Brainscape's Knowledge GenomeTM

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


See full index

Billy week 142 > Diabetic medications > Flashcards

Diabetic medications Flashcards

1
Q

What is the process that ends up with DMII?

A

Normal
Hyperinsulinaemia (normal glucose w/ raised insulin)
Hyperglycaemia (high both)
DMII (falling insulin levels as beta cells fail)

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

First line treatment for diabetes?

A

Diet control, and then metformin 500mg/day for 1 week, raising to 500mg BD. Max dose is 2g/day.

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

What type of drug is metformin?

A

Biguanide

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

MOA of biguanides?

A

AMPK (liver enzyme) activation:

  • decreased hepatic gluconeogenesis
  • decreased hepatic fatty acid and cholesterol synthesis
  • increased peripheral insulin sensitivity (skeletal muscle)
  • Increased peripheral insulin sensitivity is by AMPK-mediated GLUT4 transporter upregulation in skeletal muscle which increases insulin dependent glucose uptake, and stabilisation of the insulin:insulin receptor interaction

ALL RESULTS IN WEIGHT LOSS, IMPROVED GLYCAEMIC CONTROL, IMPROVED LIPID PROFILE, IMPROVED VASCULAR FUNCTION

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

Limitation of metformin?

A

Requires beta cell function

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

Indications of metformin?

A

First line oral agent if diet control fails

Primarily for those with a BMI of over 25 but basically everyone goes onto it

ALSO PCOS

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

Caution with metformin

A
  • NO hypoglycaemia risk.
  • SAFE in pregnancy.
  • Iodine contrast: suspend before and 48h after and normal renal function returned.
  • GA: suspend before and until normal renal function.
  • Monitor renal function: before commencing and at least twice a year
  • Lactic acidosis: usually secondary to CKD/AKI on CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Contraindications of metformin

A

eGFR below 30
GA
Iodine contrast

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

AEs of metformin

A

GI: (a,n,v,d) - take with food
Quite significant diarrhoea
Metallic taste
Lactic acidosis - withdraw

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

When would you stop metformin?

A

eGFR below 30
Iodine contrast/GA
Lactic acidosis

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

Sulfonylureas examples?

A

Glubenclamide (LA)
Gliclazide (SA)
Tolbutamide (SA)

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

Which SU is not suitable in the elderly?

A

Glubenclamide as LA so high risk of hypos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MOA of gliclazide?

A

It is a SU (what are the other SUs?); so it binds to the SUR1 receptor on the pancreatic beta cell, causing closure of the ATP-dependent K+ channel, which prevents K+ induced hyperpolarisation of the cell, and therefore causes depolarisation and induces calcium influx, which increases insulin vesicle release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Limitations of gliclazide?

A

SU

Insulin release augmentation only, so requires some beta cell function

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

Indications of SUs?

A

When metformin not tolerated/contraindicated (E.g. CKD stage 4 patient), or in combination with metformin.

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

A/Es of SUs?

A

Weight gain*
Hypoglycaemia**

  • Weight gain obvious as increased insulin and decreased glycosuria

** Hypoglycaemia worse with long-acting e.g. glubenclamide; can persist for hours so needs hospital treatment

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

Cautions with SUs?

A
  • THERE IS A hypoglycaemia risk.
  • AVOID in pregnancy (nn hypoglycaemia)
  • Weight gain (avoid in obese)
  • Surgery: omit in AM and replace with insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

AEs of SUs

A

Weight gain
GI
Hypo

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

Contraindications of SUs

A

Porphyria

Ketoacidosis

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

MOA of acarbose?

A

Intestinal alpha-glucosidase inhibitor

  • decreased breakdown of polysaccharides = decreased production/absorption of monosaccharides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Indications of acarbose?

A

3rd line - rarely used

Note useful for weight loss!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

AEs of acarbose?

