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Drugs In Healthcare > Insulin Resistance As A Drug Target > Flashcards

Insulin Resistance As A Drug Target Flashcards

1
Q

Risk factors of T2 diabetes?

A

Older age
Ethnicity
Hypertension
Family history
Obesity
Increased alcohol intake
Smoking
Polycystic ovarian syndrome
Antipsychotic medication
Steroids

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2
Q

Clinical features/symptoms of diabetes and persistent hyperglycaemia I.e

A

HbA1c 48 mol/mol or more
Fasting plasma glucose 7 mmol/L or more
Random plasma glucose 11.1 mmol/L or more
Plasma glucose of 11.1mmol/L or more 2 hours after OGTT

IF PATIENT ASYMPTOMATIC
2X fasting plasma glucose samples >7mmol/L

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3
Q

Insulin resistance

A

Where the body is unable to respond to normal levels of insulin

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4
Q

Relative insulin deficiency

A

Where the pancreas is unable to secrete enough insulin to compensate for this resistance

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5
Q

T2 diabetes caused by combination of?

A

Insulin resistance and relative insulin deficiency

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6
Q

Pre-diabetes may refer to?

A

Impaired fasting glucose
Impaired glucose tolerance

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7
Q

Impaired fasting glucose

A

Higher than normal blood glucose after a period of fasting

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8
Q

Impaired glucose tolerance

A

Higher than normal blood glucose after eating or OGTT

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9
Q

Why is pre-diabetes: impaired fasting glucose (IFG) and impaired glucose tolerance ( IGT) important

A

They are considered to be a stage of development of T2 diabetes and a risk factor of CVD

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10
Q

GESTATIONAL diabetes

A

A degree of glucose intolerance with onset (or first diagnosis) during pregnancy and usually resolving shortly after delivery

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11
Q

Hormones secreted by the placenta during pregnancy increase or decrease insulin resistance?

A

Increase
During pregnancy, post-grandial glucose conc. increase as insulin resistance increase

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12
Q

Managing T2 diabetes

A

Adult with T2 diabetes
Lifestyle interventions + dietary control
Consider mono therapy
Consider dual therapy
Consider triple therapy/ consider insulin programme

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13
Q

Examples of diabetic drug

A

Metformin
Sulphonylureas
GLP-1 agonists
DPP4 inhibitors
SGLT-2 inhibitors
Thiazolidinediones

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14
Q

Examples of Sulphonylureas and mechanism

A

Gliclazide
Mechanism= stimulates pancreatic insulin secretion by blocking K+ channels in pancreatic beta cells

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15
Q

GLP-1 agonists: example and mechanism of action

A

Exenatide/ Liraglutide
Mechanism = increases insulin secretion from beta cells after meals + suppresses glucagon release + reduces gastric emptying, increases satiety

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16
Q

GLP-1 meaning

A

Glucagon like peptide 1

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17
Q

DPP4 inhibitors :example and mechanism of action

A

Sitagliptin , linagliptin
Delays inactivation of GLP-1

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18
Q

SGLT-2 inhibitors: example and mechanism of action

A

Dapagliflozin
Mech= inhibits renal absorption of glucose

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19
Q

Thiazolidinediones: example and mechanism of action

A

Enhances insulin action= increased peripheral glucose uptake + gluconeogenesis

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20
Q

Diabetic drug that has an advantage of weight loss

A

Metformin,
GLP-1 inhibitors (consider use if BMI > 35)
, SGLT-2 inhibitors ( CAN improve BP)

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21
Q

SGLT-2 stands for?

A

Sodium-glucose co- transporter-2

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22
Q

Advantages of sulphonylureas

A

Good reduction in HbA1c

23
Q

The haemoglobin A1c- HbA1c measures?

A

The amount of blood sugar (glucose) attached to your haemoglobin

24
Q

DPP4 inhibitors advantages:

A

Generally well-tolerated, helps reduces appetite= weight loss

25
Thiazolidinediones advantages:
Increase insulin sensitivity
26
Micro vascular complications
Retinopathy (eye damage) Nephropathy (kidney damage) Neuropathy (nerve damage)
27
Retinopathy - management
Annual retinal screening/monitoring using digital retinal photography Tight glycaemic control BP control Hyperlipidaemia management Proliferative retinopathy
28
Proliferative retinopathy examples:
Laser photocoagulation Vascular endothelial growth factor inhibitors (bevazcizumab) Virectomy
29
Damage to glomeruli=
Proteinuira
30
Nephropathy management early on to catch diagnosis
Monitor renal function and albuminuria (albumin: creatinine ratio) to catch early diagnosis
31
Nephropathy management
Tight blood glucose control BP control- ACE inhibitor Low protein diet Lipid control
32
Neuropathy
Nerve damage secondary to hyperglycaemia
33
Common symptoms of neuropathy
Loss of sensation Numbness and tingling in hands and feet Muscle weakness Dizziness when standing up Erectile dysfunction/vaginal distress Inability to sense low blood sugar
34
Neuropathy management
Patient education e.g. correct shoe fitting Annual foot review Manage neuropathic pain with analgesia e.g gabapentin Manage ulcers
35
Commonest cause of death in T2 diabetes?
Ischaemia heart disease Central process= atherosclerosis leading to narrowing of arterial walls
36
Micro vascular complications of diabetes
Changes in medium to large vessels : retinopathy, Nephropathy, neuropathy
37
Macro vascular management
Optimise glycaemia control Patient education - healthy diet Control other CDK risk factors e.g: BP control
38
When to offer statins (Atorvastatin 20 mg) in T2DM if:
<85 years and 10% risk of developing CDK(QRISK score) OR Has chronic kidney disease OR >84 year (take into account preferences, benefits/risks, comorbidities)
39
When to offer statins (Atorvastatin 20 mg) in T1DM if:
>40 years OR HAD diabetes > 10 years OR Established Nephropathy OR Has other CVD risk factors
40
When to start ACE inhibitors?
If albuminuria and BP > 130/80 IF NO albuminuria, then start ACE inhibitor if > 135/80
41
albuminuria
a sign of kidney disease and means that you have too much albumin in your urine
42
Ramipril
ACE inhibitor for hypertension etc = inactive prodrug that is converted to ramiprilat in liver= antagonises effect RAAS (inhibits release of renin)
43
Sitaglipin mech of action
Insulin secretagogue
44
Exenatide mech
Insulin secretagogue
45
Metformin mech
Insulin sensitiser and uptake of insulin by skeletal muscle Suppress hepatic gluconeogenesis
46
Tolbutamide mech
Insulin secretagogue
47
Pioglitazone mech
Insulin sensitiser
48
Empagliflozin mech
Increase glucose excretion
49
Linagliptin mech
DPP4 inhibitor
50
Dapagliflozin mech
SGLT2 inhibitor
51
Pioglitazone mech
PPAR gamma
52
Glimperide mech
Binds to SUR1 receptor blocking ATP dependent efflux of potassium
53
Liraglutide receptor
GLP-1 receptor agonist
54
Complications of gestational diabetes can include which of hte following
Increased risk of premature labour

Drugs In Healthcare (12 decks)

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