Treatment for TII DM Flashcards
What are the five diabetic drug classes?
Biguanides e.g. metformin
Sulponylureas e.g. Gliclazide
Glitazone e.g. Pioglitazone
Gliptins e.g. Stiagliptin, Vidagliptin
Insulin
What is the first line of action in DM2?
Biguanides
i.e. Metformin
What is the mode of action of Biguanides?
Decrease glucose entering bloodstream
- decreased intestinal absorption of glucose
- decreased hepatic gluconeogenesis
Increases insulin sensitivity
- increases uptake and usage of glucose
Reduces CV risk by decreasing vLDL (bad cholesterol)
What drug class does Metformin belong to?
Biguanides
What are the side effects of Metformin?
Common: GI upset - D&V, dyspepsia
Rare: lactic acidosis
Rare: B12 deficiency
When is Metformin contraindicated?
Renal failure - inability to excrete H+
Recent MI or chest pain
Liver failure
What drug class does Gliclazide belong to?
Sulphonylureas
What is the mode of action of Sulphonylureas drugs?
Stimulates increased insulin release from pancreas
What are the side effects of Sulphonylureas drugs?
GI problems, dizziness (common)
Hypoglycaemia
Weight gain - due to anabolic effect of insulin
When are Sulphonylureas drugs contraindicated?
Renal impairment
- since excreted through renal system
Liver impairment
- Cause hypoglycaemia if liver not producing glucose
Pregnancy
- teratogenic
Which drug belong to the Glitazones class?
Pioglitazone
What is the mode of action of Pioglitazone?
Decrease hepatic gluconeogenesis
Increase insulin sensitivity
What are the side effects of pioglitazone?
Wight gain
Fluid retention and oedema
Hepatic toxicity
Increased risk of MI
Increased risk of Bladder Ca
When is Pioglitazone contraindicated?
Heart failure
Liver disease
What is the mode of action of Gliptins (i.e. DPP4 inhibitors)?
Increase GLP-1 production which:
- increases insulin release
- decreases glucagon secretion
