Oral hypoglycaemic agents Flashcards
describe the MOA of metformin
- decreases hepatic gluconeogenesis
- increases peripheral glucose utilisation (increases cellular sensitivity to insulin)
suggest possible ADRs of metformin. what are the benefits of it?
ADRs:
- GI disturbance, inc. diarrhoea, abdo. pain, nausea
- lactic acidosis (dyspnoea, muscle cramps, abdo. pain, hypothermia, asthenia)
- vitamin B12 deficiency
Benefits:
- weight neutral
- low risk of hypoglycaemia
what monitoring should be performed before and during treatment with metformin?
Measure UandEs to determine renal function before treatment and at least annually.
describe the MOA of sulphonylureas. name an example.
GLICLAZIDE
Increase insulin secretion from pancreatic B-cells.
suggest possible ADRs for sulphonylureas. what are the benefits?
ADRs:
- GI disturbance, inc. diarrhoea, abdo. pain and nausea
- weight gain
- hypoglycaemia
Benefits:
- cheap
- rapid glucose decrease
describe the MOA of gliptins. name some examples.
VILDAGLIPTIN, SITAGLIPTIN
Inhibit DPP-4, causing decreased GLP-1 breakdown to:
- increase insulin secretion
- decrease glucagon secretion
suggest possible ADRs of gliptins. what are the benefits?
ADRs
- dizziness
- pancreatitis
- peripheral oedema
- hepatitis
Benefits
- weight loss
- low risk of hypoglycaemia
- oral preparation
describe the MOA of GLP-1 mimetics. name some examples.
EXENATIDE (s/c injection within 1hr before morning and evening meal)
LIRAGLUTIDE (only given OD)
GLP-1 analogues that activate GLP-1 Rs to:
- increase insulin secretion
- decrease glucagon secretion
- slow gastric emptying
describe possible ADRs for GLP-1 mimetics. what are the benefits?
ADRs
- GI disturbance, e.g. nausea and vomiting
- pancreatitis
Benefits
- most potent weight loss
- low risk of hypoglycaemia
which criteria must be achieved to justify ongoing prescription of GLP-1 mimetic?
After 6 mths:
- 11 mmol/mol (1%) reduction in HbA1c
- 3% weight loss
describe the MOA of SGLT-2 inhibitors. name some examples
DAPAGLIFOZIN, CANAGLIFOZIN, EMPAGLIFOZIN
Inhibit SGLT-2 in renal PCT to decrease glucose reabsorption and increase urinary glucose excretion.
suggest possible ADRs of SGLT-2 inhibitors. what are the benefits?
ADRs
1. polyuria
2. increased risk of infection, inc. UTI and thrush
Rare:
3. euglycaemic DKA
4. Fournier’s gangrene, penile cellulitis
5. increased risk of lower limb amputation
Benefits:
- weight loss
- decreases BP (Na loss)
- renoprotective (decreased albumin, increased adenosine release from macula densa)
- cardioprotective
