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Endocrine > Management of Diabetes > Flashcards

Management of Diabetes Flashcards

1
Q

What the mechanism of action of Sulphonylureas

A

Binds to sulfonylurea receptors (SUR-1) on functioning pancreatic beta-cells.
Binding closes the linked ATP-sensitive potassium channels
Decreased potassium influx depolarization of the beta-cell membrane.
Voltage-dependent calcium channels open and result in an influx of calcium
Translocation and exocytosis of secretory granules of insulin to the cell surface

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2
Q

How often do you take glimepiride

A

once daily

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3
Q

What is metformins action

A

Metformin works by improving insulin action which then lowers blood glucose because the insulin works more effectively

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4
Q

What drug is first line treatment for diabetes

A

Metformin

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5
Q

What two GLP analogues have cardiovascular benefit

A

Liraglutide and semaglutide

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6
Q

What are the Dis-advantages of Pioglitazone

A 
Increase risk of bladder cancer
-	Caution in those of increased risk bladder cancer (Age, industry etc)
Fluid retention - CCF
Weight gain
Fractures in females
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7
Q

What is a THIAZOLIDINEDIONE

A

Pioglitazone

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8
Q

What is the dose of glimepiride

A

1-6mg

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9
Q

What is the mechanism of action of Pioglitazone

A

Selectively stimulates thenuclear receptorperoxisome proliferator-activated receptor gamma (PPAR-gamma) and to a lesser extentPPAR - alpha

Modulates the transcription of theinsulin-sensitive genes involved in the control of glucose andlipid metabolismin themuscle,adipose tissue, and theliver.

Reduces insulin resistancein the liver and peripheral tissues;
increases the expense of insulin-dependent glucose;

Decreases withdrawal of glucose from the liver;

Reduces quantity of glucose, insulin andglycated haemoglobinin the bloodstream.

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10
Q

Are Sulphonylurea’s used as first line treatment?

A

No - Metformin is

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11
Q

How long does it take for the effect of metformin to start

A

Effect is quick but usually optimal after 2-3 weeks

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12
Q

What are Dis-advantages of gliflozins

A 
Expensive
SE:
-	UTI, fungal infections, osmotic symptoms
Risk of digital amputation
Glucoseuria – Gluocse in urine 
Risk of DKA
CI in pregnancy and breastfeeding.
Cannot use in renal impairment
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13
Q

Whats the mechanism of action for DPP IV inhibitors

A

They delay the breakdown of incretins by DPP-4 and thereby increase active incretin levels

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14
Q

What are advantages of Sulphonylureas

A 
Used with metformin
Rapid improvement in control 
Rapid improvement if symptomatic
Rapid titration
Cheap 
-	Gliclazide 160mg bd £3.30 X1.4
-	Glimepiride 6mg od £1.72 x0.7
Generally well tolerated
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15
Q

What are Dis-advantages of GLP analogues

A

Injection
Expensive
Contra Indicated in pregnancy and breastfeeding.
Nausea, vomiting

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16
Q

Where are Sulphonylureas metabolised

A

liver

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17
Q

Whats the mechanism of action of GLP-1 Analogues

A

work similar to bodies normal GLP BUT:

resistant to enzymatic degradation

greatly prolonged biological half-life

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18
Q

How are GLP-1 analogues taken

A

Most are subcutaneous

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19
Q

What are incretins and what do they do

A

Incretinsare a group of metabolic hormones that stimulate a decrease in blood glucose levels and are released after eating.

They augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism.

