Lipids/ Diabetis/ BP drugs Flashcards
What is the MOA of metformin?
What is the effects on lipids?
- Enhances the effect of insulin via modification of the glucose metabolic pathways
–> Inhibition of mitochondrial GDP
–> Decrease in hepatic gluconeogenesis and intestinal glucose absorption
–> Increases peripheral insulin sensitivity
Increase in HDL, lowering of LDL
Is there current evidence that high intensity Blood pressure control (target under 120) is effectiveß
Yes! (control under 140) –> halves mortality
Is there current clinical evidence in useing Evolovumab (PCSK9 inhibitor) on top of Statins to reduce CVS risk?
Not really –> no reduction in deaths, but reduction in MI and Cardivascular events and Triglicerides but expensive
Generally currently reserved for high risk
- very high lipid levels (especially Familiar)
- If statins are contraindicated
What time of good diabetic control is needed until a difference in complications seen?
9-15 years
Name some example of SGLT-inhibitors
**- gliflozin **
Dapagliflozin
Empagliflozin
Canagliflozin
What are the effects of SGLT2 inhibitors on eGFR?
Similar to ACE inhibitors
–> initial drop, but after 1 year it is long-term protective
What are the benefits of SGLT-2 inhibitors?
- Weight loss
- glycamic control
- CVS protective (hypotension)
- Renal protective
- all protective
–> good
What is the MOA of SGLT-2 inhibitors?
Blocking glucose resorption in kidney leading to glucose diuresis (via inhibition of Sodium-Glucose co-transporters)
What are the main side-effects of SGLT2 inhibitors?
- UTIs
- potentially initial drop in eGFR
- increased incidence in normoglycaemic DKA
Other than Metformin and SGL-2 inhibitors, what other 2 classes of drugs are now more commonly used in the control of Type 2 diabetis?
- GLP-1 receptor agonist
- DPP-4 inhibitor
Name some examples of DDP-4 inhibitors. What is their MOA?
Gliptins
Sitagliptin, Linagliptin
MOA:
prevent break down of own GLP-1)
Indications/side effects same as FLP-1 analogue) Improve diabetic control and potentially weight loss (but usually no weight changes can be observed)
What is the MOA of GLP-1 receptor agonists?
GLP 1 is
- Endogenous proteins that stimulate glucose-dependant insulin secretion and decrease glucagon secretion
- Reduce gastric emptying + appetite
What are the benefits of using GLP-agonist in T2 diabetes control?
a) Weight loss
b) No risk of hypoglycaemia (so expecially good in patients with increased risk of hypoglycaemia)
+ Cardioprotective etc. (but not as good as SGLT2)
What are the benefits of using GLP-agonist in T2 diabetes control?
a) Weight loss
b) No risk of hypoglycaemia (so expecially good in patients with increased risk of hypoglycaemia)
+ Cardioprotective etc. (but not as good as SGLT2)
Name an examples of GLP-1 receptor agoinsts
Incretin (GLP-1 analogue –> peptide increasing insulin secretion )(-atide/- glutide)
What type of drug is Gliclazide?
Waht is the main side-effect?
Sulphonylureas
Now used less and less frequently due to increaed risk of Hypos
Work by
- Increased insulin secretion (Blockage of ATP-sensitive K+ channels on pancreatic beta cells) –> depolarisation of the cell membrane –> calcium influx–> increased insulin secretion
- Decrease in hepatic gluconeogenesis and increase in peripheral insulin sensitivity
