using
Biguanides and Thiazolidinediones
53
Glucose absorption from intestine can be reduced by using
Biguanides
54
Glucose reabsorption in kidney can be decreased by using
SGLT2 inhibitor
55
Reduced insulin resistance =
Increased insulin sensitivity
56
Metformin (Biguanides) action
Decrease hepatic gluconeogenesis by inducing AMP dependent protein kinase, increase skeletal muscle sensitivity to insulin -improve peripheral glucose binding and utilisation and increase GLUT 4 expression indirect, decrease intestinal glucose absorption and decrease LDL and TG level
57
Metformin is the first choice drug for
DM 2 therapy,it has both hypoglycemic effect and reduce risk of cardio vascular disease
58
Sae of Metformin
Dose dependent GIT disturbance (should take aftermeal),B12 deficiency,dose dependent lactic acidosis,In patients with impaired renal fn, Metformin accumulates
59
Metformin inhibits
Mitochondrial electron complex 1 - decreased gluconeogenesis and increased risk of lactic acidosi
60
Thiazolidinediones
Pioglitazone ,Rosiglitazone
61
Thiazolidinediones (pioglitazone) action
Are PPAR gamma agonists,which increase insulin sensitivity in tissue ( in adipocyte,muscle and promote GLUT 4 expression), decrease hepatic gluconeogenesis, Decrease TG level
62
Use of Thiazolidinediones (Pioglitazone)
Type 2 diabetes
63
SE of pioglitazone (Thiazolidinediones)
Fluid retention,edema ( caution for CHD patients ), increased body weight
64
PPAR gamma expressions in
Skeletal muscle, adipose tissue, pancreatic beta cells, vascular endothelium, Macrophage, CNS
65
PPAR alpha expression
Liver,heart , skeletal muscle, vascular wall
66
PPAR gamma expressions provides
More glut 4-hypoglycemic effect
67
PPAR alpha has
Lipid lowering effect
68
Sulphonylurea derivatives
Gliclazide is an ATP dependant potassium channel blocker
69
Gliclazide binds to
SUR1 subunit of ATP dependent potassium channel multi complex ,cause potassium channel inhibition and calcium channel opening
70
Gliclazide acts by
Increase insulin secretion when the calcium concentration increases,so hypoglycemic effect
71
Gliclazide use
Type 2 diabetes
72
SE of Gliclazide
Hypoglycemic bin overdose, increase bodyweight
73
Interactions of Gliclazide (sulfonylurea derivatives)
BAB masks symptoms of hypoglycemia
74
GLP analogue (Semaglutide, exenatide) action
Increase insulin secretion glucose dependent, decrease glucagon secretion, decrease appetite -anorexigenic effect, decrease emptying of stomach(prevent food derived glucose from entering into blood stream)
75
GLP 1 analogue (semaglutide, exenatide) are resistant to
Dipeptidyl peptidase 4
76
GLP 1 analogue use
Type 2 diabetes
77
SE of GLP1 analogue
GIT disturbance like nausea, vomiting and diarrhea
78
Dipeptidyl peptidase is a
GLP 1 degrading enzyme
79
GLP 1 analogue has increase risk of
Pancreatitis and c- cell tumors
80
Semaglutide (ozempic )
Used for weight management
81
DPP 4 inhibitors (sitagliptin) action
Increase circulating GLP 1 and thus increase insulin secretion and decrease glucagon secretion
82
Use of sitagliptin (DPP4)
Type 2 diabetes
83
DPP4 inactivates all
Incretins (GLP 1 and GiP.....)
84
SGLT2 inhibitor (dapagliflozin and empagliflozin) acts on
Renal proximal tubule
85
SGLT2 inhibitor (dapagliflozin and empagliflozin) action
Reduce glucose reabsorption causing glycosuria,reduce glucose plasma concentration,weak osmotic diuretic effect, decrease bodyweight
86
Use of SGLT2 inhibitor
Type 2 diabetes and chronic heart failure
87
SE of SGLT2 inhibitor (dapagliflozin and empagliflozin)
Urinary tract infection
88
Hypoglycemia parenteral therapy is done using
Glucagon
89
Glucagon action
Increase gluconate, increase Glycogenolysis (especially in liver), positive inotropic and chronotropic effect
90
Glucagon can be given
IM/SC
91
Use of glucagon
Severe hypoglycaemia and BAB overdose
92
DM 2 treatment options
SGLT2 inhibitor (dapagliflozin and empagliflozin),DPP4 inhibitor (Sitagliptin),GLP 1 analogue (semaglutide and exenatide), sulphonylurea derivatives (Gliclazide) Thiazolidinediones (Pioglitazone), Biguanides (Metformin) and insulin
93
Major risk of sulfonylurea derivatives
Weight gain and risk of hypoglycemia
94
SGLT2 inhibitor are characterized by
Potential for weight loss, urinary tract infection,genital infection
95
Number 1 SE of Metformin
Stomach discomfort and diarrhea
96
Forms of diabetes
Type 2 and 2,LADA,MODY

Diabetes Mellitus (1 decks)

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