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PHCY 310 > L 26 Pharmacology of T2DM > Flashcards

L 26 Pharmacology of T2DM Flashcards

1
Q

What is T2DM?

A

Dysregulated glucose associated with impaired insulin secretion and action
This is a metabolic disorder

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2
Q

How is blood glucose normally regulated?

A

Pancreatic B cells precisely adjust the amount of insulin secreted to promote glucose uptake AFTER meals.
Pancreatic ‘Beta cells’ produce glucagon to increase glucose output from cells when fasting.

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3
Q

How Insulin is released under FASTING conditions?

A

In a pulsatile manner every 10-14 minutes However,(insulin is almost consistently released in healthy individuals)

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4
Q

Where does insulin act? and what does this do?

A

On a plasma membrane receptor. It activates a cascade of signalling events

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5
Q

What is the half life of insulin?

A

It is a hormone.it reaches in peak within 3-5 mins and remember it has very short half life like 10 minutes.

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6
Q

Where does insulin work?

A

It activates a cascade on a plasma membrane receptor through signalling events.

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7
Q

What does insulin do?

A

Insulin has various effects on our body like uptake use and storage of glucose lipids and amino acids.
It stimulates Glycogenesis, lipogenesis, and protein synthesis.
Inhibits glycogenolysis, lipolysis and proteolysis.
They promote translocation of proteins between cellular compartments, regulates action of specific enzymes and controls gene transcription and mRNA translation.

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8
Q

So what usually happens when a patient has Type 2DM?

A

Insufficient insulin can not maintain plasma glucose concentration within normal range thus dramatically increasing sugar level in blood.
The sensitivity of Beta cell to glucose is impaired.

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9
Q

What occurs to glucose during (untreated) T2DM?

A

Blood glucose rises dramatically after meals.
Failure to restrain liver glucose release during fasting.
Higher rate of lipolysis and release of fatty acids into circulation thus increase dyslipidaemia.

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10
Q

What is insulin resistance?

A

Reduced production of insulin and the amount of glucose produced which been cleared all amount of insulin ti muscle and fat or in blood stream.

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11
Q

Effects of insulin resistance

A
  • Reduced amount of glucose taken up by cells
  • No restraint(under control) on glucose production
  • Higher rates of lipolysis into circulation
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12
Q

Drug treatment options for T2DM

A
  • Insulin secretagogues (sulphonylureas, meglitinides, incretin/GLP-1 agonists, DPP4 inhibitors)
  • Exogenous insulin
  • Alpha glucosidase inhibitors
  • Biguanides
  • PPARy activators/glitazones
  • SGLT2 inhibitors i.e. gliflozins
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13
Q

Therapeutic effects of exogenous insulin. Is it a first line treatment for T1 and T2?

A

First line for T1, usually last line for T2.
Gives an identical effect to endogenous insulin.
Given by SC injection

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14
Q

How many different types of exogenous insulin are in the market?

A

Very rapid acting
Short acting
Mixed(intermediate)
Long acting

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15
Q

Side effects of exogenous insulin treatment

A

Hypoglycaemia

Sometimes weight gain. Why? Because insulin stops (lipolysis) lipid breakdown.

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16
Q

Insulin secretagogues

A

sulphonylureas, meglitinides, GLP-1 agonists, and DPP-4 inhibitors

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17
Q

Therapeutic effects of sulfonylureas and meglitinides

A

Binding to B-cell K-ATP channel causes insulin release.

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18
Q

Examples of sulphonylureas (x3)

A

glipizide, gliclazide and glibenclamide

19
Q

Example (x1) of meglitinide

A

Repaglinide

20
Q

Side effects of sulphonylureas or meglitinides

A

Hypoglycaemia, Nausea, Vomiting, jaundice, initial weight gain with sulfonylureas

21
Q

What is the Therapeutic effects of incretins/GLP-1 agonists?

A

Incretins (e.g GLP-1) are hormones naturally released after meals to stimulate/activate insulin secretion.
And GLP-1 receptor agonists activate GLP-1 receptors by B cells to produce insulin.

22
Q

What is the Example of GLP-1 agonists?

A

Dulaglutide (injected)

23
Q

What are the Side effects of GLP-1 agonists

A

GI disturbances, Nausea, Diarrhoea, decreased appetite (despite being injected)

24
Q

What is the Therapeutic effects of DPP-4 inhibitors

A

DPP-4 inhibitors are enzymes. It is a serine protease, this is widely distributed throughout the body. It inactivates GLP-1.
Inhibiting DPP-4 causes Increased GLP-1 resulting in increased insulin synthesis and secretion.
Ex: Vildagliptin

25
Q

What is an Example of DPP-4 inhibitor?

A

Vildagliptin

26
Q

Side effects of DPP-4 inhibitors

A

Headache, dizziness, GI disturbances (esp when given w/ metformin)

27
Q

Therapeutic effects of alpha glucosidase inhibitors

A

Reduce intestinal absorption of glucose but inhibiting x-glucosidase in the intestinal brush border. Ex: Acarbose

28
Q

What are Examples of an alpha glucosidase inhibitor?

A

Acarbose

29
Q

Side effects of alpha glucosidase inhibitors

A

Malabsorption, flatulence, diarrhoea, abdominal bloating.

30
Q

What are the Therapeutic effects of biguanides?

A

Metformin reduces hepatic gluconeogenesis, activates AMP kinase by stimulating glucose uptake, fatty acid oxidation, reduction of lipogenesis and by reduction of the effects of glucagon.Ex: Metformin

31
Q

What is an Example of biguanide?

A

Metformin

32
Q

What are the main Side effects of biguanides?

A 
GI effects (N,D, cramps, dyspepsia)
Lactic acid build up
33
Q

Therapeutic effects of PPARy activators. Other name for PPARy activators.

A

PPARy is a nuclear hormone receptor. It Promotes glucose uptake into muscle and adipose tissue, decreasing insulin resistance.
Also called thiazolidinediones.
Ex:Pioglitazone

34
Q

What are Examples of PPARy activators?

A

Pioglitazone

35
Q

What are the Side effects of PPARy’s?

A

Weight gain and edema. Potential Heart Failure may occur because of edema with long-term use.

36
Q

What are the Therapeutic effects of SGLT2 inhibitors?

A

SGLT2 is a Na+/glucose transporter in the proximal portion of the renal tubule. Glucose moves against conc gradient from tubular tubular lumen through epithelial cells. Inhibition blocks glucose transport, therefore lowering blood glucose Ex: Empagliflozin

37
Q

What is an example of SGLT2 inhibitor?

A

Ex: Empagliflozin

38
Q

Side effects of SGLT2 inhibitors

A

Lower Urinary tract infection
Increase in genital infections
Mild diuresis/mild hypotension(reduces blood pressure) (vvi to remember)

39
Q

When are SGLT2 inhibitors contraindicated?

A

In kidney disease

40
Q

What are Examples of SGLT2 inhibitors?

A

Empagliflozin, dapagliflozin

41
Q

Patients with reduced renal function should avoid

A

Sulphonylureas, meglitinides

42
Q

Patients who are obese may not be offered

A

Sulphonylureas

43
Q

Heart failure may be exacerbated by…

A

Glitazones/PPARy activators

PHCY 310 (65 decks)

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