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 are the main side-effects of GLP-1 agonists?
- GI complications, especially if already existing reduced gastric emptying.
- Increased risk of pancreatitis and pancreatic cancer
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
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Arcabose
What type of drugs is thiazolidinediones?
What are they used for?
Insulin sensitisers tht could be used in monotherapy treatment of Type 2 Dieabets
Indiations
- severe renal failure
- and/or contraindication for insulin therapy
What is the first line-treatment for Type 2 diabetes?
Metformin monotherapy
initiated if
- conservative measurements failed
- if HBA1c >48 (aim for < 48)
Which drugs can alternatively be used as first-line monotherapy in T2DM if Metformin is not tolarated?
What is the indication for adding a second drug in patients with T2DM on monotherapy?
HbA1c >58
