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Pharmacology > Oral Hypoglycaemic Agents > Flashcards

Oral Hypoglycaemic Agents Flashcards

1
Q

What is the mechanism of action of Metformin

A

Reduce insulin resistance

Inhibit hepatic gluconeogenesis

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2
Q

What are the benefits of Metformin

A 
Does not cause hypoglycaemia 
Can be combined with other hypoglycaemic agents 
Cheap
Weight neutral
Reduces risk of CVS events
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3
Q

What are the side effects of Metformin

A

GI: nausea, indigestion, loose stools
Lactic acidosis
Vitamin B12 deficiency

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4
Q

When is Metformin contraindicated

A

CKD <30ml/min
Period of tissue hypoxia (MI, Sepsis, AKI, Severe dehydration)
Iodine-containing x Ray contrast (provoke renal impairment - discontinued on the day)

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5
Q

What is the mechanism of action of Sulphonylureas

A

Stimulate beta cells to produce more insulin

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6
Q

What are the benefits of sulphonylurea

A

Reduces risk of microvascular disease

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7
Q

What are the side effects of sulphonylurea

A

Weight gain
Hypoglycaemia
SIADH
Liver dysfunction (cholestatic)

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8
Q

What are the types of sulphonylurea

A

Long-acting: Glibenclamide

Short-acting: Glipizide, Glicazide

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9
Q

What is the mechanism of action of arcabose

A

Inhibits carbohydrate breakdown in gut

By inhibiting alpha glucosidase enzyme

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10
Q

What are the side effects of arcabose

A

Loose stools, diarrhoea

Modest reduction in HbA1c

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11
Q

What is the mechanism of action of Glitazones

A

Increase insulin sensitivity in muscle and adipose

Decrease hepatic glucose output

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12
Q

What are the types of Glitazones

A

Pioglitazone

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13
Q

What are the side effects of Glitazones

A 
Weight gain
Fluid retention 
Liver impairment 
Increased risk of Bladder cancer
Increased risk of fractures
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14
Q

What are contraindications of Glitazones

A

Heart failure

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15
Q

What are indications for Glitazones

A

As add-on therapy to Metformin if HbA1c rise to 58mmol/mol

As first-line If Metformin not tolerated/contra-indicated
And HbA1c rise to 48mmol/mol on lifestyle

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16
Q

What are the types of GLP1 therapies

A

DPP-4 inhibitors

GLP-1 receptor agonist

17
Q

What is GLP1

What do they do

A

Glucagon-like peptide 1: hormone released from SI in response to an oral glucose load

Increase insulin production
Reduce glucagon production
Increase satiety
Slow gastric emptying

18
Q

What is the mechanism of action of DPP-4 inhibitors

A

Inhibit activity of DPP-4, enzyme that degrades GLP1

19
Q

What are the types of DPP-4 inhibitors

A

Sitagliptin
Vildagliptin
Saxagliptin
Linagliptin

20
Q

What are the benefits of gliptins

A

Weight neutral

Low risk of hypoglycaemia

21
Q

What are the side effects of gliptins

A

GI

Modest HbA1c reduction

22
Q

What is the mechanism of action of GLP-1 Receptor Agonist

A

Mimic action of GLP1

23
Q

What are the types of GLP1 agonist

A

Exenatide

Liraglutide

24
Q

How are GLP1 receptor agonists administered

A

SC injection

Once-weekly

25
Q

What are the benefits of GLP1 receptor agonists

A

Effective HbA1c reduction
Weight loss
Safe and well tolerated

26
Q

What are the side effects of GLP1 Receptor agonists

A

GI: nausea, loose stools
GORD
Painful to inject
Pancreatitis

27
Q

When is GLP1 receptor agonists Contra-indicated

A

GFR <30ml/min

28
Q

When is GLP1 receptor agonist indicated

A

If triple therapy contra-indicated AND:

  • BMI >35 and problems associated with weight
  • BMI =/<35 And Insulin therapy has occupational implications or weight loss would benefit comorbidities
29
Q

What is the mechanism of action of SGLUT2 inhibitor

A

Inhibit SGLT2 in PCT
Inhibit glucose reabsorption
Increase renal excretion of glucose

30
Q

What are the types of SGLT2 inhibitors

A

Dapaglifozin
Canaglifozin
Empaglifozin

31
Q

What are the benefits of SGLT2 inhibitors

A

Weight loss

Low risk of hypoglycaemia

32
Q

What are the side effects of SGLT2 inhibitors

A

Polyuria
UTIs
Thrush

33
Q

Who can receive ongoing GLP1 mimetic therapy

A

Patients who achieve 11 mmol/mol reduction in HbA1c and 3% weight loss after 6 months

Pharmacology (19 decks)

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