Drugs Used In Diabetes Flashcards
Semi-synthetic Insulin label
EMP
Bio-Synthetic Insulin label
PRB, CRB or PYR
What is Isophane Insulin
Complexed with protamine
What is Biphasic Isophane
Mix of protamine insulin and soluble insulin
New Human Insulin Analogues
Aspart, Glulisine, Degludec, Lispro, Gargine, Determir
Rapid acting example and counselling point
Novorapid - take 5mins before eating, during or straight after
Short acting example and counselling point
Actrapid/ Humulin S - take 15 mins before eating
Analogue mixture example and counselling point
Novomix 30 - 5mins before eating, during or straight after
Medium and Long acting examples and counselling point
Medium - Insulatard
Longer - Levemir and lantus
Inject at night
Mixture example and counselling point
Humulin M3 - 20/30 mins before food
+ve and -ve of multiple regimen
Flexible - can delay meals
More injections
+ve and -ve of Twice daily regimen
Less injections
Fixed times for injections, not flexible- needs constant food intake.
Name classes of drugs affecting Insulin SECRETION (SMGD)
Sulphonylureas
Meglitinides
GLP-1 agonists
DPP-4 inhibitors
Name classes of drugs affecting cellular Energy METABOLISM (MP)
Metformin
PPAR-y agonists
Name classes of drugs affecting absorption and reabsorption of GLUCOSE (SG)
SGLT-2 inhibitors
alpha-Glucosidase Inhibitors
Mechanism of action of Sulphonylureas and Meglitinides
Block the ATP-sensitive K+ clannels causing depolarisation in the cell, therefore votage gated Ca2+ channels open and conc. of Ca2+ increases. Ca2+ released from cell by exocytosis in vesicles/granules with insulin.
Risk of hypoglycaemia as insulin conc. increased without glucose/
Mechanism of action of GLP-1 Agonists
GLP-1 increases the glucose-dependent secretion of insulin.
It acts on the GLP-1 G-protein coupled receptors (GPCR) in B-cells
G alpha S
Mechanism of action of DPP-4 Inhibitors
GLP-1 has a short half life.
DPP-4 inactivates GLP-1 in plasma.
Therefore, inhibitor inhibits breakdown of GLP-1 allowing the insulin secretion to increase.
Mechanism of action of Metformin
Inhibits complex 1 in mitochondria , therefore less ATP is made which activates AMPK, causing lipolysis and inhibits fat synthesis and transcription of gluconeogenesis enzymes.
Increases function of insulin receptors.
Reduces gluconeogenesis in liver.
Increases peripheral glucose uptake and utilization.
Mechanism of action of PPAR-y
Regulates transcription of genes involved in fatty acid storage and glucose metabolism.
Therefore, increases sensitivity to insulin by increasing transcription of genes involved in insulin signalling and therefore increases effectiveness of insulin.
Mechanism of action of SGLT-2 Inhibitors
Inhibitors decrease reabsorption of glucose in proximal kidney and therefore increase concentrations of glucose in the urine.
Mechanism of action of Alpha-Glucosidase Inhibitors
Alpha-glycosidase breaks down maltose to glucose in GIT. Inhibiting this prevents maltose -> glucose. Therefore, decreases glucose absorption after a meal.
Where is Insulin secreted from
B-cells of islet of langerhans
What does insulin target
Tyrosine kinase receptors
