Type II Diabetes Flashcards
What are the classes of drugs used to treat type II Diabetes?
Insulin secretagogues, insulin sensitizers, alpha-glucosidase inhibitor, Dipeptidyl Peptidase IV (DPP-IV) inhibitors, Glucagon-like peptide-1 (GLP-1) Mimetic, Sodium-glucose co-transporter 2 (SGLT2) inhibitors
What do Insulin secretagogues do?
Increase basal and/or postprandial insulin levels.
They reduce microalbuminuria
ACTIONS DEPEND OF FUNCTION BETA CELLS
What types of drugs are Insulin secretagogues?
Solfonylureas (1-2 times daily) and Meglitinides (3-4 times daily)
What are the adverse effects of insulin secretagogues?
Weight gain, hypoglycaemia
What is the MOA of Sulfonylureas?
↑ insulin secretion
↓ hepatic clearance of
insulin
↓ Glucagon levels
What drugs are Sulfonylureas?
Glibenclamide & Gliclazide (Long acting 24 hrs)
Glipazide & Glimepiride (Short acting 12-24 hrs)
Where are Sulfonylureas’ metabolised?
In the liver
T or F - Sulfonylureas’ do not cross the placenta
False, they do
What are the CI for Sulfonylureas’?
Hepatic/renal impairment
What are the adverse effects of Sulfonylureas’?
Hypoglycemia, nausea, vomiting, allergic skin reactions,
minor disulfiram-like reactions, headache, cardiotoxicity
What are the drug interactions of Sulfonylureas’?
Aspirin & Sulphonamides potentiate the effects of SUs
Hepatic enzyme inducers, corticosteroids, oral
contraceptives ↓ the effects of SUs
β-blockers mask the signs of hypoglycemia
What are the two types of Meglitinides?
Repaglinide and Nateglanide
T or F - Meglitinides have a slow onset and long duration of action?
False. They have a rapid onset and are short acting
What is the MOA of Meglitinides?
Bind to ATP-dependent K+ channels,
causing insulin release
What drugs can Meglitinides be combined with?
metformin or thiazolidinediones
What are the adverse effects of Meglitinides?
Hypoglycemia
Upper respiratory tract infections
Weight gain
Bronchitis
Headache
What drugs are Thiazolidinediones?
Rosiglitazone (withdrawn) and Pioglitazone
What is the MOA of Thiazolidinediones?
Agonist at peroxisome proliferator-activated receptor – γ (PPARγ). Induces insulin genes
What are the therapeutic uses of Thiazolidinediones?
Monotherapy
With Sulfonylureas
With Metformin
With injected insulin
What are the cautions with Thiazolidinediones?
Heart failure
What are the adverse effects of Thiazolidinediones?
Fluid retention (oedema)
Weight gain
Anaemia
CVD
Increased risk of cardiac ischaemia
What drug is a Biguanide?
Metformin
What is the use of Metformin?
Obese pts- decrease their body weight
What is the MOA of Metformin?
Decrease hepatic glucose synthesis and increase glucose uptake from muscles
What are the therapeutic uses of Metformin?
In combination with SUs, meglitinide,
thiazolidinediones, insulin, or α-glucosidase
inhibitor
What are the adverse effects of Metformin?
GI disturbances – abdominal discomfort and diarrhoea, metallic taste, mild anorexia
Lactic acidosis
What are the CI of Metformin?
Renal Impairment & hepatic
disease
* Alcohol abuse
* If predisposed to CV
collapse, acute CHF,
severe infection
* History of lactic acidosis
What is the drug that belongs to the α-glucosidase inhibitor class?
Acarbose
What is the MOA of Acarbose?
- Inhibits the breakdown of complex CHO in small
intestine - Delays CHO absorption
- Inhibits glucoamylase > sucrase > maltase
> dextranase
What are the benefits of Acarbose?
- ↓s postprandial hyperglycemia (hypoglycemia – rare)
- No effect on lipids or insulin levels
What are the adverse effects of Acarbose?
GI disturbances
* Dose-dependent toxicity
What can Acarbose be combined with?
Can be combined with insulin, metformin or sulfonylureas – additive effect
What are the CI of Acarbose?
- Inflammatory bowel disease, GI obstruction, cirrhosis
What drugs are Dipeptidyl Peptidase IV
(DPP-IV) Inhibitors?
Sitagliptin, Vildagliptin, Saxagliptin
What is the MOA of DPP-IV inhibitors?
Inhibits DPP-IV. Extend action of insulin while
suppressing release of
glucagon
What can DPP-IV inhibitors be combined with?
Insulin, metformin or sulfonylureas – additive
effect
What are the adverse effects of DPP-IV inhibitors?
Gastrointestinal discomfort, peripheral oedema, liver dysfunction
What is the caution associated with DPP-IV inhibitors?
Renal impairment
What are Glucagon-like peptide-1 (GLP-1) drugs?
Dulaglutide, Exenatide, Liraglutide, Semaglutide
What is another name GLP-1 drugs?
Incretin Mimetics
What is the MOA for GLP-1 drugs?
Incretin mimetic. Increase Insulin secretion and decrease glucagon secretion
What are 2 additional benefits of GLP-1 drugs?
Promote weight loss and cardiovascular benefits
What are the adverse effects of GLP-1 drugs?
- Hypoglycemia,
- Nausea, vomiting, rash
- pancreatitis
What are the contraindications for GLP-1 drugs?
Type 1 diabetes,
ketoacidosis, severe
renal impairment.
* Not for use in pregnancy
What drugs are Sodium-glucose co-transporter 2
(SGLT2) inhibitors?
Dapagliflozin, Canagliflozin, Empagliflozin
What is the MOA of SGLT2 inhibitors?
Competitive, selective inhibitor of SGLT-2 –
preventing kidneys from reabsorbing glucose into the blood
What are the CI for SGLT2 inhibitors?
Renal impairment
* Not for use in pregnancy or
lactation
What can SGLT2 inhibitors be combined with?
Can be combined with
metformin, pioglitazone or
sitagliptin
What are the AE of SGLT2 inhibitors?
Increased risk of genital and urinary tract infections
* Hypotension
