DM- Pharmacology Flashcards
What is the first line medication for T2DM?
Metformin
What are the second line medications for T2DM?
Added to metformin:
- Sulfondylurea (Gliclazide)
- Pioglitazone (Thiazolidinedione)
- Incretins (GLP-1)
- SGLT-2 inhibitor (empagliflozin)
How does metformin work?
- Biguanide
- Increases insulin sensitivity and decreases hepatic gluconeogenesis
What is important about metformin?
Weight neutral
What side effects are there to metformin?
- LACTIC ACIDOSIS
- Diarrhoea and abdo pain
Can metformin cause hypoglycaemia?
No
How is the GI upset with metformin relieved?
Dose-dependent
What are the contraindications of metformin?
Liver and renal dysfunction
How does pioglitazone (a type of thiazolidinedione) work?
- Increase insulin sensitivity
- Decrease hepatic gluconeogenesis
- Decrease FFA release
What are the side effects of pioglitazone?
- Weight gain
- Anaemia
- Fractures
- HF and peripheral oedema (fluid ret.)
Does pioglitazone cause hypoglycaemia?
No
When is pioglitazone contraindicated?
Heart Failure
Liver Failure
How do sulfonylureas (gliclazide) work?
Stimulate B cells to release insulin
What are the side effects of sulfonylureas (gliclazide)?
- Weight gain
- Hypoglycaemia
Why shouldn’t sulfonylureas (gliclazide) be given as a monotherapy?
CVD and MI risk when used alone
What are incretins?
Hormones produced by the GI tract
What do incretins do?
- Increase insulin secretion
- Inhibit glucagon
- Slow GI absorption
What inhibits incretins?
DPP-4
What is the most common incretin?
GLP-1
Name a GLP-1 analogue.
Exenatide
What are the side effects of a GLP-1 analogue?
- GI upset
- Weight loss
- Dizziness/Headaches
Can GLP-1 analogues cause hypoglycaemia?
Yes, but low risk
How are GLP-1 analogues administered?
SC Injection, either BD or once weekly
Name a DPP-4 inhibitor.
Sitagliptin
What are the side effects of DPP-4 inhibitors?
- GI upset
- URTIs
- Pancreatitis
How do DPP-4 inhibitors work?
Inhibit DPP-4, increasing GLP-1 activity.
How do SGLT-2 inhibitors work?
Inhibit SGLT-2 in the proximal tubules of the nephron, reducing glucose reabsorption, increasing excretion
Name some SGLT-2 inhibitors.
- Empagliflozin
- Canagliflozin
- Dapagliflozin
What does SGLT-2 inhibition cause?
Glycosuria
What effect do SGLT-2 inhibitors also have?
Reduce risk of cardiovascular disease e.g. CVA, MI, HF
What are the side effects of SGLT-2 inhibitors?
- Weight loss
- UTIs
- DKA (Rare)
How does insulin work?
- Causes cells to take in glucose
- Increases glycogenesis in the liver and muscles
Name two rapid-acting insulins.
10 mins onset, 4 hours duration
- Novorapid
- Humalog
Name two short-acting insulins.
30 mins onset, 8 hours duration
- Actrapid
- Humulin S
Name two intermediate-acting insulins.
1 hour onset, 16 hours duration
- Insulatard
- Humilin I
Name two long-acting insulins.
1 hour onset, 24 hour duration
- Degludec (lasts 40 hours)
- Levemir
Name three combination insulins and their ratios.
Humalog 25 (25:75)
Humalog 50 (50:50)
Novomix (30:70)
(Long acting:Short acting)
