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Diabetes and Endocrine - Conditions > Type 2 Diabetes Medication > Flashcards

Type 2 Diabetes Medication Flashcards

1
Q

7 drugs types

A
  1. metformin
  2. sulphonyureas
  3. thiazolidones
  4. DDP-IV inhibitor
  5. SGLT-2 inhibitor
  6. GLP-1 agonist
  7. insulin
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2
Q

mechanism of metformin

A

acts on liver and muscle to improve insulin receptor sensitivity, stimulate glucose breakdown and inhibit gluconeogenesis

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3
Q

3 ways in which metformin improves insulin receptor sensitivity

A

improves receptor function, reduces fatty acid synthesis and improve glucose transport

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4
Q

side effects of metformin

A

GI problems, B12 malabsorption and lactic acidosis

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5
Q

pros of metformin

A

cheap, well tolerated, no weight gain, good for CV

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6
Q

drugs with risk of hypos

A

sulphonylureas and insulin

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7
Q

mechanism of sulphonylureas

A

binds to receptors on b-cells to close K+ channels and stimulate insulin exocytosis

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8
Q

site of sulphonylureas action

A

pancreas

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9
Q

side effects of sulphonylureas

A

weight gain, hypos, not good for renal or liver disease

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10
Q

when are sulphonylureas indicated as a 1st line

A

when there is concern of weight loss or osmotic symptoms?

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11
Q

what are the other 2nd line options for when weight gain, hypos and renal/liver disease are present

A

thiazolidinedione
DPP-IV inhibitor
SGLT-2 inhibitor

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12
Q

which 2 drugs are only 3rd line options

A

GLP-1 agonist and insulin

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13
Q

mechanism of thiazolidiones action

A

activated PPAR-ϒ gene in liver, muscle and fat to reduce free fatty acids and insulin resistance

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14
Q

true/false thiazolidiones lower HbA1c by ~1%

A

true - not very much compared to metformin’s 12-17%

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15
Q

true/false sulphonylureas can be used in pregancy and breastfeeding

A

false - it’s contraindicated

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16
Q

true/false metformin can be used in pregnancy and breastfeeding

A

true

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17
Q

side effects of thiazolidiones

A

weight gain, congestive cardiac failure, bladder cancer, fractures

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18
Q

what test is set as a target marker in treatment

A

HbA1c

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19
Q

true/false you would prescribe thiazolidinedione when there is a concern of congestive heart failure

A

false - thiazolidinedione causes fluid retention and then congestive cardicat failure.
give sulphonylurea, DPP-IV inhibitor or SGLT-2 inhibitor

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20
Q

when are DPP-IV inhibitors indicated

A

when 1st line isn’t cutting the mustard and there is concern of weight gain, CCF or hypos

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21
Q

mechanism of DPP-IV inhibitors

A

the DPP-4 enzyme breaks down incretins. Incretins are gut hormones that stimulate insulin release and inhibit glucagon.
therefore inhibit DPP-4 and you increase insulin release

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22
Q

gut hormones acted on by DPP-4 inhibitors (gliptins)

A

incretins

23
Q

DPP-IV inhibitors are used as what line drug

A

2nd or 3rd line

24
Q

true/false DPP-IV inhibitors can be used in renal impairment

A

true

25
Q

cons of DPP-IV inhibitors

A

nausea, small glycaemic control, risk of pancreatitis/prancreatic cancer

26
Q

true/false DPP-IV inhibitors can be given in pregnancy

A

false - contraindicated

27
Q

pros of DPP-IV inhibitors

A

well tolerated, used in renal impairment, no weight gain

28
Q

what line are GLP-1 analogues

A

3rd line

29
Q

how are GLP-1 analogues administered

A

injected

30
Q

mechanism of GLP-1 analogues

A

stimulate release of incretin hormones to increase insulin release

31
Q

pros of GLP-1 analogues

A

weight loss

32
Q

cons of GLP-1 analogues

A

expensive, risk of pancreatitis/pancreatic cancer, nausea and vomiting

33
Q

increasing what hormones gives greater risk of pancreatitis and pancreatic cancer

A

incretins

34
Q

side effects of increasing incretins

A

nausea and vomiting, pancreatitis/pancreatic cancer

35
Q

which drug classes work by increasing incretin secretions

A

GLP-1 analogues and DPP-IV inhibitors

36
Q

what line are SGLT-2 inhibitors

A

2nd and 3rd line

37
Q

mechanism of SGLT-2 inhibitors

A

inhibit the SGLT-2 transporter in the proximal tubule that reabsorbs glucose

38
Q

how do SGLT-2 inhibitors cause hypotension

A

they prevent glucose reabsorption at the renal tubules and so pull across more water and reduce circulating volume

39
Q

what infection do SGLT-2 inhibitors put you at greater risk of

A

UTIs and genital infections (candidiasis) because there’s more glucose for microorganisms

40
Q

pros of SGLT-2 inhibitors

A

weight loss, improves CV morbidity/mortality

41
Q

where are SGLT-2 transporters found

A

in the proximal tubule of the kidney

42
Q

cons of SGLT-2 inhibitors

A

urogenital infections, expensive, risk of DKA, can’t use in renal impairment

43
Q

which drugs can be used in pregnancy/breastfeeding

A

metformin and one or two thiazolidinediones

44
Q

a drug ending in …glitazone is what class

A

thiazolidinediones

45
Q

drugs ending in …gliptin are what class

A

DPP-IV inhibitors

46
Q

drugs that cause weight gain

A

sulphonylureas, glitazones and insulin

47
Q

drugs that cause weight loss

A

SGLT-2 inhibitors and GLP-1 analogues

48
Q

cheapest drugs

A

metformin, sulphonylureas and glitazones

49
Q

true/false sulphonylureas, glitazones and insulin have no renal restriction

A

true - most of the other ones can’t be used if eGFR < 30/60

50
Q

drug that gives increased risk of bladder cancer

A

glitazones

51
Q

order of 1st, 2nd and 3rd line treatments

A

1st: metformin (sulphonylureas)
2nd: sulphonylureas (glitazones, DPP-IV inhibitors, SGLT-2 inhibitors)
3rd: (glitazones, DPP-IV inhibitors, SGLT-2 inhibitors, GLP-1 agonists, insulin)

52
Q

what drugs can be injected

A

GLP-1 analogues and insulin

53
Q

5 step framework

A
  1. set target HbA1c
  2. assess risk factors to be treated
  3. review current treatments
  4. what are the options
  5. arrange a review
54
Q

how many people with diabetes in grampian

A

28,000

Diabetes and Endocrine - Conditions (3 decks)

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