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My2 endocrinology > T2DM drugs > Flashcards

T2DM drugs Flashcards

1
Q

where does insulin induce glucose uptake mainly

A

muscle and liver

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2
Q

in adipose tissue what is glucose converted to with insulin

A

fat

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3
Q

what does insulin do to amino acids

A

stimulated amino acids –> proteins

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4
Q

what are first-line lifestyle modifications in T2DM

A

stop smoking, diet, lower BMI, exercise

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5
Q

what drug types are dependent upon insulin

A

increase secretion of insulin (SURs, incretin mimics - meglitinides, DPP4 - gliptins), decrease insulin resistance and reduce hepatic glucose output (metformin, thiazolidinediones)

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6
Q

what drug types are independent of insulin

A

slow glucose absorption fro GI tract (alpha-glucosidase inhibitors), enhance glucose excretion via kidneys (SGLT2)

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7
Q

describe insulin release in beta cells (briefly)

A

enters via GLUT2 –> phosphorylated –> ATP by glucokinase, ATP/K channels shut –> increased K –> depolarisation –> ca channels open –> insulin secretion

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8
Q

what is first line drug

A

metformin

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9
Q

what type of drug is metformin

A

biguanides

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10
Q

how does metformin work (4)

A

reduces gluconeogenesis, increases glucose uptake in muscle, reduces carb absorption, increases fatty acid oxidation

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11
Q

what side effects of metformin are there

A

GI upset, rarely acidosis (DKA)

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12
Q

what is a positive side effect of metformin

A

weight loss

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13
Q

what type of drug are sulfonylureas (SURs)

A

insulin secretagogues so need functional beta cells

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14
Q

name 3 SURs

A

gliclazide, glipizide, tolbutamide (-ide)

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15
Q

how do SURs work

A

close K/ATP channels –> depolarisation –> insulin release

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16
Q

when are SURs used first line

A

metformin intolerant or osmotic symptoms

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17
Q

what are side effects of SURs

A

hypoglycaemia, weight gain

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18
Q

what are contraindications for hypoglycaemia ie SURs

A

elderly, renal impairment, pregnant, professional drivers (DVLA strict rules)

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19
Q

what is a positive side effect of SURs

A

good for heart

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20
Q

when do SURs peak

A

after 1-2 hours

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21
Q

name 2 glinides/ meglinitides

A

repaglinide, mateglinide, - glinide

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22
Q

how do glinides work

A

similar to SURs but augmented by glycaemia, close KATP channels (not really used)

23
Q

when do glinides kick in

A

fast onset 30-60 mins

24
Q

what are contraindications of glinides

A

severe hepatic impairment, pregnancy and breast feeding

25
Q

name a thiazolidinediones/ TZDs/ glitazones

A

pioglitazone only one used now

26
Q

how do glitazones work

A

enhance insulin action at target (no effect on secretion), agonist of TF that promotes insulin signalling

27
Q

what effects do glitazones have

A

fatty acid uptake to apidocytes, reduce hepatic output

28
Q

what are adverse affects of glitazones

A

weight gain, fluid retention, bone fractures

29
Q

what peptides are released from the intestine in the incretin effect

A

glucagon like peptide-1 (GLP1) and glucose dependent insulinotropic peptide (GIP)

30
Q

describe the incretin effect

A

GLP1 and GIP released from intestine into blood, GLP1 and GIP enhance insulin release, GLP1 decreases glucagon release

31
Q

what breaks down GLP1 and GIP

A

DPP4

32
Q

what are incretin analogues. GLP1 agonists

A

peptides that miic action of GLP1 but resist breakdown by DPP4

33
Q

give an example of an incretin mimic/ GLP1 agonist

A

exenatide

34
Q

how are incretin analogues. GLP1 agonists given

A

subcut injections

35
Q

what are side effects of incretin analogues/ GLP1 agonists

A

nausea, pancreatitis, very short half life - not long acting

36
Q

name a DPP4 inhibitors/ gliptins

A

sitagliptin, -gliptin

37
Q

how do DPP4is/ gliptins work

A

competitively inhibit DPP4 which therefore increases GLP1 and GIP

38
Q

what are downsides of gliptins

A

not very effective, can cause nausea

39
Q

how do SGLT2 inhibitors work

A

selectively blocks reabsorption by SGLT2 deliberately causing glucosuria

40
Q

name and SGLT2 inhibitor

A

dapagliflozin

41
Q

name a side effect of SGLT2i’s

A

UTIs

42
Q

how do alpha glucosidase inhibitors work

A

breaks down starch to absorbable glucose, inhibitors stop this happening in intestines

43
Q

name 2 alpha glucosidase inhibitors

A

acarbose, voglibose, -bose

44
Q

what are side effects of alpha glucosidase

A

GI symptoms, not very effective

45
Q

what drugs cause weight gain

A

SUR’s and piogliazatone

46
Q

what drugs cause weight loss

A

metformin, SGLT2i, GLP1 agonists

47
Q

what drugs are good for the heart

A

metformin, SGLT2i

48
Q

what drugs cause hypoglycaemic risk

A

SURs, insulin

49
Q

what drugs are safest in CDK

A

pioglitazone, GLP1 agonists, insulin (NOT SLGT2i)

50
Q

what drug causes fractures and oedema

A

pioglitazone

51
Q

what is orlistat

A

inhibits lipases and stops absorption of fat

52
Q

which bariatric surgery is most malapsorptive

A

route en Y

53
Q

which bariatric surgery can slip

A

adjustable bands

My2 endocrinology (19 decks)

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