A

Flatulence
Diarrhoea
Abdo cramps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Thiazolidinediones examples

A

Pioglitazone

Rosi but banned due to ?CV effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pioglitazone MOA?

A

Insulin sensitisation

  • decreased insulin resistance and increased biological response of liver and muscle cells
  • PPARy activation = liver / muscle cell increased insulin signalling (e.g. increased glucose uptake into muscle and decreased glucose production in liver)
  • PPARa activation = increased lipogenesis of adipocytes -> decreased FFA/TG levels and decreased visceral fat but increased S/C fat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cautions of pioglitazone?

A

Do not prescribe to this with bladder cancer

If less than 0.5% Hba1c drop in 6 months, discontinue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

AEs of pioglitazone

A

Peripheral oedema
CHF
Anaemia
Fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Indications of pioglitazone

A
  • Combination with metformin
  • Combination with SU if metformin not tolerated (e.g. CKD4)
  • Combination with metformin + SU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Where are the incretin hormones produced and what is their effect?

A

L and K endocrine cells of the intestine following food ingestion

Stimulate insulin secretion from beta cells of islets of Langerhans in the pancreas

29
Q

What is the secretory insulin response relevant to the action of exenatide?

A

Plasma insulin response following oral glucose load is significantly higher (50-70%) than an IV bolus of glucose of the same size.

This is due to the release of GLP-1 (and GIP in non-diabetics) by K and L cells of the intestine when food is in the intestine.

30
Q

Examples of GLP-1 agonists?

A

Liraglutide

Exenatide

31
Q

MOA of GLP-1 agonists?

A

Mimic native GLP1.

Enhance insulin secretion in glucose-dependent manner (which means increased glucose uptake by muscles)

Suppress glucagon secretion in pancreas = decreased gluconeogenesis

Restore first phase plasma insulin response

Also delays gastric emptying which decreases food intake.

ALL OF THIS LEADS TO DECREASED GLUCOSE + WEIGHT LOSS :)

32
Q

Examples of DPP-4 inhibitors?

A

Sitagliptin
Saxagliptin

etc

33
Q

DPP4 inhibitor MOA?

A

Prevent breakdown of GLP-1 and GIP in the blood by DPP-IV enzyme (which is usually very fast)

This leas to increased GLP1 and GIP =

  1. Increased insulin secretion by beta cells (which means increased glucose uptake from muscles)
  2. Suppresses glucagon secretion by alpha cells = decreased gluconeogenesis
  3. Restores first phase insulin response
  4. Delays gastric emptying = early satiety = decreased food intake
34
Q

Why might GLP-1 agonists be particularly useful in a diabetic patient?

A
  1. Lowers BP
  2. Lowers lipids
  3. Improved beta cell function
  4. Weight loss
35
Q

GLP-1 agonist A/Es

A

GI effects: N&V
Acute pancreatitis
Hypoglycaemia (minor)

36
Q

Which drug may cause acute pancreatitis?

A

GLP-1 agonists (e.g. exenatide, liraglutide)

37
Q

Which drug is linked with thyroid carcinoma in mice?

A

GLP-1 agonists

38
Q

Cautions with GLP-1 agonists?

A

MILD hypoglycaemia risk
AVOID in pregnancy

Previous acute pancreatitis; discontinue if pancreatitis diagnosed

39
Q

A/Es with DPP-IV inhibitors?

A

GI disturbances
Peripheral oedema
URTI
Pancreatitis

40
Q

Cautions with DPP-IV inhibitors?

A

Pancreatitis risk

Reduce dose in CKD

41
Q

Indications of incretin drugs?

A

Monotherapy or combo therapy

42
Q

SGLT-2 inhibitor examples?

A

-Flozins e.g. cana, dapa

43
Q

SGLT2 MOA?

A

90% of glucose reabsorption is via SGLT2 transporters in the proximal tubule. This lowers blood glucose.

(The transporters reach capacity and at that point glycosuria ensues (around 10).

