Lipids/ Diabetis/ BP drugs Flashcards

1
Q

What is the MOA of metformin?

What is the effects on lipids?

A
  • Enhances the effect of insulin via modification of the glucose metabolic pathways
    –> Inhibition of mitochondrial GDP
    –> Decrease in hepatic gluconeogenesis and intestinal glucose absorption
    –> Increases peripheral insulin sensitivity

Increase in HDL, lowering of LDL

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2
Q

Is there current evidence that high intensity Blood pressure control (target under 120) is effectiveß

A

Yes! (control under 140) –> halves mortality

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3
Q

Is there current clinical evidence in useing Evolovumab (PCSK9 inhibitor) on top of Statins to reduce CVS risk?

A

Not really –> no reduction in deaths, but reduction in MI and Cardivascular events and Triglicerides but expensive

Generally currently reserved for high risk

  • very high lipid levels (especially Familiar)
  • If statins are contraindicated
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4
Q

What time of good diabetic control is needed until a difference in complications seen?

A

9-15 years

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5
Q

Name some example of SGLT-inhibitors

A

**- gliflozin **

Dapagliflozin
Empagliflozin
Canagliflozin

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6
Q

What are the effects of SGLT2 inhibitors on eGFR?

A

Similar to ACE inhibitors

–> initial drop, but after 1 year it is long-term protective

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7
Q

What are the benefits of SGLT-2 inhibitors?

A
  1. Weight loss
  2. glycamic control
  3. CVS protective (hypotension)
  4. Renal protective
  5. all protective

–> good

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8
Q

What is the MOA of SGLT-2 inhibitors?

A

Blocking glucose resorption in kidney leading to glucose diuresis (via inhibition of Sodium-Glucose co-transporters)

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9
Q

What are the main side-effects of SGLT2 inhibitors?

A
  • UTIs
  • potentially initial drop in eGFR
  • increased incidence in normoglycaemic DKA
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10
Q

Other than Metformin and SGL-2 inhibitors, what other 2 classes of drugs are now more commonly used in the control of Type 2 diabetis?

A
  1. GLP-1 receptor agonist
  2. DPP-4 inhibitor
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11
Q

Name some examples of DDP-4 inhibitors. What is their MOA?

A

Gliptins
Sitagliptin, Linagliptin

MOA:
prevent break down of own GLP-1)
Indications/side effects same as FLP-1 analogue) Improve diabetic control and potentially weight loss (but usually no weight changes can be observed)

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12
Q

What is the MOA of GLP-1 receptor agonists?

A

GLP 1 is

  • Endogenous proteins that stimulate glucose-dependant insulin secretion and decrease glucagon secretion
  • Reduce gastric emptying + appetite
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13
Q

What are the benefits of using GLP-agonist in T2 diabetes control?

A

a) Weight loss
b) No risk of hypoglycaemia (so expecially good in patients with increased risk of hypoglycaemia)

+ Cardioprotective etc. (but not as good as SGLT2)

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14
Q

What are the benefits of using GLP-agonist in T2 diabetes control?

A

a) Weight loss
b) No risk of hypoglycaemia (so expecially good in patients with increased risk of hypoglycaemia)

+ Cardioprotective etc. (but not as good as SGLT2)

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15
Q

Name an examples of GLP-1 receptor agoinsts

A

Incretin (GLP-1 analogue –> peptide increasing insulin secretion )(-atide/- glutide)

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16
Q

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

A
  • GI complications, especially if already existing reduced gastric emptying.
    • Increased risk of pancreatitis and pancreatic cancer
17
Q

What type of drug is Gliclazide?

Waht is the main side-effect?

A

Sulphonylureas

Now used less and less frequently due to increaed risk of Hypos

Work by

  1. Increased insulin secretion (Blockage of ATP-sensitive K+ channels on pancreatic beta cells) –> depolarisation of the cell membrane –> calcium influx–> increased insulin secretion
  2. Decrease in hepatic gluconeogenesis and increase in peripheral insulin sensitivity
18
Q

Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.

A

Arcabose

19
Q

What type of drugs is thiazolidinediones?

What are they used for?

A

Insulin sensitisers tht could be used in monotherapy treatment of Type 2 Dieabets
Indiations

  • severe renal failure
  • and/or contraindication for insulin therapy
20
Q

What is the first-line treatment for patients with T2DM and CKD stage 4 (eGFR < 30ml/min)

A

Sulphonylureas (e..g Gliclazide)

21
Q

What do you need to consider regarding Metformin perscription and CKD?

A

Contraindicated if eGFR < 30ml/min
Caution if < 45 ml/min due to riks of lactic acidosis