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Anaesthetic FRCA Primary - eLFH Pharmacology > eLFH - Drugs used to treat Diabetes Mellitus > Flashcards

eLFH - Drugs used to treat Diabetes Mellitus Flashcards

1
Q

Definition of diabetes mellitus

A

Chronic multisystem disease with dysregulation of plasma glucose control resulting in macrovascular and microvascular complications

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2
Q

Classification of diabetes mellitus

A

Type 1 - absolute insulin deficiency

Type 2 - insulin deficiency or resistance

Type 3 - drug induced

Type 4 - gestational diabetes

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3
Q

Diagnosis of diabetes

A
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4
Q

Insulin administration

A

SC or IV

Short, medium or long acting preparations

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5
Q

Functions increased by insulin

A

Glucose uptake into muscle and fat

Glycogen synthesis

Fat synthesis

Protein synthesis

K+ uptake by cells

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6
Q

Functions decreased by insulin

A

Fat breakdown

Ketone body synthesis

Glycogen breakdown

Gluconeogenesis

Protein breakdown

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7
Q

Sulphonylurea mechanism of action

A

Increases insulin release - displaces insulin bound to beta cells

Decreases peripheral insulin resistance

Decreases glucagon secretion

Decreases hepatic insulinase activity

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8
Q

Sulphonylurea use

A

Oral hypoglycaemic

Primarily used on T2DM

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9
Q

Sulphonylurea examples

A

Gliclazide

Glibenclamide

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10
Q

Sulphonylurea pharmacokinetics

A

80% oral bioavailability

Bound to albumin

Liver metabolism

Renal excretion

Half life 8 - 12 hours

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11
Q

Side effect of sulphonylureas

A

Hypoglycaemia

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12
Q

Drugs which inhibit effect of sulphonylureas

A

Thiazides

Corticosteroids

Phenothiazines (e.g. prochlorperazine, promethazine)

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13
Q

Biguanide structure

A

2 guanide rings

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14
Q

Biguanide mechanism of action

A

Decreases gluconeogenesis in liver

Increases peripheral insulin utilisation in skeletal muscle

Delays glucose uptake from gut

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15
Q

Biguanide example

A

Metformin

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16
Q

Biguanide use

A

Oral hypoglycaemic - doesn’t cause hypos

T2DM

17
Q

Biguanide pharmacokinetics

A

60% oral bioavailability

Unbound

Excreted in urine unchanged - caution in renal failure

18
Q

Side effect of biguanides

A

Lactic acidosis

Doesn’t cause hypoglycaemia alone as doesn’t increase insulin release

19
Q

Thiazolidinedione example

A

Rosiglitazone

20
Q

Thiazolidinedione mechanism of action

A

Regulates genes involved in glucose and lipid metabolism

Improves insulin sensitivity

21
Q

Acarbose mechanism of action

A

Delays intestinal glucose absorption

Reduces post-prandial hyperglycaemia

22
Q

SGLT2 (sodium glucose cotransporter 2) inhibitor example

A

Dapagliflozin

23
Q

SGLT2 inhibitor mechanism of action

A

Inhibits glucose reabsorption in kidney

24
Q

Side effects of SGLT2 inhibitors

A

Hypoglycaemia

Negative cardiac chronotropy and inotropy

Glycosuria leading to UTIs

25
Q

DPP4 inhibitor examples

A

Sitagliptin

26
Q

DPP4 inhibitor mechanism of action

A

Prevents breakdown of GIP and GLP1

Gastric inhibitory polypeptide
Glucagon like peptide 1

27
Q

Action of GLP1

A

Endogenous hormone which:
- Decreases gastric emptying
- Improves insulin sensitivity
- Decreases inflammation

28
Q

Action of GIP

A

Endogenous hormone which:
- Stimulates insulin secretion
- Promotes bone formation.
- Facilitates fat deposition
- Reduces inflammation

29
Q

GLP1 receptor agonist examples

A

Dulaglutide

Exenatide

Semaglutide - aka Ozempic

30
Q

Side effects of GLP1 receptor agonists

A

Delayed gastric emptying - nausea and vomiting

Weight loss

31
Q

Anaesthetic precautions with GLP1 receptor agonists

A

Injectable once weekly examples have long half life so would need to be stopped a long time before surgery to reduce aspiration risk

32
Q

HbA1c level cut off required for diabetic patients attending for purely elective surgery, above which surgery should be delayed

A

HbA1c must be < 69

33
Q

Patient insulin pumps mechanism

A

Continuous short acting insulin infusion with feedback loop to sensor

34
Q

Perioperative blood glucose target

A

6 - 10 aim

Slight buffer to avoid hypoglycaemia

35
Q

Anaesthetic issue with diabetic patients

A

Higher aspiration risk due to autonomic dysfunction leading to delayed gastric emptying

Generally avoid using supraglottic airway

Anaesthetic FRCA Primary - eLFH Pharmacology (11 decks)

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