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50 drugs > T2DM Drugs > Flashcards

T2DM Drugs Flashcards

1
Q

What is increased is T2DM?

A

increased glucose reabsorption
increased glucagon secretion
increased lipolysis

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2
Q

What is an example of a biguanide

A

metformin

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3
Q

How does metformin work?

A

Acts through AMP Kinase and reduces the rate of gluconeogenesis and therefore hepatic output of glucose, by increasing peripheral utilisation of glucose.
It also increases insulin sensitivity.

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4
Q

What is beneficial with metformin?

A

It does not affect insulin secretion, or induce hypoglycaemia or predispose people to weight gain, making it helpful in people who are overweight.
It also is beneficial in reducing CV risk

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5
Q

What are the unwanted effects of metformin?

A

Weight loss - anorexia
Diarrhoea (5-10% people cannot use metformin because of this)
Epigastric discomfort

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6
Q

What is the mechanism of action of sulphonyureas?

A

Act on the SUR receptor on pancreatic beta cells.
This closes ATP sensitive K+ channels and thus potassium efflux.
This causes depolarisation of the cell, and opens voltage gated calcium channel, leading to calcium influx.
Calcium influx is a signal for insulin release

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7
Q

What are the side effects of sulphonyureas?

A

Hypoglycaemia

Weight gain

Increased cardiovascular mortality/morbidity

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8
Q

Give two examples of sulphonylureas

A

Tolbutamide

Glicazide

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9
Q

What are meglitinides

A

These act like sulphonylureas, by acting via the closure of the K+-ATP channel in beta-cells.
These are short acting agents that promote insulin secretion in response to a meal
More expensive than sulphonylureas

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10
Q

Give an example of two meglitinides

A

Repaglinide

Nateglinide

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11
Q

What is the mechanism of action of thiazolidinediones?

A

These reduce insulin resistance by interacting with PPAR-gamma. This is a nuclear receptor that regulates genes involved with lipid metabolism and insulin action.
These drugs may act via the glucose-fatty acid cycle, lowering free fatty acid levels promoting glucose consumption by the muscles.
They reduce hepatic glucose production and enhance peripheral glucose uptake.

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12
Q

Give an example of a thiazolidinedione

A

Pioglitazone

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13
Q

What are the side effects of thiazolidinediones?

A 
Weight gain (5-6kg)
Heart failure
Fluid retention
Increased risk of bladder cancer
Osteoporosis
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14
Q

What do GLP-1 hormones do?

A 
Decrease appetite
Increase glucose uptake
Decrease glucagon release
Increase Insulin release
Decrease gastric emptying
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15
Q

What does DPP-4 do

A

Breaks down and inhibits GLP-1

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16
Q

What is the incretin effect?

A

The idea that incretins cause an increase in insulin after administration of oral glucose more so than IV glucose

17
Q

What are incretins

A

Hormones that reduce plasma glucose levels and are released after eating e.g. GLP-1/GIP

18
Q

Whats the mechanism of action of DPP-4 inhibitors

A

Inhibit DPP-4 and therefore increase endogenous incretin-mediated increase in insulin secretion
These enhance the incretin effect

19
Q

Give an example of a DPP-4 inhibitor

A

Sitagliptin, Sidagliptin, Linagliptin

20
Q

What are SGLT2 inhibitors

A

SGLT2 is a channel found in the proximal tubule of the kidney. They function to reabsorb glucose into the cell.
SGLT2 Inhibitors work by reducing the threshold for glucose and increasing the excretion of glucose in the urine

21
Q

What are the side effects of SGLT2 inhibitors

A

UTIs

22
Q

What are GLP-1 agonists

A

These increase the incretin effect therefore act by increasing insulin secretion, inhibiting glucagon secretion, delaying gastric emptying and having effects on appetite.

23
Q

Give an example of a GLP-1 agonist

A

Exenatide

Liraglutide

24
Q

Give an example of a SGLT2 inhibitor

A

Empagliflozin

Dapagliflozin

25
Q

What are the side effects of GLP-1 agonists?

A

Nausea
Vomiting
AKI

50 drugs (7 decks)

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