Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GERR > Lecture 29: Treatment of Diabetes 3 > Flashcards

Lecture 29: Treatment of Diabetes 3 Flashcards

1
Q

what is the first line drug treatment of diabetes

A

metformin (biguanides)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where is SGLT1 found in the body and what is its role

A
  • highly expressed in small intestine

- responsible for glucose and galactose absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

where is SGLT2 found in the body and what is its role

A
  • highly expressed in S1 segment of PCT
  • glucose reabsorption
    (>90% glucose reabsorption occurs here)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how does SGLT2 inhibition lower plasma glucose levels

A
  • inhibits glucose reabsorption
  • reduces renal threshold for glucose
  • excess glucose excreted in urine
  • plasma glucose levels lowered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what name ending do SGLT2 inhibitor drugs commonly have

A

-gliflozin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

give some SGLT2 inhibitor drug examples

A
  • dapagliflozin
  • canagliflozin
  • empagliflozin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when is use of SGLT2i contraindicated

A
  • if eGFR <45mL/min

- urinary glucose excretion depends on kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how can SGLT2i be prescribed

A
  • as monotherapy

- as add on therapy to metformin or other gluc. lowering drugs incl. insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

give some side effects of SGLT2i

A
  • loss of calories –> weight loss and dec. of SBP
  • polyuria and ^ UTI
  • ^ risk of acute kidney injury
  • ketoacidosis (even w/o ^ in blood glucose)
  • ^ risk of osteoporosis
  • risk of lower limb complications; ^ risk of amputation (mainly toe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are some drug interactions SGLT2i has

A

ACEi/ARBs and NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how is insulin prescribed to T2D Px and why

A
  • added to oral therapies
  • particularly metformin
  • Px started on single daily dose of intermediate (first line) acting ordinary insulin
  • reduces weight gain and offers CV protection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when introducing insulin to T2D Px why would you consider stopping sulfonylureas

A
  • reduce risk of hypoglycaemia

- insulin is a very potent hypoglycaemic agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

outline some indications for insulin therapy in T2D

A
  • significant hyperglycaemia at presentation
  • hyperglycaemia despite max. doses of oral agents
  • decompensation:
  • -> stress, infection, acute injury
  • -> sever hypergly. w. ketoanaemia and/or ketonuria
  • -> uncontrolled weight loss
  • surgery
  • pregnancy
  • renal disease
  • allergy or serious reaction to oral agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when might you need to give long acting insulin therapy (second line) for T2D Px

A
  • depending on their lifestyle
  • compliance might make freq. injections inappropriate
  • if unable to self inject NPH insulin
  • if target HbA1c not reached
  • higher risk of hypo with NPH insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are thiazolidinediones

A

insulin resistance reducer drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do thiazolidinediones work

A
  • impact fatty acid metabolism
  • bind to peroxisome proliferator activated receptors (complexed with retinoid X receptor - RXR)
  • located in adipose tissue, skeletal muscle and large intestine
  • TZD acts as agonist
  • causes PPARy-RXR complex to bind to DNA
  • promotes transcription of genes –> products involved in insulin signalling e.g. GLUT4
  • ^ tissue sensitivity to glucose
  • so reduce insulin resistance, ^ gluc. uptake, dec. FFA and blood glucose levels
17
Q

when are TZDs effective

A

only in presence of insulin, either injected or endogenous

18
Q

when are TZDs used

A
  • T2D Px w/ inadequate control of hyperglycaemia esp. if sig. insulin resistance
  • not used in T1D
19
Q

what is a contraindication of TZD

A
  • potential hepatotoxicity so LFTs required before starting therapy and every 2-6 months after
20
Q

what are some side effects of TZD

A
  • weight gain

- potential for heart failure esp if in combination w/ insulin

21
Q

what is the only oral TZD agent now available

A

pioglitazone

22
Q

what are other examples of a hypoglycaemic agent (not insulin, SGLT2i or TZD)

A
  • meglitinides

- acarbose

23
Q

what name ending is commonly seen in meglitinides and give some examples

A

-glinide

  • repaglinide
  • nateglinide
24
Q

what are meglitinides

A

non-sulfonylurea oral hypoglycaemic agents

25
Q

what is meglitinides MoA

A
  • stimulates insulin secretion (insulinotropic agent)
  • fast acting, short duration (can be administered between 30min or right before meals)
  • causes closure of ATP dependent K+ channels
26
Q

what is acarbose and how does it work

A
  • intestinal disaccharidase inhibitor, a-glucosidase inhibitor
  • taken preprandially
  • delays or inhibits carb absorption
27
Q

what are some side effects of acarbose

A
  • GI –> flatulence, diarrhoea, nausea, vomiting
  • elevated serum aminotransferase
  • hyperbilirubinaemia rare
28
Q

what vascular risk managements should be in place when treating T2D Px

A
  • BP < 130/80 esp if microalbunuria (UACR) or early nephropathy/retinopathy
  • preferential use of ACEi and ARBs if not contraindicated
  • agressive lipid management e.g. atorvastatin, rosuvastatin

GERR (46 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions