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Flashcards in Type 2 diabetes Drugs Deck (42)
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1
Q

What are Biguanides?

A

Insulin sensitizers

2
Q

What drug class is Metaformin?

A

Biguanide

3
Q

What are the usual dosages for Metaformin?

A

500, 850 or 1000mg tablets

4
Q

What is the usual starting dosage for Metaformin?

A

500mg

5
Q

What effect does metaformin have on hyperglycaemia?

A

Reduces HbA1c by 15/20mmolL by lowering insulin resistance

6
Q

Does metaformin make you gain weight?

A

No- weight neutral

7
Q

Does metaformin cause Hypoglycaemia?

A

Not when used as a monotherapy

8
Q

What properties other than reducing insluin resistance does metaformin have?

A

Reduces triglycerides and LDL

Minor reduction in BP

Safe in pregnancy

USed in Polycucstic Ovarian Syndrome

Used in Non-alcholic fatty liver disease

9
Q

What are the adverse effects of Metaformin?

A

GI side affects:- anorexia, nausea , diahrrhoea. abdo pain

Lactic acidosis (rare but serious)

Liver failure

Interference with vitamin B12 and folic acid absorption

10
Q

Give examples of some Sulphonylureas

A

“Gli__ides”

Glicazide

Glipizide

Glibenclamide

Glimepiride

11
Q

What is the mechanism of action of Sulphonylureas?

A

Blocks the ATP potassium ion channel mimicing the role of ATP

12
Q

What effect do Sulphonylureas have on blood glucose levels?

A

Reduce HbA1c by 15/20mmol/mmol by increasing insulin secretion.

More rapid change than metaformin or other insulin sensitisers

13
Q

What are the adverse effects of using sulphonylureas?

A

Hypoglycaemia

Weight gain

GI upset

14
Q

What are the 1st and 2nd line treatments for type 2 diabetes?

A
  1. Metaformin
  2. Gli___ides ( Sulphonylureas)
15
Q

What are Thiazolidinediones?

A

PPARgamma agonists

16
Q

What is the only available Thiazolidinedione (TZD)

A

Pioglitazone

17
Q

What is the mechanisim of action of Pioglitazone?

A
18
Q

What effect does piaglitazone have on HbA1c?

A

Reduces HbA1c by 15-20mmol/mol by increasing insulin sensativity

19
Q

What are the adverse effects of TZDs?

A

Weight gain:- very common due to increase in subcutaneous fat and fluid retention

Heart Failure:- Fluid retention results in doubling of risk of admission with heart failure

20
Q

What does this graph show?

A

Drugs are great at the start but then start to loose their effect

21
Q

What are the benefits of DPP4 inhibitors?

A

Promote insulin secretion without hypoglycaemia

Suppress glucagon

Weight neutral

22
Q

What are the downsides of DPP4 inhibitors?

A

Not that potent

pancreatitis

Pancreatic cancer

23
Q

How do you spot a SGLT2 inhibitor?

A

“____flozin”

24
Q

What do SGLT2 inhibitors?

A

Make you pee sugar

25
Q

What are the four ways in which type 2 diabetes drugs can work?

A

Increase insulin secreation

Decrease insulin resistance

Slowdown Glucose absorption in the GI tract

Enhance glucose excretion by the kidneys

26
Q

What drug classes increase insulin secretion?

A

Sulfonylureas

DPP-4 inhibitors

27
Q

What do Glinides do?

A

Similar to sulfonylureas they bind to SUR1 to close K+ channels and trigger insulin release

28
Q

Name two Glinides

A

repaglinide

Nateglinide

29
Q

How do glinides differ from sulfonylureas?

A

Have rapid onset/offset kinetics so are less likely to cause hypogycaemia

30
Q

How is GLP-1 and GIP released?

A

Ingestion of food stimulates GLP-1 and GIP release from enteroendocrine cells in the small intestine.

31
Q

What does GLP-1 do?

A

Enhances insulin release from prancreatic beta cells and delays gastric emptying.

Results in enhanced glucose uptake and utilization

Also decreases glucagon release from pancreatic alpha cells

32
Q

How do incretin analogues work?

A

They mimic the action of GLP-1 but are longer lasting

33
Q

Give and example of an incretin analogue

A

Extenatide

34
Q

How is Etenatide administered?

A

subcutaneous injection twice daily

35
Q

What effect do incretin analogues/extenatide have?

A

increase insulin secretion

supress glucagon secretion

slows gastric emptying

decreases appetite

36
Q

What is a longer acting version of extenatide?

A

Liraglutide

37
Q

What is DPP-4 ?

A

Enzyme which rapidly terminates the action of GLP1 and GIP

38
Q

How do Gliptins work?

A

Competativly inhibit DPP-4 prolonging the actions of GLP-1 and GIP

39
Q

Give an example of a Gliptin?

A

Sitagliptin

40
Q

What is alpha-glucosidase?

A

enzyme which breacks down statch and disaccharides into absorbable glucose

41
Q

How do alpha glucosidae inhibitors work?

A

Inhibit alpha glucosidase delaying absoption of glucose thus reducing postprandial increase in blood glucose

42
Q
A