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MET3B > Drugs used in the treatment of type 2 diabetes > Flashcards

Drugs used in the treatment of type 2 diabetes Flashcards

1
Q

How often should a type 2 diabetic be seen for review? What should the review include?

A

Review of symptoms
▪ Review clinical issues – glucose levels, BP, cholesterol, urine
albumin creatinine ratio (ACR)
▪ Screen for complications – Eyes - digital retinal photography yearly

Feet - yearly check for nerves and pulses

Kidneys - yearly ACR and estimated GFR (ie serum creatinine)

▪ Issues identified can be addressed at subsequent visits
▪ An opportunity to develop targets over the next year

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2
Q

What is the goal blood pressure for diabetic patients?

What is the first line medication recommended to control hypertension in diabetics?

A

140/80 mmHg (130/80 mmHg if CVD or Renal d) (some places = 135/85)

First line Ace inhibitors
then
calcium Channel blockers
often need > 2 medications

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3
Q

When should a diabetic patient be put on a statin?

What is the aim for total cholesterol and LDL?

A

Diabetic >40 or Diabetic <40 + 1 risk factor
total cholesterol aim = <4.0 mmol
LDL = <2.0 mmol

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4
Q

What is the goal cholesterol level for diabetic patients?

A

Aim for total cholesterol < 4.0 mmol/L, LDL < 2.0 mmol/L

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5
Q

Which blood test is used to replace HbA1c if it becomes invalid for some reason e.g haemoglobinopathies?

A

Fructosamine
lasts around 2 weeks

May be useful in to measure glucose control in pregnancy

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6
Q

What type of carbohydrates are recommended for diabetic patients?

A

low glycaemic index

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7
Q

How much exercise is recommended for diabetic patients?

A

at least 30 minutes vigorous exercise 3x per week

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8
Q

Name all 7 drugs used to treat diebetes?

A

Sulfonylureas / Prandial glucose regulators (PGRs)

Biguanides

Alpha glucosidase inhibitors

Thiazolidinediones (glitazones)

DPP-4 inhibitors

GLP-1 analogues

Insulin

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9
Q

Name the Biguanide drug is used to treat diabetes. State its mode of action, positive components and potential side effects

A

Metformin

MOA - Enhances the effect of insulin - increases insulin sensitivity.
Reduce the rate of gluconeogenesis, and hence hepatic glucose output

Positives -

  • Does not cause hypoglycaemia
  • Does not cause weight gain
  • Suitable for those over weight

S.E -

  • Lactic acidosis (avoid in people with sever hepatic or renal disease)
  • Stop using when serum creatinine >150 µmol/L.
  • Weight loss
  • GI disturbances (diarrhoea, abdominal cramps)
  • Reduces vitamin B 12 absorption
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10
Q

Describe the relationship between the use of metformin and the administration of iodinated contrast agent?

A

Metformin must be stopped prior to intravascular administration of iodinated contrast agent because of the risk of renal failure and subsequent lactic acidosis. Restart no earlier than 48 h after test of renal function has shown no deterioration.

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11
Q

Name the Sulphonylureas drugs used to treat diabetes. State their mode of action, positive components and potential side effects

A

Drugs - Gliclazide, glyburine, glimperide, Chlorpropamide, Glibenclamide, Tolbutamide

MOA
- Increases insulin secretion from Beta cells. Bind to the sulphonylurea receptor on the cell membrane, which closes ATP-sensitive potassium channels and blocks potassium efflux. The resulting depolarization promotes influx of calcium, a signal for insulin release

Positives -

  • Cheap
  • Effective in obtaining short term (1-3y) glucose control

S.E

  • ineffective in patients with no functional β-cell mass
  • Avoid in pregnancy
  • Increased cardiovascular morbidity and mortality
  • Weight gain (do not use if over weight)
  • Hypoglycaemia
  • should be used with care in patients with liver disease
  • Patients with renal impairment should use sulphonylureas primarily excreted by the liver
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12
Q

Which Sulphonylureas drugs can be used in renal impairment?

A

Gliclazide

Tolbutamide

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13
Q

Name the Meglitinides drugs used to treat diabetes. State their mode of action and potential side effects

A

Drugs -
Repaglinide and Nateglinide

MOA- Increases insulin secretion from Beta cells in response to meals.

S.E

  • Hypoglycaemia
  • Weight gain
  • Do not use in sever renal or liver failure
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14
Q

Name the Thiazolidinediones drug used to treat diabetes. State their mode of action and potential side effects

A

Drugs
- Pioglitazone

MOA-

  • Reduce insulin resistance by stimulating peroxisome proliferator-activated receptor-gamma (PPAR-γ)
  • Increase transcription of adipokines
  • hepatic glucose production
  • enhance peripheral glucose uptake

S.E

  • weight gain of 5–6 kg
  • Fluid retention (oedema)
  • heart failure and a modestly increased risk of bladder cancer
  • Mild anaemia
  • Osteoporosis (increased risk of bone fractures)

Should not be used in patients with

  • Congestive heart failure
  • Liver failure
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15
Q

Where are peroxisome proliferator-activated receptor-gamma (PPAR-γ) receptors mainly found?