With SGLT2i’s, the level of capacity is lowered and glycosuria occurs earlier which means more glucose excreted in urine.)

44
Q

SGLT2 indications?

A

Combo treatment e.g. with SUs, biguanide

45
Q

A/Es of SGLT2s

A

Genital infections / UTIs
Hypotension*
Euglycaemia DKA

AKI
Fractures
Amputations

Due to osmotic effect of glucose; average drop around 4mmHg

46
Q

Which drug has association with hypotension?

A

SGLT-2 inhibitors e.g. -flozins

47
Q

Which drugs are asssociated with increased fractures?

A

SGLT-2 inhibitors e.g. -flozins

Pioglitazone (thiazolidinedione)

48
Q

Which drugs are associated with euglycaemic DKA?

A

SGLT-2 inhibitors e.g. -flozins

49
Q

Which drugs are associated with amputations?

A

SGLT-2 inhibitors e.g. -flozins

50
Q

Which drugs are associated with diarrhoea?

A

Metformin++

51
Q

Which drugs are associated with metallic taste?

A

Metformin

Clarithromycin
Metronidazole

52
Q

Which drugs are safe in pregnancy?

A

Metformin

53
Q

Which drugs should be stopped with IV contrast?

A

Metformin

54
Q

Which drugs are associated with lactic acidosis?

A

Metformin

55
Q

Which drug is unsuitable for elderly living alone?

A

Glubenclamide; long acting SU which can cause hypos

56
Q

Which drugs activate AMPK to cause insulin sensitisation?

A

Metformin

AMPK (liver enzyme) activation:

  • decreased hepatic gluconeogenesis e.g. decreased fatty acid and cholesterol synthesis
  • increased peripheral insulin sensitivity*
  • Increased peripheral insulin sensitivity is by AMPK-mediated GLUT4 transporter upregulation in skeletal muscle which increases insulin dependent glucose uptake, and stabilisation of the insulin:insulin receptor interaction
57
Q

Which drugs close the ATP-dependent K+ channel to increase beta cell secretion of insulin?

A

SUs

E.g. Gliclazide, gubenclamide

58
Q

Which drugs are associated with weight gain?

A

SUs e.g. gliclazide

Insulin!!

59
Q

Which drug has an effect on starch absorption? What is its MOA?

A

Acarbose

Alpha glucosidase inhibitor = decreased monosacharride production and absorption

60
Q

Which drugs are associated with flatulence / diarrhoea? Its MOA?

A

Acarbose - alpha glucosidase inhibitor

61
Q

Which drug is associated with increased S/C fat?

A

Pioglitazone (thiazolidinedione); activates PPAR receptors

  • PPARy activation = liver / muscle cell increased insulin signalling (e.g. increased glucose uptake into muscle and decreased glucose production in liver)
  • PPARa activation = increased lipogenesis of adipocytes -> decreased FFA/TG levels and decreased visceral fat but increased S/C fat
62
Q

Which drug is associated with bladder cancer?

A

Pioglitazone

63
Q

Which drugs cause peripheral oedema?

A

Pioglitazone

64
Q

Which drugs are associated with anaemia?

A

Pioglitazone

65
Q

Which drugs have particular protective effects on the heart?

A

GLP-1 agonists (exenatide) and DPP-IV inhibitors (sitagliptin) (lower BP, lower lipids)

Metformin (lowers lipids, improves vascular)

66
Q

Which drugs are associated with acute pancreatitis?

A

DPPIVi (gliptins) and GLP-1 agonists (-tides)

67
Q

Which drugs are associated with UTIs?

A

SGLT2 inhibitors e.g. -flozin’s

68
Q

Which øf the drug class _____ are most associated with fractures?

A

Canagliflozin (SGLT2i)

69
Q

Which drugs are associated with AKI?

A

Metformin
SGLT2-inhibitors

Monitor renal function prior to initiation; above 60

Billy week 142 (1 decks)

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