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Pharmacology > Type 2 Diabetes > Flashcards

Type 2 Diabetes Flashcards

1
Q

Classification of Type 2 diabtes

A

insulin resistance with relative insulin deficiency

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2
Q

Classes of Drugs used in Type 2 diabtets

A

Insulin Secretagogues
Insulin Sensitizers
a-Glucosidase Inhibitor
Dipeptidyl Peptidase IV Inhibitors: DPP-IV
Glucagon-like Peptide-1 GLP-1 Mimetic
Sodium-glucose co-transporter 2 SGLT2 inhibitors

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3
Q

Function of Insulin Secretagogues

A

Increase basal and/or postprandial insulin levels

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4
Q

The action of Insulin Secretagogues depend on

A

Functional B cells

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5
Q

Which are the Insulin Secretagogues

A

Sulfonylureas
Meglitinides

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6
Q

Dosing of the Sulfonylureas

A

1-2 times daily

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7
Q

Dosing of Meglitinides

A

3-4 times daily

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8
Q

AEs of Insulin Secretagogues

A

Weight gain
Hypoglycemia

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9
Q

Insulin Secretagogues cause a reduction in

A

Microalbuminuria

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10
Q

Which are the 2nd gen Sulfonylureases

A

Gibenclamide
Gliclazide
Glipazide
Glimepiride

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11
Q

Which are the long acting Sulfonylureas

A

Gibenclamide
Glimepiride
DOA: 24 hrs

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12
Q

Which are the short acting Sulfonylureas

A

Glipizide
Gliclazide
DOA: 12-24

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13
Q

MOA of Sulfonylureas

A

Incr. Insulin secretions
Decr. Hepatic clearance of insulin
decr. Glucagon levels

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14
Q

CIs of Sulfonylureas

A

Significant Hepatic/renal impairment–> incr. T1/2 of drug

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15
Q

AEs of Sulfonylureas

A

Hypoglycemia
NV
Headache
Allergic skin rxn
Minor Disulfiram-like rxns
Cardiotoxicity

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16
Q

DIs with Sulfonylureas

A

Aspirin + Sulphonamides: potentiate effecrs of Sulfonylureas
-Hepatic enzyme inducers
-Corticosteroids
-Oral contraceptives
–> decr. effects of Sulfonylureas
B-Blockers mask signs of hypoglycemia

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17
Q

Which are the Meglitinides?

A

Repaglinide
Nateglanide

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18
Q

MOA of Meglitinides

A

Bind to ATP dependent K channels causing insulin release
*have no effect on lipids

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19
Q

Can Meglitinides be used with the Sulfonyureases

A

Nope, they Incr. insulin secretions

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20
Q

Repaglinide can be combined with

A

Metformin
Thiazolidine-diones

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21
Q

AEs of Repaglinide

A

Hypoglycemia
URTIs
Weight gain
Bronchitis
Headache

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22
Q

MOA of Nateglinide

A

Rapid onset action: 3x more than Repa..
–> incr. early phase of insulin release
Rapid-off action: 5x more than Repa
–> insulin return to pre-prandial levels 3-4 hrs
–> decr. risk of postprandial hypoglycemia

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23
Q

AEs of Nateglinide

A

Nausea
diarrhea
Mild Hypoglycemia
*no increase in body weight

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24
Q

What are Thiazolidinediones

A

They are insulin sensitisers= enhance effects of insulin
-decr. glucose ouptout in liver
-incr. glucose uptake and incr. insulin sensitivity in mucsles

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25
Q

MOA of Thiazolidinediones

A

Are agonists at Peroxisome Proliferator-activated receptor-γ (PPARγ)
–> induce insulin genes

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26
Q

The induction of insulin genes cause

A

incr. expression of glucose transporter Rs
–> decr. glucose output by incr. glucose uptake by incr. glucose sensitivity in muscles

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27
Q

Why is the therapeutic effect of Thiazolidinediones delayed

A

Bcos they work at the gene transcription levels
–> induce insulin genes and decr. peripheral resistance of insulin
*ddelayed for 4-12 wks

28
Q

Name a Thiazolidinedione

A

Pioglitazone

29
Q

Effects of Pioglitazone

A

Decr. Trigs and FFA levels
Incr. HDL levels
No effect on LDL levels
Decr. rsk of Hypoglycemia

