T1 L14:Drug treatement of Type 2 Diabetes Flashcards

1
Q

what tissues does insulin target

A

liver

adipose

skeletal muscle

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2
Q

advantages of metformin

A

cheap

effective

safe-least side effects

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3
Q

what does insulin do to the hepatic cells (processes)

2m

A

Decreases:
gluconeogenesis, glycogenolysis, ketogenesis,

(increases glycogen synthesis)

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4
Q

what & how do muscle cells do to respond to insulin

3m

A

decreases- glycogenolysis & amino acid release

increases GLUT-4 translocation to the membrane and hence increase glucose uptake, glucose oxidation, glycogen synthesis, amino acid uptake, protein synthesis

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5
Q

what do adipocytes do in response to insulin

A

increase glucose uptake, increase triglyceride synthesis; decrease FFA and glycerol release

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6
Q

what is the net effect of insulin

A

is to cause hypoglycemia

and increase fuel storage in muscle, fat tissue and liver

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7
Q

what happens to the insulin sensitivity and insulin conc from a normal to a t2 diabetic

A

usually, insulin sensitivity is high and insulin conc is low.

Both decrease in t2 but reverse as well- high resistance and low insulin conc

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8
Q

what causes hyperglycaemia

A

Renal glucose absorption

Loss of beta-cell mass

Insulin resistance

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9
Q

what is an example of a sulfonylureas

when are they active, and what are they bound to and %

A

Gliclazide

glipizide

orally active

90-99% bound to plasma protein

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10
Q

What is the primary mechanism of how sulfonylureas act

A
  • stimulates endogenous insulin release
  • binds to ATP-sensitive-K-channel, inhibiting cell opening to ATP
  • causing beta cells to depolarise and ca influx and insulin release

-

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11
Q

what are the secondary mechanisms of how sulfonylureas work

A

Sensitize ß-cells to glucose

Decrease lipolysis

Decrease clearance of insulin by the liver

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12
Q

who is sulfonylureas best used on and what is it’s side effects

A

The best patient-

  • over 40 years
  • DM duration less than 10 years

Side effect-hypoglycaemia

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13
Q

give an example of a biguanide

A

Metformin

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14
Q

what do biguanides do and secondary effects (3m)

A

increase glucose uptake in muscle and decrease glucose production by liver (Increasing insulin sensitivity via):

  • Enhances peripheral glucose uptake
  • –Increased GLUT 4 translocation through AMPK

-Increases fatty acid oxidation via decreasing insulin-induced suppression of fatty acid oxidation

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15
Q

what is the mechanism of action of biguanides

A

It reduces hepatic glucose production:

via AMP-activated protein kinase (AMPK) dependent and independent pathways

AMPK increases expression of the nuclear transcription factor SHP which in turn inhibits the expression of hepatic gluconeogenic genes. ie G-6-P glucose-6-phosphatase

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16
Q

what other properties of metformin is peculiar (3)

A
  • orally active
  • does not bind plasma proteins
  • often combined in a single pill with other anti-diabetic medications
17
Q

what other syndrome can metformin treat

A

also used for polycystic ovary syndrome

18
Q

when can you not use metformin

A

hepatic disease

past history of lactic acidosis (any cause)

cardiac failure

19
Q

Give an example of a Glitazones (thiazolidinediones

A

Pioglitazone-

20
Q

how does Pioglitazone function

3m

A

Activate peroxisome proliferator-activated receptor-g (PPARg)

(involved in involved in transcription of insulin-responsive genes and in regulation of adipocyte lipid metabolism)

21
Q

what does pioglitazone cause

and what does it need to work

A

It needs the presence of endogenous or exogenous insulin to:

  • decrease gluconeogenesis, glucose output, and triglyceride production in liver
  • increase glucose uptake and utilization in skeletal muscle
  • Cause differentiation of adipocytes
22
Q

what are the adverse effects of pioglitazone

A

interactions due to liver metabolism.

weight gain

fluid retention

23
Q

what is a major advantage of Glucagon-like peptide-1 analogs GLP-1

A

It increases satiety and reduces food intake

24
Q

give an example of a GLP-1

25
how does exenatide work | 4m
- Augmenting pancreas response - Suppresses pancreatic release of glucagon helping stop the liver overproducing glucose - Slows down gastric emptying - Reduces appetite and promote satiety via hypothalamic receptors
26
what is a DPP-4 inhibitor stand for
Dipeptidyl peptidase-4
27
what is DPP-4 inhib its mechanism and results
Class of oral hypoglycaemic agents Mechanism of action is through increased Incretins GLP-1 and GIP Increased incretins cause: -Inhibit glucagon release - Increase glucose-induced insulin secretion - Decrease gastric emptying
28
Give an example of a DPP-4 inhibitor
vildagliptin
29
what is an SGLT drug -
Sodium-glucose transporter protein inhibitors
30
where does it act
SGLT-2 receptor has high capacity and low affinity Found in PCT causes glucose to be excreted by kidneys through the urine
31
overall effects of SGLT-2 are
Increased insulin sensitivity Improved beta cell function decreased gluconeogenesis