Diabetic drugs Flashcards
biguanide e.g =
metformin
metformin Moa
- cAMP mediated action in regulating cellular metabolism
- reduces gluconeogenesis and glycogenolysis and peripheral insulin resistance
clinical effects of metformin (4)
- doesn’t induce hypoglycaemia or cause sig weight gain
- improves CV mortality
- Safe in pregnancy
- improves HbA1c
side effects of metformin
- GI disturbance
- lactic acidosis in patients with severe hepatic or renal disease
when is metformin contraindicated
eGFR <30
MI
sulonylureas with hepatic metabolism examples
tobutamide
gliclazide
sulfonureas with renal excretion (avoid in renal failure)
gliplizide
glimperide
moa of sulpnylureas
insulin secretagons -act on beta cells increasing insulin secretion
clinical effect of sulonylureas
effective in reducing HbA1c
side effects of sulonylureas
weight gain hypoglycaemia hepatotoxicity SIADH cholestatic liver dysfunction
glitazone e.g
pioglitazone
moa of glitazone
reduce insulin resistance by interaction with PPAR-gamma nuclear receptor. regulating genes to enhance insulin sensitivity and reducing hepatic gluconeogenesis
side effects of glitazone
weight gain
fluid retention/ oedema
bone fracture
bladder cancer
glitazone contraindicated in
previous bladder cancer
HF
dipeptidyl peptidase 4 inhibitors (DPP4 inhibitor) examples
linagliptin
saxagliptin
sitagliptin
moa of DPP4 inhibitors (3)
- enhance incretin effect- GLP-1
- acts on brain to promote satiety
- enhances beta-cell proliferation and decreases apoptosis
where is GLP-1 released from and why
intestinal L cells and K cells in response to feeding
clinical effect of DPP4 inhibitors
moderate plasma glucose reducing effect (mainly in early stage when beta cell preserved)
effect of DPP4 on weight
neutral
GLP-1 agonist examples
liraglutide
exenatide
moa of GLP-1 agonists
injectable long acting analogues of GLP-1 promoting incretin effect
clinical effects of GLP-1 agonists
may promote weight loss
improve CV mortality
good glucose control
when are GLP-1 agonists used
alternative to insulin in obese
SGLT-2 inhibitors example
canaglifozin
dapagliflozin
Moa of SGLT-2 inhibitors
reduces renal threshold and increases excretion of glucose from kidneys (proximal renal tubules)
clinical effects of SGLT-2
weight loss
CV protective
SE of SGLT-2 inhibitors
UTI
candidiasis
