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DIABETES & ENDOCRINOLOGY > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

what are examples of rapid acting insulin

A
  • insulin lispro (humalog)
  • insulin aspart (novorapid)
  • insulin glulisine (apidra)
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2
Q

rapid acting insulin
- onset of action
- time of peak action
- duration of action

A
  • 5-15 mins
  • 30-60 mins
  • 3-4 hours
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3
Q

what are examples of short acting insulin

A
  • actrapid
  • humulin S
  • insuman rapid
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4
Q

short acting insulin
- onset of action
- time of peak action
- duration of action

A
  • 30-60 mins
  • 2-3 hours
  • 6-8 hours
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5
Q

give examples of intermediate acting insulin

A
  • isophane
  • insulatard
  • humulin I
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6
Q

intermediate acting insulin
- onset of action
- time of peak action
- duration of action

A
  • 1-2 hours
  • 4-6 hours
  • 14-16 hours
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7
Q

what are examples of long acting insulin

A
  • insulin glargine (lantus); abasaglar
  • insulin determir
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8
Q

how should insulin be stored

A
  • unopened vials/cartridges/pens should be stored in the fridge
  • once opened and in use store at room temp
  • cold injections are more painful and absorption profile of cold insulin differs from that of room temp insulin
  • discard after 30 days once opened
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9
Q

how can insulin be given

A
  • s/c by either insulin syringes, pen device or insulin pumps
  • give into abdomen or outer thighs
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10
Q

What is the primary mechanism of action of Metformin?

A

Increases insulin sensitivity and decreases glucose production by the liver

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11
Q

What class of medication does Metformin belong to?

A

Biguanide

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12
Q

Does Metformin cause weight gain?

A

No, it does not cause weight gain and may cause some weight loss

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13
Q

Does Metformin cause hypoglycaemia?

A

No, it does not cause hypoglycaemia

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14
Q

What are notable gastrointestinal side effects of Metformin?

A

Pain, nausea, and diarrhoea (depending on the dose)

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15
Q

What serious condition can Metformin lead to, particularly in the context of acute kidney injury?

A

Lactic acidosis

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16
Q

What alternative can patients with gastrointestinal side effects try?

A

Modified-release metformin

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17
Q

Name three examples of SGLT-2 inhibitors.

A
  • empagliflozin
  • canagliflozin
  • dapagliflozin
  • ertugliflozin
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18
Q

Where is the sodium-glucose co-transporter 2 protein located?

A

In the proximal tubules of the kidneys

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19
Q

What is the primary action of SGLT-2 inhibitors?

A

They block the reabsorption of glucose, causing more glucose to be excreted in the urine

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20
Q

What effect do SGLT-2 inhibitors have on HbA1c levels?

A

They lower HbA1c levels

due to loss of glucose in the urine

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21
Q

What are two cardiovascular benefits of SGLT-2 inhibitors?

A
  • Reduce the risk of cardiovascular disease
  • Improve outcomes in heart failure
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22
Q

Which SGLT-2 inhibitors are licensed for heart failure?

A
  • Empagliflozin
  • Dapagliflozin
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23
Q

Which SGLT-2 inhibitor is also licensed for chronic kidney disease?

A

Dapagliflozin

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24
Q

What notable side effect is associated with SGLT-2 inhibitors?

A

Glycosuria (glucose in the urine)

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25
Q

True or False: SGLT-2 inhibitors can cause hypoglycaemia when used with insulin or sulfonylureas.

A

True

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26
Q

List two common side effects of SGLT-2 inhibitors.

A
  • Increased urine output
  • Genital and urinary tract infections
27
Q

What severe infection is associated with SGLT-2 inhibitors, though rare?

A

Fournier’s gangrene

28
Q

Fill in the blank: SGLT-2 inhibitors can lead to _______ loss.

29
Q

What potential risk is associated with canagliflozin specifically?

A

Lower-limb amputation may be more common

30
Q

What serious condition can occur with SGLT-2 inhibitors despite only moderately raised glucose?

A

Diabetic ketoacidosis

31
Q

what can SGLT-2 inhibitors cause when used with insulin or sulfonylureas

A

hypoglycaemia

32
Q

What class of medication is pioglitazone?

A

Thiazolidinedione

33
Q

What is the primary action of pioglitazone?

