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Endocrinology > Drugs - diabetes > Flashcards

Drugs - diabetes Flashcards

1
Q

What is the first line drug used in diabetes?

A
  • Metformin
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2
Q

Metformin is __hyrdophillic/hydrophobic___

A
  • hydrophilic
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3
Q

Where does metformin predominently concentrate?

A
  • intestine
  • liver
  • kidney
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4
Q

Metformin is excreted___

A
  • unchanged
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5
Q

Metformin can be described as a weak cellular poison.

True or false?

A
  • True
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6
Q

Briefly explain the action of metformin?

A
  • inhibition of complex 1 of electron transport chain
  • fall in cellular ATP
  • rise in AMP kinase
  • reduction in gluconeogenesis
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7
Q

What is the rough drop in HbA1c by metformin?

A
  • 18mmol/mol
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8
Q

What are side effects of metformin?

A
  • GI intolerance

- MALA (metformin associated lactic acidosis)

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9
Q

Metformin dose should be __increased/decreased__ with decreasing renal function?

A
  • decreased
  • should start to be decreased when eGFR <45ml/min
  • should be stopped when eGFR <30ml/min
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10
Q

Name the most commonly used sulphonylureas?

A
  • Gliclazide
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11
Q

How do sulphonylureas work?

A
  • bind to SURI
  • closer of ATP sensitive K+ channels
  • rise in membrane potential
  • depolarisation
  • opening of Ca2+ channels
  • insulin released
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12
Q

sulphonylureas can be described as what?

A
  • insulin secretagogues
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13
Q

Side effects of sulphonylureas

A
  • increase weight
  • risk of hypoglycaemia
  • lack of CV benefit
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14
Q

What diabetes drug is known for its cardiovascular benefit?

A
  • metformin
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15
Q

Name a thiazolidinediones drug?

A
  • Pioglitazone
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16
Q

Thiazolidinediones are described as what type of drug?

A
  • insulin sensitiser
17
Q

Explain the effect of thiazolidinediones?

A
  • increase fat mass storage
  • removes fat from liver, muscle and pancreas
  • increases adiponectin, increases insulin sensitivity
18
Q

Side effects of thiazolidinediones

A
  • increased weight
  • reduction in blood pressure
  • fluid retention
  • fracture risk
19
Q

Explain the incretin effect?

A
  • equal amount of glucose given both IV and oral shows that less insulin is produced when IV
  • GLP-1 in the gut good for increasing insulin production
20
Q

What are the 2 types of drugs that work alongside the incretin effect?

A
  • GLP-1 agonists

- DDP4 antagonists

21
Q

What are the pathways of incretin drugs?

A
  • amplify secretion of insulin
22
Q

What is the simple result of GLP-1 agonists?

A
  • increase insulin
  • decrease glucagon
  • decrease gastric emptying
23
Q

Name a DDP4 inhibitor?

A
  • sitagliptin
24
Q

What is the role of DD4?

A
  • Inactives GLP-1 and GIP
25
Q

DDP4 inhibitors are insulin_____

A
  • secretors

- block the breakdown of GLP-1

26
Q

Name a GLP-1 receptor agonist?

A
  • liraglutide

- Semaglutide

27
Q

What is the main mode of delivery of GLP-1 receptor agonists?

A
  • subcutaneous injection
28
Q

2nd line drug treatment for diabetic patients with atherosclerotic risk?

A
  • GLP-1 agonist
29
Q

What is the effect on weight of GLP-1 and DDP4 antagonist?

A
  • GLP-1 = weight loss

- DPP4 = weight neutral

30
Q

Name a SGLT2 inhibitor?

A
  • dapagliflozin
31
Q

What is the main role of SGLT2 inhibitors?

A
  • block the reabsorption of glucose in the kidneys
  • causes excretion of glucose
  • lowering blood glucose levels
32
Q

What is the 2nd line diabetic medication for patients with kidney failure or heart failure?

A
  • SGLT2 inhibitor(dapagliflozin)
33
Q

What are the bad side effects of SGLT2 inhibitors?

A
  • Thrush

- risk of DKA

34
Q

What are the good side effects of SGLT2 inhibitors?

A
  • reduce cardiovascular death
  • good for kidneys
  • weight loss
  • urate lowering
35
Q

What percentage of glucose is reabsorbed by SGLT2 transporters in the kidneys?

A
  • 90% of glucose

Endocrinology (16 decks)

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