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
What are the benefits of GLP1 receptor agonists
Effective HbA1c reduction Weight loss Safe and well tolerated
26
What are the side effects of GLP1 Receptor agonists
GI: nausea, loose stools GORD Painful to inject Pancreatitis
27
When is GLP1 receptor agonists Contra-indicated
GFR <30ml/min
28
When is GLP1 receptor agonist indicated
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
What is the mechanism of action of SGLUT2 inhibitor
Inhibit SGLT2 in PCT Inhibit glucose reabsorption Increase renal excretion of glucose
30
What are the types of SGLT2 inhibitors
Dapaglifozin Canaglifozin Empaglifozin
31
What are the benefits of SGLT2 inhibitors
Weight loss | Low risk of hypoglycaemia
32
What are the side effects of SGLT2 inhibitors
Polyuria UTIs Thrush
33
Who can receive ongoing GLP1 mimetic therapy
Patients who achieve 11 mmol/mol reduction in HbA1c and 3% weight loss after 6 months