Oral Hypoglycaemic Agents Flashcards
Metformin MoA?
Decrease insulin resistance
Decrease hepatic gluconeogenesis
Decrease CVS events
Metformin ADRs and contra-indications?
GI symptoms, lactic acidosis (rare), vitamin B deficiency (uncommon)
Stop if CKD <30ml/min
Sulphonylyurea MoA?
Decrease insulin resistance
via blockage of ATP-sensitive K+ channel -> increased K+ in cell -> depolarise cell -> opens v-gated Ca2+ channels -> increased Ca2+ -> insulin release
Sulphonylurea ADRs?
Weight gain
?Hypoglycaemia
Decreased glucose -> increased fatty acid storage (thiozolidinediones)
DPP-4 Inhibitors MoA?
Inhibits DPP-4 activity -> increase postprandial active glucagon like peptide 1 concentrations
- > increase secretion from beta cells
- > decrease glucagon production from alpha cells
DPP-4 Inhibitors ADRs?
GI effects, pancreatitis, nausea, weight loss
Name some DPP-4 Inhibitors
Sitagliptin
Vildagliptin
DPP-4 inhibitors are also known as Gliptins
Name some sulphonylureas, which is commonly used and why?
Most commonly used = Gliclazide (modified release - has hepatic metabolism so can be used in renal impairment)
Glimepiride
GLP-1 agonists MoA?
Agonise GLP-1 receptor -> ?increased active GLP-1
-> increase insulin secretion from beta cells
-> decrease glucagon production from alpha cells
Reduce gastric emptying
GLP-1 Agonists ADRs and contra-indications?
Nausea, loose stools, diarrhoea, GI reflux, pancreatitis, pancreatic carcinoma, occasionally painful to inject
Avoid if eGFR <30ml/min
Weight loss
Gliflozins MoA?
Inhibit sodium-glucose co-transporter 2 -> decreased glucose reabsorption in kidney -> excess glucose gets peed out
Gliflozins ADRs?
Polyurea, polydipsia, increased risk of lower urinary tract symptoms
Name a Gliflozin
Dapagliflozin
Name general glucagon like peptide 1 therapies
DPP-4 inhibitors
GLP-1 agonists
Name specific glucagon-like peptide 1 drugs
Exenatide Liraglutide Lixisenatide Sitagliptin (DPP-4 I) Vildagliptin (DPP-4 I)
