Oral Hypoglycaemic Agents Flashcards
What is the mechanism of action of Metformin
Reduce insulin resistance
Inhibit hepatic gluconeogenesis
What are the benefits of Metformin
Does not cause hypoglycaemia Can be combined with other hypoglycaemic agents Cheap Weight neutral Reduces risk of CVS events
What are the side effects of Metformin
GI: nausea, indigestion, loose stools
Lactic acidosis
Vitamin B12 deficiency
When is Metformin contraindicated
CKD <30ml/min
Period of tissue hypoxia (MI, Sepsis, AKI, Severe dehydration)
Iodine-containing x Ray contrast (provoke renal impairment - discontinued on the day)
What is the mechanism of action of Sulphonylureas
Stimulate beta cells to produce more insulin
What are the benefits of sulphonylurea
Reduces risk of microvascular disease
What are the side effects of sulphonylurea
Weight gain
Hypoglycaemia
SIADH
Liver dysfunction (cholestatic)
What are the types of sulphonylurea
Long-acting: Glibenclamide
Short-acting: Glipizide, Glicazide
What is the mechanism of action of arcabose
Inhibits carbohydrate breakdown in gut
By inhibiting alpha glucosidase enzyme
What are the side effects of arcabose
Loose stools, diarrhoea
Modest reduction in HbA1c
What is the mechanism of action of Glitazones
Increase insulin sensitivity in muscle and adipose
Decrease hepatic glucose output
What are the types of Glitazones
Pioglitazone
What are the side effects of Glitazones
Weight gain Fluid retention Liver impairment Increased risk of Bladder cancer Increased risk of fractures
What are contraindications of Glitazones
Heart failure
What are indications for Glitazones
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
What are the types of GLP1 therapies
DPP-4 inhibitors
GLP-1 receptor agonist
What is GLP1
What do they do
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
What is the mechanism of action of DPP-4 inhibitors
Inhibit activity of DPP-4, enzyme that degrades GLP1
What are the types of DPP-4 inhibitors
Sitagliptin
Vildagliptin
Saxagliptin
Linagliptin
What are the benefits of gliptins
Weight neutral
Low risk of hypoglycaemia
What are the side effects of gliptins
GI
Modest HbA1c reduction
What is the mechanism of action of GLP-1 Receptor Agonist
Mimic action of GLP1
What are the types of GLP1 agonist
Exenatide
Liraglutide
How are GLP1 receptor agonists administered
SC injection
Once-weekly
What are the benefits of GLP1 receptor agonists
Effective HbA1c reduction
Weight loss
Safe and well tolerated
What are the side effects of GLP1 Receptor agonists
GI: nausea, loose stools
GORD
Painful to inject
Pancreatitis
When is GLP1 receptor agonists Contra-indicated
GFR <30ml/min
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
What is the mechanism of action of SGLUT2 inhibitor
Inhibit SGLT2 in PCT
Inhibit glucose reabsorption
Increase renal excretion of glucose
What are the types of SGLT2 inhibitors
Dapaglifozin
Canaglifozin
Empaglifozin
What are the benefits of SGLT2 inhibitors
Weight loss
Low risk of hypoglycaemia
What are the side effects of SGLT2 inhibitors
Polyuria
UTIs
Thrush
Who can receive ongoing GLP1 mimetic therapy
Patients who achieve 11 mmol/mol reduction in HbA1c and 3% weight loss after 6 months
