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MPharm 2 - PH2113 > Unit 5 - Diabetes 2 > Flashcards

Unit 5 - Diabetes 2 Flashcards

1
Q

What do all diabetic patients benefit from advice on?

A
  • nutrition
  • physical activity
  • weight loss
  • smoking cessation
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2
Q

What is the mainstay of treatment for Type 2 diabetes?

A

Dietary control

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3
Q

What does DESMOND stand for?

A

Diabetes Education and Self-Management for Ongoing and Newly Diagnosed

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4
Q

What does X-PERT stand for?

A

eXPert Education versus Routine Treatment health diabetes programme

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5
Q

What does DAFNE stand for?

A

Dose-Adjustment for Normal Eating

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6
Q

What are the pharmacological options to manage type 2 diabetes?

A
  • agents that primarily lower glucose levels by their actions on the liver, muscle and adipose tissue
  • agents that primarily work by stimulating insulin release by binding to the sulphonylurea receptor
  • drugs that affect glucose absorption
  • drugs that control blood glucose via the kidneys
  • drugs that target the incretin axis
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7
Q

Give two examples of agents that primarily lower glucose levels by their actions on the liver, muscle and adipose tissue

A

Biguanides - e.g Metformin

Thiazolidinediones - rosiglitazone and pioglitazone

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8
Q

Give an example of a biguanide

A

Metformin

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9
Q

What is the first line treatment for type 2 diabetes patients?

A

Metformin

- especially in overweight and obese patients

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10
Q

How does metformin work?

A

Increases hepatic insulin sensitivity
Increases uptake of glucose into peripheral cells
Reduces hepatic glucose production by both gluconeogenesis and glycogenolysis
Delays intestinal glucose absorption

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11
Q

What are the effects of metformin?

A

Aids weight loss

Shown to reduce total cholesterol, LDL cholesterol and triglyceride levels

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12
Q

What are the side effects of metformin?

A

Gastrointestinal effects

  • abdominal bloating
  • cramps
  • nausea
  • vomiting
  • diarrhoea
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13
Q

How can the side effects of metformin be mitigated?

A

Start at a low dose and titrate upward

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14
Q

Which rare, but life threatening disease, can be caused by metformin?

A

Lactic acidosis

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15
Q

Give an example of a thiazolidinedione

A

Pioglitazone

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16
Q

Why have thiazolidinediones lost favour as a second or third line of type 2 diabetes management?

A

Adverse effects

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17
Q

How do thiazolidinediones work?

A

Decreases insulin resistance by activation of peroxisome proliferator-activated receptor-gamma (PPAR-gamma)

  • increased glucose transporter (GLUT-1 GLUT-4) expression
  • decreased free fatty acid levels
  • decreased hepatic glucose output
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18
Q

What are the side effects of thiazolidinediones?

A

Weight gain
Increased fracture risk
Possible increased risk of bladder cancer
Fluid retention

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19
Q

Why was the marketing authorisation for rosiglitazone suspended in 2010?

A

New evidence suggesting that cardiovascular risk outweighed benefits

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20
Q

Give two examples of agents that primarily works by stimulating insulin release by binding to the sulphonylurea receptor

A 
Sulphonylureas
- gliclazide
- glimepride
Glinides
- repaglinide
21
Q

What are the second-line agents in treating patients with type 2 diabetes?

A

Sulphonylureas

Glinides

22
Q

When are sulphonylureas used as a first-line treatment for type 2 diabetes?

A

When the patient is not overweight

When the patient is not able to tolerate metformin

23
Q

What is added to metformin if glycaemic control is inadequate?

A

Sulphonylureas

24
Q

How do sulphonylureas and glinides work?

A

Bind to sulphonylurea receptor on pancreatic beta cells
- increasing sensitivity to glucose
- increased secretion of endogenous insulin in response to a given glucose load
Increase tissue sensitivity to insulin

25
Q

What are the side effects of sulphonylureas and glinides?

A

Weight gain
Hypoglycaemia
Increased risk in people with mild to moderate renal impairment and severe hepatic impairement

26
Q

Give an example of alpha-glucosidase inhibitors

A

Acarbose

27
Q

How do alpha-glucosidase inhibitors work?

A

Acarbose reduces carbohydrate digestion by interfering with GI glucosidase activity
- leading to reduced post-prandial hyperglycaemic peaks

28
Q

What are the side effects of alpha-glucosidase inhibitors?

A

Abdominal discomfort
Flatulence
Diarrhoea

GI side effects limit the use of acarbose in practice

29
Q

What are SGLT2?

A

Sodium/glucose cotransporter 2

30
Q

Give examples of SGLT2 inhibitors?

A
  • dapagliflozin
  • canagliflozin
  • empagliflozin
31
Q

What are SGLT2 inhibitors?

A

‘Gluco-uretic agents and control blood sugar levels via the kidneys

32
Q

How do SGLT2 inhibitors work?

A

Normally glucose is reabsorbed from the kidneys via the SGLT2 transporter protein
Inhibiting the action of these transporters leads to more glucose excreted in urine
- lowers blood glucose with a low risk of hypoglycaemia

33
Q

What are the side effects of SGLT2 inhibitors?

A
  • severe life threatening cases of diabetic ketoacidosis have been reported
  • dehydration and hypotension
  • particularly in those urine diuretics
  • increased fungal genital infections and urinary tract infections
34
Q

What is the HbA1c test?

A

Glycated haemoglobin lab tests are used to diagnosis and assess control of diabetes mellitus

35
Q

How long is the lifespan of a red blood cell?

A

120 days

36
Q

What does the proportion of glycated haemoglobin depend on?

A

Glycation of haemoglobin occurs at a variable rate during the lifespan of the red blood cells
The proportion of glycated haemoglobin depends on the mean glucose level over the previous 120 days

37
Q

What is the normal range of HbA1c?

A

20 - 42 mmol/mol

38
Q

When is diabetes usually diagnosed?

A

HbA1c = or > 48 mmol/mol

39
Q

Give examples of agents that target the incretin axis in type 2 diabetes

A

GLP-1 receptor agonists

  • exenatide
  • liragluide
  • dulaglutide
40
Q

How do GLP-1 receptor agonists work?

A

Stimulation of GLP-1 receptor leads to longer lasting glucose dependant insulin release

  • GLP-1 agonists increase insulin release
  • GLP-1 agonists decrease glucagon release
  • GLP-1 agonists slow gastric emptying
  • GLP-1 receptor agonists there fore aid weight loss
41
Q

Apart from type 2 diabetes, what else is liraglutide licensed for?

A

Non-diabetic individuals as a weight loss treatment

42
Q

What are the side effects of GLP-1 receptor agonists?

A

Nausea - usually temporary and disappears around two weeks after initiation
Increased satiety, augment weight loss
Pancreatitis
- rare but patients and carers should be aware of signs

43
Q

What is a DDP4 inhibitor?

A

DPP-4 inhibitors work by blocking the action of DPP-4, an enzyme which destroys the hormone incretin

  • incretins help the body produce more insulin only when it is needed
  • reduce the amount of glucose being produced by the liver when it is not needed
44
Q

What are DDP4 inhibitors also known as?

A

Gliptins

45
Q

What are recommended for use by NICE as an alternative second or third-line therapy for Type 2 diabetes?

A

DDP4-inhibitors

- gliptins

46
Q

How do DDP4 inhibitors work?

A

DPP-4 inhibitors work by blocking the action of DPP-4, an enzyme which destroys the hormone incretin. Incretins help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed. These hormones are released throughout the day and levels are increased at meal times

47
Q

What are the advantages of DDP4 inhibitors as a Type 2 diabetes treatment?

A

Low risk of hypoglycaemia

Do not lead to weight gain

48
Q

What are the side effects of DDP4 inhibitors?

A

GI side effects

Upper respiratory tract infections

MPharm 2 - PH2113 (50 decks)

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