A

Increases insulin sensitivity and decreases liver production of glucose

34
Q

Does pioglitazone typically cause hypoglycaemia?

35
Q

List notable side effects of pioglitazone.

A
  • Weight gain
  • Heart failure
  • Increased risk of bone fractures
  • A small increase in the risk of bladder cancer
36
Q

What is the most common sulfonylurea?

A

Gliclazide

37
Q

What do sulfonylureas stimulate?

A

Insulin release from the pancreas

38
Q

List two notable side effects of sulfonylureas.

A
  • Weight gain
  • Hypoglycaemia
40
Q

What are incretins?

A

Hormones produced by the gastrointestinal tract

41
Q

When are incretins secreted?

A

In response to large meals

42
Q

How do incretins reduce blood sugar? List the mechanisms.

A
  • Increasing insulin secretion
  • Inhibiting glucagon production
  • Slowing absorption by the gastrointestinal tract
43
Q

What is the main incretin?

A

Glucagon-like peptide-1 (GLP-1)

44
Q

What enzyme inhibits incretins?

A

Dipeptidyl peptidase-4 (DPP-4)

45
Q

What do DPP-4 inhibitors do?

A

Block the action of DPP-4, allowing increased incretin activity

46
Q

Name two examples of DPP-4 inhibitors.

A
  • Sitagliptin
  • Alogliptin
47
Q

Do DPP-4 inhibitors cause hypoglycaemia?

48
Q

What are notable side effects of DPP-4 inhibitors? List them.

A
  • Headaches
  • Low risk of acute pancreatitis
49
Q

What do GLP-1 mimetics do?

A

Imitate the action of GLP-1

50
Q

Name two examples of GLP-1 mimetics.

A
  • Exenatide
  • Liraglutide
51
Q

How are GLP-1 mimetics administered?

A

As subcutaneous injections

52
Q

Can liraglutide be used for weight loss?

A

Yes, in non-diabetic obese patients

53
Q

What are notable side effects of GLP-1 mimetics? List them.

A
  • Reduced appetite
  • Weight loss
  • Gastrointestinal symptoms, including discomfort, nausea and diarrhoea
55
Q

What are key complications of type 2 diabetes?

A
  • Infections (e.g., periodontitis, thrush and infected ulcers)
  • Diabetic retinopathy
  • Peripheral neuropathy
  • Autonomic neuropathy
  • Chronic kidney disease
  • Diabetic foot
  • Gastroparesis (slow emptying of the stomach)
  • Hyperosmolar hyperglycemic state

These complications can significantly impact the health and quality of life of individuals with type 2 diabetes.

56
Q

What is the first-line medication for hypertension in patients with type 2 diabetes?

A

ACE inhibitors

ACE inhibitors are effective in managing hypertension and offer renal protective benefits.

57
Q

When should ACE inhibitors be started in type 2 diabetics with chronic kidney disease?

A

When the albumin-to-creatinine ratio (ACR) is > 3 mg/mmol

This threshold is lower than that for patients without diabetes.

58
Q

When should SGLT-2 inhibitors be initiated in type 2 diabetics?

A

When the albumin-to-creatinine ratio (ACR) is > 30 mg/mmol

SGLT-2 inhibitors are used in conjunction with ACE inhibitors for better management of kidney disease.

59
Q

What medications may be used for erectile dysfunction in type 2 diabetes?

A

PDE‑5 inhibitors (e.g., sildenafil or tadalafil)

These medications are commonly prescribed for erectile dysfunction.

60
Q

What are prokinetic drugs used for in type 2 diabetes?

A

Gastroparesis (slow emptying of the stomach)

Examples include domperidone and metoclopramide, which should be used with caution due to potential cardiac side effects.

61
Q

List four options for treating neuropathic pain in type 2 diabetes.

A
  • Amitriptyline (tricyclic antidepressant)
  • Duloxetine (SNRI antidepressant)
  • Gabapentin (anticonvulsant)
  • Pregabalin (anticonvulsant)

These medications can help alleviate symptoms of diabetic neuropathy.

62
Q

how can you calculate estimated insulin dose from pt weight

63
Q

how can you calculate estimated insulin dose form insulin requirements during VRIII

DIABETES & ENDOCRINOLOGY (6 decks)

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