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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
Q

Thiazolidinediones advantages:

A

Increase insulin sensitivity

26
Q

Micro vascular complications

A

Retinopathy (eye damage)
Nephropathy (kidney damage)
Neuropathy (nerve damage)

27
Q

Retinopathy - management

A

Annual retinal screening/monitoring using digital retinal photography
Tight glycaemic control
BP control
Hyperlipidaemia management
Proliferative retinopathy

28
Q

Proliferative retinopathy examples:

A

Laser photocoagulation
Vascular endothelial growth factor inhibitors (bevazcizumab)
Virectomy

29
Q

Damage to glomeruli=

A

Proteinuira

30
Q

Nephropathy management early on to catch diagnosis

A

Monitor renal function and albuminuria (albumin: creatinine ratio) to catch early diagnosis

31
Q

Nephropathy management

A

Tight blood glucose control
BP control- ACE inhibitor
Low protein diet
Lipid control

32
Q

Neuropathy

A

Nerve damage secondary to hyperglycaemia

33
Q

Common symptoms of neuropathy

A

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
Q

Neuropathy management

A

Patient education e.g. correct shoe fitting
Annual foot review
Manage neuropathic pain with analgesia e.g gabapentin
Manage ulcers

35
Q

Commonest cause of death in T2 diabetes?

A

Ischaemia heart disease
Central process= atherosclerosis leading to narrowing of arterial walls

36
Q

Micro vascular complications of diabetes

A

Changes in medium to large vessels : retinopathy, Nephropathy, neuropathy

37
Q

Macro vascular management

A

Optimise glycaemia control
Patient education - healthy diet
Control other CDK risk factors e.g: BP control

38
Q

When to offer statins (Atorvastatin 20 mg) in T2DM if:

A

<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
Q

When to offer statins (Atorvastatin 20 mg) in T1DM if:

A

> 40 years OR
HAD diabetes > 10 years OR
Established Nephropathy OR
Has other CVD risk factors

40
Q

When to start ACE inhibitors?

A

If albuminuria and BP > 130/80
IF NO albuminuria, then start ACE inhibitor if > 135/80

41
Q

albuminuria

A

a sign of kidney disease and means that you have too much albumin in your urine

42
Q

Ramipril

A

ACE inhibitor for hypertension etc
= inactive prodrug that is converted to ramiprilat in liver= antagonises effect RAAS (inhibits release of renin)

43
Q

Sitaglipin mech of action

A

Insulin secretagogue

44
Q

Exenatide mech

A

Insulin secretagogue

45
Q

Metformin mech

A

Insulin sensitiser and uptake of insulin by skeletal muscle
Suppress hepatic gluconeogenesis

46
Q

Tolbutamide mech

A

Insulin secretagogue

47
Q

Pioglitazone mech

A

Insulin sensitiser

48
Q

Empagliflozin mech

A

Increase glucose excretion

49
Q

Linagliptin mech

A

DPP4 inhibitor

50
Q

Dapagliflozin mech

A

SGLT2 inhibitor

51
Q

Pioglitazone mech

A

PPAR gamma

52
Q

Glimperide mech

A

Binds to SUR1 receptor blocking ATP dependent efflux of potassium

53
Q

Liraglutide receptor

A

GLP-1 receptor agonist

54
Q

Complications of gestational diabetes can include which of hte following

A

Increased risk of premature labour

Drugs In Healthcare (12 decks)

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