Year 3 Diabetes Drugs Flashcards
Management of Hyperglycaemia
0) Diet and Exercise
1) Biguanides - METFORMIN
2) Sulphonylureas - GLICLAZIDE, GLIBENCLAMIDE
3) Thiozolidinediones - PIOGLITAZONE
4) GLP-1 analogues (incretins) - EXANATIDE, LIRAGLUTIDE
5) DPP4 inhibitors (gliptins) - SITAGLIPTIN, LINAGLIPTIN
6) SGLT2 inhibitors - CANAGLIFLOZIN, EMPAGLIFLOZIN (trial –> make you pee glucose, also diuretic)
7) Insulin
Pre-drug management
0) Diet and exercise
Stage 1 drug management
1) Biguanides - METFORMIN METFORMIN MR (modified release)
Stage 2 drug management
Add to metformin
2) Sulphonylureas - GLICLAZIDE, GLIBENCLAMIDE
3) Thiozolidinediones - PIOGLITAZONE (??link to bladder cancer)
5) DPP4 inhibitors (gliptins) - SITAGLIPTIN, LINAGLIPTIN
Stage 3 drug management
Injectables
4) GLP-1 analogues (incretins) - EXANATIDE, LIRAGLUTIDE
Stage 4 drug management
7) Insulin
Trial medications
6) SGLT2 inhibitors - CANAGLIFLOZIN, EMPAGLIFLOZIN (trial –> make you pee glucose, also diuretic)
What class is METFORMIN?
Biguanide
What class are GLICLAZIDE, GLIBENCLAMIDE?
Sulphonylurea
What class is PIOGLITAZONE?
Thiozolidinediones
What class are EXANATIDE, LIRAGLUTIDE?
GLP-1 analogues (incretins)
What class are SITAGLIPTIN, LINAGLIPTIN?
DPP4 inhibitors (gliptins) [Dipeptidyl peptidase 4 inhibitors]
What class are CANAGLIFLOZIN, EMPAGLIFLOZIN?
SGLT2 inhibitors (trial –> make you pee glucose, also diuretic)
Name a Biguanide drug:
METFORMIN
Name a Sulphonylurea drug:
GLICLAZIDE, GLIBENCLAMIDE
Name a Thiozolidinediones drug:
PIOGLITAZONE
Name a GLP-1 analogue drug:
EXANATIDE, LIRAGLUTIDE (Incretins)
Name a DPP4 inhibitors drug:
SITAGLIPTIN, LINAGLIPTIN (Gliptins)
Name a SGLT2 inhibitors drug:
CANAGLIFLOZIN, EMPAGLIFLOZIN (Flozins)
What do biguanides do?
Reduce insulin resistance
What do sulphonylureas do?
Increase insulin release
What do thiozolidinediones do?
Reduce insulin resistance
What do GLP-1 analogues (incretins) do?
Increase glucose stimulated insulin release
Reduce gastric emptying
Reduce appetite
What do DPP4 inhibitors (gliptins) do?
Reduce GLP-1 breakdown
What do SGLT2 inhibitors (flozins) do?
Inhibit Sodium GLucose coTransporter 2
Reduce glucose re-absorption = pee glucose
Diuretic effects
Side effect of METFORMIN
GI upset
Side effect of sulphonylureas
Hypoglycaemia
Side effect of thiozolidinediones
Fluid retention (CI: Cardiac failure)
?MI
?Osteoporosis
Types of Insulin replacement
BASAL > Slow absp/release > Long duration of action BOLUS > Rapid onset > Short duration of action
Basal insulin replacements
Insulatard - Isophane insulin or NPH (Neutral Protamine Hagedorn) Insulin+Protamine from fish semen 12-18hrs
Glargine - change in amino acid composition –> aggregate formation (slow-release) lasting up to 24hr
Detemir - free fatty acid chain that binds to albumin
Bolus insulin replacements
1 Actrapid - (Soluble insulin) 30min delay
V.Rapid acting so can be taken just before snack 2i Humalog (insulin lipro) 2ii Novorapid (insulin aspart)
Insulin side effects
Hypoglycaemia
Weight gain
Can’t drive HGV –> can’t work
Side effects of SGLT2 inhibitors
Hypoglycaemia (with insulin or SUs) Urogenital infections (vulvovaginal candiasis, UTI, balanitis)
Three C’s in diabetes clinic
Control (over last 3 months –> HbA1c)
Complications (micro/macro)
Cardiovascular risk - BP/Cholesterol