20
Q

What are the DPP IV-inhibitors

A

Saxagliptin,
Sitagliptin,
Vildagliptin
Alogliptin

21
Q

What are the Sulphonylurea

A

Gliclazide
Glimepiride
Glipizide

22
Q

What are side effects of GLP-1 analogues

A

People can get nausea but others can get early satiety (helpful with people who eat lots of shite)

23
Q

What are dis-advantages of Sulphonylureas

A 
Risk of hypoglycaemia
Weight gain
Caution in renal and hepatic disease
CI in pregnancy and breastfeeding.
SE include
-	Hypersensitivity and photosensitivity reactions
-	Blood disorders
24
Q

What does Pioglitazone do

A

It increases insulin sensitivity and decreases liver production of glucose

25
Q

What kind of insulins are there

A 
Rapid acting insulins 
Short acting insulins 
Intermediatte acting insulins 
Long acting insulins 
Combination insulins
26
Q

What is the dose of gliclazide

A

40-320mg

27
Q

What is the SGLT-2 protein

A

The SGLT-2 protein is responsible for reabsorbing glucose from the urine into the blood in the proximal tubukes of the kindeys

28
Q

What is the dose of glipizide

A

2.5-20mg

29
Q

What are the GLP1 and DPP IV known as

A

The incretin mimetics

30
Q

What are advantages of metoformin

A

Improves cardiovascular outcomes and mortality in obese T2 DM

Efficaceous

Used alone can decrease fasting blood glucose by 22- 26%

Normally well tolerated

Not associated with weight gain

HbA1c by 12 – 17% reduction

Also used in pregnancy now

Cheap

31
Q

What are advantages of gliflozins

A 
Weight loss
No risk of hypoglycaemia
Good effects on glycemic control
May have beneficial effect on cardiovascular morbidity & mortality
2nd or 3rd line agent
Can add to insulin regimens in T2DM
32
Q

What drug categories are available for diabetes

A 
Metformin
Sulphonylureas
Thazolidinedione
GLP1 
DPP IV 
Gliflozins
33
Q

What are dis-advantages of metoformin

A

GI side effects 20 – 30 %
(diarrhoea and abdo pain)

Risk of lactic acidosis by inhibiting lactic acid uptake by liver

Hypoxia

Renal failure (CI if creat<150)

Hepatic failure

Alcohol abuse

Risk vitamin B12 malabsorption

34
Q

What is the mechanism of action of the gliflozins

A

SGLT-2 inhibitors. They block the action of SGLT-2 protein and cause glucose to be excreted in the urine – reducing the blood glucose levels

35
Q

What is GLP

A

Glucagon-like peptide 1 (GLP-1) is a potent incretin hormone produced in the L-cells of the distal ileum and colon

36
Q

What are the Gliflozins

A

Canagliflozin,
Dapagliflozin,
Empagliflozin

37
Q

What do the Sulphonylurea’s do?

A

Stimulate insulin release from the pancreas

38
Q

What are the GLP-1 Analogues

A

Exenatide,
Liraglutide,
Lixisenatide

39
Q

What are the advantages of Pioglitazone

A 
Good for people if insulin resistance significant
HbA1c by  0.6-1.3%
Cheap 
-	Pioglitazone 45mg od £1.50 x 0.6
Cardiovascular safety established
(Contrast with rosiglitazone
40
Q

Whats the advantage of DPP IV-inhibitors

A 
Usually well tolerated
Can be used as 2nd or 3rd line agent
Can be used in renal impairment
No risk of hypoglycaemia
Weight neutral
41
Q

Whats a Biguanide

A

Biguanideis a colorless solid that dissolves in water to give highly basic solution. These solutions slowly hydrolyse to ammonia and urea

42
Q

What are advantages of GLP analogues

A 
Weight loss
No risk of hypoglycaemia
3rd line agent 
Can be used with basal insulin
Some have benefit for CV disease
43
Q

When do you use insulin injections

A

Usually used as a last resort when all other non-insulin drugs don’t work.

44
Q

What is the DPP-4 enzyme

A

An enzyme that rapidly degrades incretins

45
Q

What is the dose of glipizide

A

Twice daily

46
Q

How often do you take gliclazide

A

Twice daily

47
Q

Whats the Dis-advantages of DPP IV-inhibitors

A

Trial data shows relatively small effects on glycemic control
CI in pregnancy and breastfeeding.
SE:x
- nausea

Endocrine (14 decks)

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