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Semester 5 - CPT > Diabetic drugs > Flashcards

Diabetic drugs Flashcards

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1
Q

What is the NICE target for Diabetes type 2 treatment? (HbA1c range)

A

HbA1c between 6.5-7.5%

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2
Q

Give an example of a Biguinide:

A

Metformin

- Is the only available medication in the biguinide class

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3
Q

To what class of drugs does Metformin belong?

A

Biguinides

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4
Q

How does Metformin work?

A

Unknown MoA but:

  • Reduces the insulin resistance of cells
  • Limits hepatic gluconeogenesis
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5
Q

Name some common side effects of Metformin:

A
  • Nausea
  • Vomiting
  • Diarrhoea
  • Abdominal pain
  • Loss of appetite
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6
Q

Name some rare and dangerous side effects of Metformin:

A
  • Lactic acidosis
  • Reduced absorption of Vit B12
  • Rash
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7
Q

Give some examples of Sulphonylureas:

A
  • Tolbutamide
  • Gliclazide
  • Glibenclamide
  • Glipizide
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8
Q

To what class of drugs does Gliclazide and Tolbutamide belong?

A

Sulphonylureas

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9
Q

What is the mechanism of action of sulphonylureas?

A
  • Antagonise ATP-sensitive K+ channel in pancreatic β cells
  • Prevent K+ efflux
  • = Increased intracellular K+ and relative depolarisation
  • Relative calcium influx
  • Leads to fusion of insulin vesicles
  • ^ Insulin released into circulation
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10
Q

What is the dose range of Metformin?

A

Between 500mg - 2g per day

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11
Q

What is the danger of taking sulphonylureas with other highly protein bound drugs such as NSAIDs?

A

Hypoglycaemia
Sulphonylureas are highly protein bound, so other highly protein bound drugs will potentiate for competition, which could cause HYPOGLYCAEMIA due to more free circulating drug

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12
Q

Name some possible side effects of sulphonylureas:

A

Hypoglycaemia
Weight gain
GI disturbances
Allergic skin reactions

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13
Q

Give some some examples of Gliptins:

A
  • Sitagliptin
  • Linagliptin
  • Vildagliptin
  • Saxagliptin
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14
Q

To which class of drugs does Linagliptin belong?

A

Gliptins

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15
Q

What is the mechanism of the Linagliptin?

A

Linagliptin is a gliptin:

  • Inhibits DPP4 enzyme which breaks down GLP1
  • GLP1 is released after a meal to increase insulin secretion, reduce hepatic gluconeogenesis and convey satiety
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16
Q

Which class of diabetic drugs inhibit DPP4 enzyme?

A

Gliptins

- ie Linagliptin

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17
Q

What are the functions of GLP1? When is it released in the body?

A

1) Increase insulin secretion
2) Reduce hepatic gluconeogenesis
3) Convey satiety

  • Released after meals
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18
Q

Which cells in the body do sulphonylureas act on?

A

Pancreatic β cells

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19
Q

What is a dangerous side effect of the Gliptins?

A

Pancreatitis

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20
Q

Name some common side effects of Sitagliptin:

A

GI disturbances
Nasopharyngitis
Peripheral oedema
URTI

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21
Q

Which classes of diabetic drugs are likely to cause weight gain?

A

Sulphonylureas

Thiazolineinediones

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22
Q

Which classes of diabetic drugs are likely to promote weight loss?

A

GLP1 agonists

SGLT2 antagonists

23
Q

Name a GLP1 agonist:

A

Exenatide
Liraglutide
Lixisenatide

24
Q

To which class of drugs does Exenatide belong?

A

GLP1 agonists

25
Q

What is the mechanism of action of GLP1 agonists?

A
  • Increase the release of GLP1, which:
    1) Increases release of Insulin
    2) Reduces hepatic gluconeogenesis
    3) Conveys satiety
26
Q

What is the route of administration of GLP1 agonists?

A

Subcutaneous injection

27
Q

Name some common side effects of Exenatide:

A 
GI disturbances
Agitation
Antibody formation
Physical weakness
Decreased appetite
GORD
Headache
Hypoglycaemia
^ Sweating
Injection-site reactions
Weight loss
28
Q

Name some SGLT2 antagonists:

A

Dapagliflozin
Canagliflozin
Empagliflozin

29
Q

To which class of drugs does Dapagliflozin belong?

A

SGLT2 antagonists

30
Q

What is the mechanism of action of SGLT2 antagonists?

A
  • Inhibit glucose reabsorption in the PCT
31
Q

Where in the kidney is the majority of glucose reabsorbed?

A

PCT

32
Q

The majority of glucose is reabsorbed in the PCT of the kidney, via which transporters?

A

SGLT2

33
Q

On average how many grams of glucose are reabsorbed In the kidney per day?

A

~ 180 g/day

34
Q

Name some common side effects of SGLT2 antagonists?

A 
UTI
Polyuria
Polydipsia
Dysuria
Genital infection
Hypoglycaemia
Back pain
Constipation
Dyslipidaemia
Volume depletion
35
Q

Which class of diabetic drugs is most likely to cause urinary side effects?

A

SGLT2 antagonists

36
Q

Why should you use SGLT2 antagonists with caution if:

  • CVS disease
  • Elderly
  • Hx of hypotension
A

^ risk of volume depletion

37
Q

What are the 6 main categories of Insulin?

A

1) Ultrafast acting
2) Rapid acting
3) Short acting
4) Intermediate acting
5) Long acting
6) Very long acting

38
Q

Give an example of an ultrafast acting Insulin:

A

FiAsp

39
Q

Give an example of a rapid acting Insulin:

A
  • Humalog

- Novorapid

40
Q

When do rapid acting Insulins peak?

A

30-90 mins

41
Q

Give an example of a short acting Insulin:

A
  • Actrapid

- Humulin S

42
Q

When do short acting Insulins peak?

A

2-3hrs

43
Q

Give an example of an intermediate acting Insulin:

A
  • Insulatard

- Humulin I

44
Q

What type of Insulin is Humulin S? When does it peak?

A

Short acting Insulin

Peaks 2-3hrs

45
Q

What type of Insulin is Humulin I? When does it peak?

A

Intermediate acting Insulin

Peaks 4-8hrs

46
Q

When do intermediate acting insulins peak?

A

4-8hrs

47
Q

Give an example of a long or very long acting Insulin:

A
  • Glargine
  • Determir
  • Degludec
48
Q

When do long or very long acting Insulins peak?

A

10-14hrs

49
Q

How long do long or very long acting Insulins last? What are they used for?

A

Long = up to 24hrs
Very long = up to 50 hrs

Used to cover overnight

50
Q

Name 2 anti-obesity drugs used to help manage diabetes:

A

1) Orlistat

2) Sibutramine

51
Q

How does Orlistat work?

A

Gastric and pancreatic lipase inhibitor

= Reduces amount of dietary fat converted to fatty acids and glycerol

52
Q

What is the main ADR of Orlistat?

A

GI disturbances of steatorrhoea

53
Q

How does Sibutramine work?

A

Noradrenaline and serotonin reuptake inhibitor

= promotes satiety and suppresses appetite

Semester 5 - CPT (5 decks)

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