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Junior Medicine- Endocrine > DM- Pharmacology > Flashcards

DM- Pharmacology Flashcards

1
Q

What is the first line medication for T2DM?

A

Metformin

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2
Q

What are the second line medications for T2DM?

A

Added to metformin:

  • Sulfondylurea (Gliclazide)
  • Pioglitazone (Thiazolidinedione)
  • Incretins (GLP-1)
  • SGLT-2 inhibitor (empagliflozin)
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3
Q

How does metformin work?

A
  • Biguanide

- Increases insulin sensitivity and decreases hepatic gluconeogenesis

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4
Q

What is important about metformin?

A

Weight neutral

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5
Q

What side effects are there to metformin?

A
  • LACTIC ACIDOSIS

- Diarrhoea and abdo pain

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6
Q

Can metformin cause hypoglycaemia?

A

No

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7
Q

How is the GI upset with metformin relieved?

A

Dose-dependent

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8
Q

What are the contraindications of metformin?

A

Liver and renal dysfunction

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9
Q

How does pioglitazone (a type of thiazolidinedione) work?

A
  • Increase insulin sensitivity
  • Decrease hepatic gluconeogenesis
  • Decrease FFA release
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10
Q

What are the side effects of pioglitazone?

A
  • Weight gain
  • Anaemia
  • Fractures
  • HF and peripheral oedema (fluid ret.)
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11
Q

Does pioglitazone cause hypoglycaemia?

A

No

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12
Q

When is pioglitazone contraindicated?

A

Heart Failure

Liver Failure

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13
Q

How do sulfonylureas (gliclazide) work?

A

Stimulate B cells to release insulin

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14
Q

What are the side effects of sulfonylureas (gliclazide)?

A
  • Weight gain

- Hypoglycaemia

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15
Q

Why shouldn’t sulfonylureas (gliclazide) be given as a monotherapy?

A

CVD and MI risk when used alone

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16
Q

What are incretins?

A

Hormones produced by the GI tract

17
Q

What do incretins do?

A
  • Increase insulin secretion
  • Inhibit glucagon
  • Slow GI absorption
18
Q

What inhibits incretins?

A

DPP-4

19
Q

What is the most common incretin?

A

GLP-1

20
Q

Name a GLP-1 analogue.

A

Exenatide

21
Q

What are the side effects of a GLP-1 analogue?

A
  • GI upset
  • Weight loss
  • Dizziness/Headaches
22
Q

Can GLP-1 analogues cause hypoglycaemia?

A

Yes, but low risk

23
Q

How are GLP-1 analogues administered?

A

SC Injection, either BD or once weekly

24
Q

Name a DPP-4 inhibitor.

A

Sitagliptin

25
Q

What are the side effects of DPP-4 inhibitors?

A
  • GI upset
  • URTIs
  • Pancreatitis
26
Q

How do DPP-4 inhibitors work?

A

Inhibit DPP-4, increasing GLP-1 activity.

27
Q

How do SGLT-2 inhibitors work?

A

Inhibit SGLT-2 in the proximal tubules of the nephron, reducing glucose reabsorption, increasing excretion

28
Q

Name some SGLT-2 inhibitors.

A
  • Empagliflozin
  • Canagliflozin
  • Dapagliflozin
29
Q

What does SGLT-2 inhibition cause?

A

Glycosuria

30
Q

What effect do SGLT-2 inhibitors also have?

A

Reduce risk of cardiovascular disease e.g. CVA, MI, HF

31
Q

What are the side effects of SGLT-2 inhibitors?

A
  • Weight loss
  • UTIs
  • DKA (Rare)
32
Q

How does insulin work?

A
  • Causes cells to take in glucose

- Increases glycogenesis in the liver and muscles

33
Q

Name two rapid-acting insulins.

A

10 mins onset, 4 hours duration

  • Novorapid
  • Humalog
34
Q

Name two short-acting insulins.

A

30 mins onset, 8 hours duration

  • Actrapid
  • Humulin S
35
Q

Name two intermediate-acting insulins.

A

1 hour onset, 16 hours duration

  • Insulatard
  • Humilin I
36
Q

Name two long-acting insulins.

A

1 hour onset, 24 hour duration

  • Degludec (lasts 40 hours)
  • Levemir
37
Q

Name three combination insulins and their ratios.

A

Humalog 25 (25:75)

Humalog 50 (50:50)

Novomix (30:70)

(Long acting:Short acting)

Junior Medicine- Endocrine (10 decks)

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