A

Fat cells

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16
Q

Name the Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) drugs used to treat diabetes. State their mode of action, positive components and potential side effects

A

Drug -
Saxagliptin
Sitagliptin
alogliptin

MOA-

  • Normally DPP-4 inactivates glucagon-like peptide-1 (GLP-1)
  • Th drug Inhibits GLP-1 degradation
  • increase glucose dependant insulin secretion
  • lowers glucagon secretions
  • most effective in the early stages of type 2 diabetes, when insulin secretion is relatively preserved

Positives -

  • moderate effect in lowering blood glucose
  • weight-neutral

S.E

  • nausea
  • acute pancreatitis
  • Athralgia
  • Headaches
  • Dizziness
  • Nasopharyngitis

Do not use in liver failure or moderate to sever renal failure

17
Q

Name the Sodium/glucose transporter 2 inhibitors (SGLT2 inhibitor) drugs used to treat diabetes. State their mode of action, positive components and potential side effects

A

Drugs

  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin

MOA-
(SGLT2) is a sodium-dependent glucose transport protein located in the proximal renal tubules, whose function is to reabsorb glucose from the renal filtrate and restore it to the circulation.
- Increases excretion of glucose in the urine

Positives

  • Causes weight loss
  • Small reductions in systolic blood pressure

S.E

  • increase in genital candidiasis
  • small increase in urinary tract infections
  • Polyuria
  • Dehydration
  • a decrease in cardiovascular mortality
  • Diabetic ketoacidosis
18
Q

Name the GLP-1 agonists drugs used to treat diabetes. State their mode of action, positive components and potential side effects

A

Drug

  • Exenatide
  • Lixisenatide
  • Liraglutide
  • Albiglutide

Injectable drugs

MOA-

  • Directly stimulate GLP-1 receptor
  • increase insulin secretion
  • inhibit glucagon secretion
  • delay gastric emptying
  • have central effects on appetite

Positives

  • Weight loss
  • Decreases food intake and induces satiety

S.E

  • limited benefit in 30% of those treated
  • nausea
  • acute pancreatitis
  • Pancreatic cancer
  • acute kidney injury

used as an alternative to insulin, particularly in the overweight

Do not use in those with pre-existing gut motility disorders

only allowed to be given to people with BMI >35 kg/m2 and poor glucose control

19
Q

Name the alpha glucosidase inhibitor drugs used to treat diabetes. State their mode of action, positive components and potential side effects

A

Drug
- Acarbose

MOA-
Reduce intestinal glucose absorption

S.E
GI complaints (fluctuance, diarrhoea, feeling full)

Do not use in those with pre-existing intestinal issues e.g. IBD, )
Do not use in sever renal failure

20
Q

Where does GLP-1 come from and which cell produces it?

A

L-cells in the GI-tract

21
Q

What is the guideline for the treatment of type 2 diabetes with glucose lower drugs

A 
HbA1c >48 mmol/mol after
lifestyle
 Metformin
Consider sulfonylurea if not overweight, metformin
contraindicated, not tolerated
HbA1c >48 mmol/mol
\+ sulfonylurea
Consider PGRs if erratic lifestyle
pioglitazone or DPP-4 here if hypoglycaemia a problem, or
metformin not tolerated

HbA1c >58 mmol/mol
+ pioglitazone or gliptin (DPP-4 inhibitors) or insulin
Consider GLP-1 analogue if: BMI >35,

HbA1c >58 mmol/mol
insulin + metformin + sulphonylurea

HbA1c >58 mmol/mol

Intensify insulin or add glitazone
Consider pioglitazone + insulin if high dose insulin
ineffective

22
Q

How should metformin be taken?

A

Slow titration of metformin, take after meals

23
Q

Before a patient is put on metformin and while they are on metformin their eGFR should be assessed, why?

A

Care with dose of metformin of eGFR <45, stop if <30.

24
Q

What are the indications for starting insulin therapy in type 2 diabetics?

A

inadequate glycaemic control on tablets

contraindications to tablets

symptomatic hyperglycaemia

pregnancy

infection / foot ulcers

25
Q

How is insulin given in those with types 2 diabetes?

A

Once-daily - intermediate or long acting insulin, given in addition to tablets. Usually given before bed or first thing in the morning

Twice-daily - premixed insulin twice daily
morning and evening. Contains basal and short acting component

Basal bolus therapy - 3 injections of rapid acting, 1 injection of long acting
Mimics normal physiology
Breakfast, lunch, dinner, long acting at night before bed

intermediate- or
long-acting (basal) insulin

MET3B (17 decks)

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