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Med 2 > Type 2 Diabetic Drugs > Flashcards

Type 2 Diabetic Drugs Flashcards

1
Q

What is first line treatment?

A

Metformin

Add SGLT2 inhibitor if existing CVD or HF. Add if QRISK score above 10%

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2
Q

Second line treatment

A

Add sulfonylurea, pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor

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3
Q

Third line option

A

Triple therapy with metformin and two second line drugs
Insulin therapy if required

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4
Q

What is the mechanism of Metformin?

A

Inc insulin sensitivity and decreases glucose production

Does not cause hypoglycaemia

Can cause:

GI issues incl pain, nausea and diarrhoea

Lactic acidosis due to acute kidney injury

Patients with GI side effects with standard release Metformin can try modified-release Metformin.

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5
Q

What should patients with GI side effects receive instead?

A

Modified release metformin

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6
Q

What do SGLT-2 inhibitors end in?

A

-glifozin

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7
Q

What do SGLT2 inhibitors do?

A

SGLT2 looks to reabsorb glucose from the urine back into the blood.

SGLT-2 inhibitors stop this from happening. Thus more glucose is excreted in urine.

Lowers glucose - lowers BP, can lower weight and improves heart failure

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8
Q

Side effects of SGLT-2 inhibitors

A

Glycosidic
Inc urine output an frequency
Genital thrush and UTI - due to lots of glucose
Weight loss
DKA
Lower limb amputation - more common in patients on canagliflozin
Fournier gangrene

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9
Q

Pioglitazone what does it do?

A

Thiazolinedione

Inc insulin sensitivity and decreases liver production of glucose

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10
Q

Side effects of thiazolidinedione

A

Weight gain
HF
Inc risk of bone fractures
Small inc in risk of bladder cancer

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11
Q

What are sulfonyureas?

A

Glicazide - stimulate insulin release

Linked with weight gain and hypoglycaemia

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12
Q

What are incretins?

A

In retina are hormones that are produced by GI tract

They are secreted in response to large meals to reduce blood sugar

Inc insulin secretion
Inhibit glucagon production
Slow absorption by GI tract

Main incretin is GLP-1

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13
Q

What are incretins like GLP-1 inhibited by?

A

Dipeptidyl peptidase-4 (DPP-4)

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14
Q

What do DPP-4 inhibitors do?

A

Block the action of DPP-4

Allow for increased incretin activity. Examples incl sitagliptin and aloglitpin.

However they do not cause hypoglycaemia

Side effects do include:

Headaches
Acute pancreatitis

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15
Q

What do GLP-1 mimetic do?

A

Imitate the action of GLP-1

Examples include exenatide and liraglutide

They are given subcutaneous injection. Liraglutide can also be sued for weight loss in non-diabetics

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16
Q

What are the side effects of GLP-1 mimetics?

A

Reduced appetite
Weight loss
GI symptoms

17
Q

How long does rapid insulin last

A

Works 10 mins after injection and lasts 4 hours

18
Q

How long does short acting insulin last?

A

Actrapid

Starts working in 30 mins, lasting 8 hours

19
Q

How long does intermediate acting insulin last?

A

Humulin I

Starts in one hour, lasts around 16 hours

20
Q

How long does long acting insulin work for?

A

Lemivir or lantus

Starts working in 1 hour and takes around 24 hrs or longer to work

21
Q

What do combination insulins look like?

A

Rapid acting and intermediate to gather

Humalog 25 (25:75) - 25% rapid: 75% intermediate acting

22
Q

Complications of T2D

A

Infections
Neuropathy
Retinopathy
Autonomic neuropathy
Chronic Kidney Disease
Gastroparesis - slow emptying of the stomach
Hyperosmolar hyperglycaemic state

23
Q

What are ACE inhibitors used for in T2Diabetics

A

ACE inhibitors - chronic kidney disease

Albumin to Creatine ratio above 3 mg/mmol (as opposed to 30mg/mmol in patients without diabetes)

Also in those with hypertension

24
Q

If ACR in chronic kidney disease is above 30 mg/mmol in diabetics what do you give?

A

SGLT-2 inhibitors in addition to ACE inhibitor

25
Q

Neuropathic pain treatment

A

Amitriptyline, duolextine - antidepressants

Gabapentin and pregabalin - anticonvulsant

Med 2 (6 decks)

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