30
Q

Therapeutic uses of Pioglitazone

A

Monotherapy

31
Q

Pioglitazone can be used in combination with

A

Sulfonylureases
Metformin
Injected insulin

32
Q

AEs of Pioglitazone

A

Fluid retention–> Oedema
Weight gain
Anemia
CVD
Incr. riks of Cardiac ischaemia

33
Q

What is Metformin

A

Its a insulin sensitiser

34
Q

MOA of Metformin

A

Incr. insulin sensitivity
decr. hepatic glucose production, fasting insulin
Decr. Trigs, FFA, LDL leves
Incr. HDL levels
Decr. risk for developmeny of macrovascular complications

35
Q

Name a Metformin agent

A

Biguanides

36
Q

Where does Metformin act

A

Liver: decr. glucose output
Muscle: incr. glucose uptake

37
Q

Uses of Biguanide (metformin)

A

1st line drug in Type 2 diabetes

38
Q

Biguanide can be used in combination with

A

Sulfonylureases
Meglitinide
Thiazolidinediones
Insulin or a-glucosidase inhibitor

39
Q

AEs of Biguanide

A

GI disturbances such as:
-abdominal discomfort
-diarrhea
-Metallic taste
-mild anorexia
Lactic Acidosis

40
Q

CIs of Biguanide

A

Renal impairment
Hepatic disease
Alcohol use
Predisposition to CV, collapse, acute CHF, sever infection
History of Lactic Acidosis

41
Q

Name an a-glucosidase inhibitor

A

Acarbose

42
Q

MOA of Acarbose

A

inhibits the breakdowm of CHO comples in SI–> delays CHO absorption
inhibits glucoamylase>sucrase>maltase>dextranase

43
Q

Benefits of taing Acarbose

A

decr. postprandial hyperglycemia
no effect on lipids or insulin levels

44
Q

AEs of Acarbose

A

GI disturbances
Dose-dependent toxicity

45
Q

CIs of Acarbose

A

Inflammatory bowel disease
GI obstruction
Cirrhosis

46
Q

Acarbose can combined with

A

Insulin
Metformin
SUlfonylureases
–> has an additive effect

47
Q

What are incretins

A

Are a group of GI enzymes that cause an icrease in the amount of insulin released from B-cells
–> Enhance GLP-1 activity= insulin enhanced

48
Q

Function of Dipeptidyl Peptidase IV

A

Breakdown/inactivates GLP-1

49
Q

What are DPP4 Inhibitors

A

They are incretin enhancers thus they inhibit the DPP-IV enzyme

50
Q

Effect of DPP4 inhibitors

A

they extend the action of insulin while suppressing release of glucagon

51
Q

Which are the DPP4 inhibitors

A

Sitagliptin
Vildagliptin
Saxagliptin

52
Q

DPP4 inhibitors can be combined with

A

Insulin
Metformin
Slufonylureases
–> have an additive effect

53
Q

AEs of DPP4 inhibitors

A

GIT discomfort
Peripheral oedema
Liver dysfunction

54
Q

Cautions when using DPP4 inhibitors

A

Renal impairment

55
Q

Which are the GLP-1 mimetics

A

LEDS
Liraglutide
Exenatide
Dulaglutide
Semaglutide

56
Q

MOA of GLP-1 mimetics

A

are incretin mimietics
exhibit GLP-1 actions
incr. insulin secretion
decr. glucagon secretion

57
Q

Admin of GLP-1 mimetics

A

SC
L: 1x daily
E: 2x daily
s: 1x daily

58
Q

Effects of GLP-1 mimetics

A

May promote weight loss
CVS benefits

59
Q

AEs of GLP-1 mimetics

A

Hypoglycemia
NV
Rash
Pancreatitis

60
Q

CIs in GLP-1 mimetics

A

Type 1 diabetics (as functional B-cells are required and they dont have these)
Ketoacidosis
Severe renal Impairment
PREGNANCY

61
Q

Function of Sodium-glucose co-transporter 2 SGL2 inhibitors

A

they prevent kidneys from reabsorbing glucose back into blood
–> kidneys can remove excess glucose

62
Q

Which are the SGL2 inhibitors

A

CDE
Canagliflozin
Dapagliflozin
Empagliflozin

63
Q

MOA of SGL2 inhibitors

A

are competitive selective inhibitors of SGL2 thus prevent the kidneys from reabsorbing glucose into blood

64
Q

SGL2 inhibitors can be used with

A

Metformin
Pioglitazone
Sitagliptin

65
Q

Admin SGL2 inhibitors

A

orally
once a day before 1st meal

66
Q

CIs with SGL2 inhibitors

A

Renal impairment
PREGNANCY
LACTATION

67
Q

AEs of SGL2 inhibitors

A

Incr. risk of gental_urinary tract infections
Hypotension

Pharmacology (50 decks)

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