T2DM drugs

Question 1

where does insulin induce glucose uptake mainly

Answer 1

muscle and liver

Question 2

in adipose tissue what is glucose converted to with insulin

Answer 2

fat

Question 3

what does insulin do to amino acids

Answer 3

stimulated amino acids –> proteins

Question 4

what are first-line lifestyle modifications in T2DM

Answer 4

stop smoking, diet, lower BMI, exercise

Question 5

what drug types are dependent upon insulin

Answer 5

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

Question 6

what drug types are independent of insulin

Answer 6

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

Question 7

describe insulin release in beta cells (briefly)

Answer 7

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

Question 8

what is first line drug

Answer 8

metformin

Question 9

what type of drug is metformin

Answer 9

biguanides

Question 10

how does metformin work (4)

Answer 10

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

Question 11

what side effects of metformin are there

Answer 11

GI upset, rarely acidosis (DKA)

Question 12

what is a positive side effect of metformin

Answer 12

weight loss

Question 13

what type of drug are sulfonylureas (SURs)

Answer 13

insulin secretagogues so need functional beta cells

Question 14

name 3 SURs

Answer 14

gliclazide, glipizide, tolbutamide (-ide)

Question 15

how do SURs work

Answer 15

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

Question 16

when are SURs used first line

Answer 16

metformin intolerant or osmotic symptoms

Question 17

what are side effects of SURs

Answer 17

hypoglycaemia, weight gain

Question 18

what are contraindications for hypoglycaemia ie SURs

Answer 18

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

Question 19

what is a positive side effect of SURs

Answer 19

good for heart

Question 20

when do SURs peak

Answer 20

after 1-2 hours

Question 21

name 2 glinides/ meglinitides

Answer 21

repaglinide, mateglinide, - glinide

Question 22

how do glinides work

Answer 22

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

Question 23

when do glinides kick in

Answer 23

fast onset 30-60 mins

Question 24

what are contraindications of glinides

Answer 24

severe hepatic impairment, pregnancy and breast feeding

Question 25

name a thiazolidinediones/ TZDs/ glitazones

Answer 25

pioglitazone only one used now

Question 26

how do glitazones work

Answer 26

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

Question 27

what effects do glitazones have

Answer 27

fatty acid uptake to apidocytes, reduce hepatic output

Question 28

what are adverse affects of glitazones

Answer 28

weight gain, fluid retention, bone fractures

Question 29

what peptides are released from the intestine in the incretin effect

Answer 29

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

Question 30

describe the incretin effect

Answer 30

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

Question 31

what breaks down GLP1 and GIP

Answer 31

DPP4

Question 32

what are incretin analogues. GLP1 agonists

Answer 32

peptides that miic action of GLP1 but resist breakdown by DPP4

Question 33

give an example of an incretin mimic/ GLP1 agonist

Answer 33

exenatide

Question 34

how are incretin analogues. GLP1 agonists given

Answer 34

subcut injections

Question 35

what are side effects of incretin analogues/ GLP1 agonists

Answer 35

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

Question 36

name a DPP4 inhibitors/ gliptins

Answer 36

sitagliptin, -gliptin

Question 37

how do DPP4is/ gliptins work

Answer 37

competitively inhibit DPP4 which therefore increases GLP1 and GIP

Question 38

what are downsides of gliptins

Answer 38

not very effective, can cause nausea

Question 39

how do SGLT2 inhibitors work

Answer 39

selectively blocks reabsorption by SGLT2 deliberately causing glucosuria

Question 40

name and SGLT2 inhibitor

Answer 40

dapagliflozin

Question 41

name a side effect of SGLT2i's

Answer 41

UTIs

Question 42

how do alpha glucosidase inhibitors work

Answer 42

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

Question 43

name 2 alpha glucosidase inhibitors

Answer 43

acarbose, voglibose, -bose

Question 44

what are side effects of alpha glucosidase

Answer 44

GI symptoms, not very effective

Question 45

what drugs cause weight gain

Answer 45

SUR's and piogliazatone

Question 46

what drugs cause weight loss

Answer 46

metformin, SGLT2i, GLP1 agonists

Question 47

what drugs are good for the heart

Answer 47

metformin, SGLT2i

Question 48

what drugs cause hypoglycaemic risk

Answer 48

SURs, insulin

Question 49

what drugs are safest in CDK

Answer 49

pioglitazone, GLP1 agonists, insulin (NOT SLGT2i)

Question 50

what drug causes fractures and oedema

Answer 50

pioglitazone

Question 51

what is orlistat

Answer 51

inhibits lipases and stops absorption of fat

Question 52

which bariatric surgery is most malapsorptive

Answer 52

route en Y

Question 53

which bariatric surgery can slip

Answer 53

adjustable bands