Endo- diabetes drugs Flashcards
main treatment for T1DM
insulin
insulin basal-bolus regimen
Long-acting insulin 1-2 times a day and short-acting insulin before each meal
when do short acting soluble insulins reach their peak
2-4 hours after injection
short acting soluble insulins examples
actrapid
humulin S
when do short acting insulin analogues reach their peak
60-90 mins after injection
short acting insulin analogues examples
insulin aspart (NovoRapid)
lispro (Humalog)
glulisine (apidra)
what short acting insulins are preferred- soluble/analogues
analogues- disappear from circulation more rapidly
when do isophane basal insulins reach their peak
4-6 hours
when do analogue basal insulins reach their peak
longer duration of action with less peak activity and may be given once or twice daily
isophane basal insulins examples
insulatart
humulin
analogue basal insulin examples
Lantus (glargine)
Levemir (dertermir)
why should injection site be rotated when injecting insulin
to prevent lipohyperthrophy
adverse effect of insulin
weight gain
risk of hypoglycaemia
first line medication in T2DM
biguanide (metformin)
metformin has a CVS benefit true/false
true
when is metformin contraindicated
in renal impairment, heart failure, and hepatic failure because of the risk of lactic acidosis
adverse effects of metformin
GI- anorexia, nausea, abdominal pain, diarrhoea
lactic acidosis
Sulphonylureas example
gliclazide
alternative first line medication in T2DM where cost is a major issue
Sulphonylureas
mechanism of action of Sulphonylureas
bind to the Sulphonylurea receptor of beta cells, which closes ATPase K+ channels, resulting in influx of Ca2+, which stimulates insulin release
adverse effects of Sulphonylureas
weight gain
hypoglycaemia
what is the only TZDs currently available
pioglitazone
follow on to metformin where cost is a major issue
TZDs
avoid TZDs in which patients
> 65 due to side effects
TZDs are particularly potent in which patients
obese women
adverse effects of TZDs
weight gain
> risk of fracture
mild anaemia
which diabetic drug is associated with fluid retention
TZDs
examples of GLP-1 receptor antagonists
liraglutide
semaglutide
diabetic patients with atherosclerotic CVD should be given
metformin + GLP-1 receptor antagonist
diabetic patients with heart failure or chronic kidney disease should be given
metformin + SGLT2i
diabetic patients with heart failure or chronic kidney disease where SGLTi are contraindicated
metformin + GLP-1 receptor antagonist
non glucose effects of GLP-1 receptor antagonists
reduce appetite
lower blood pressure
< CVS risk
when are GLP-1 receptor antagonists contraindicated
in patients with a history of acute pancreatitis
adverse effects of GLP-1 receptor antagonists
GI- bloating, nausea, vomiting, diarrhoea
small increase in incidence of gallstones
is there is a risk of hypo with GLP-1 receptor antagonists
no
examples of DPP4 inhibitors
sitagliptin
alogliptin
saxagliptin
main indications of DPP4 inhibitors
most effective in early stages of T2DM
can be used as mono therapy where metformin is contraindicated, or as an add on
non glucose effect of DPP4 inhibitors
lowers blood pressure
adverse effects of DPP4 inhibitors
> risk of acute pancreatitis
nausea
weight neutral
is there a risk of hypo with DPP4 inhibitors
no
examples of SGLT2i
empagliflozin
dapagliflozin
canagliflozin
when should you use SGLT2i with caution
in patients already on a diuretic
adverse effects of SGLT2i
genital candiasis
hypovolaemia and hypotension
dehydration
DKA
slight increase in LDL and HDL cholesterol
which class of diabetic drugs increase the risk of UTIs
SGLT2i
which diabetic drug reduces hepatic gluconeogenesis
metformin
mechanism of action of metformin
reduces hepatic glucose production (gluconeogenesis)
increased gut glucose utilisation and metabolism
which drug used in the treatment of T2DM works by inhibiting a brush border enzyme in the small intestine responsible for the absorption of disaccharrides
alpha-glucosidase inhibitor eg acarbose
