DM Type 2 Drugs Flashcards
What are the drugs used for Type 2? (1st/2nd/3rd line)
1st - Metformin
2nd - Sulphonyurea (OR thiazolidinedione/DPP-IV inhibitor/SGLT-2 inhibitor)
3rd: - Thiazolidinedione - DPP-IV inhibitor - SGLT-2 inhibitor - GLP-1 analogue - Insulin
How does Metformin Work?
It increases insulin sensitivity
Decreases glyogenolysis
Decreases gluconeogenesis
Pros and cons of metformin?
- Well tolerated -
Effective
- Weight neutral
- Improves mortality & CV complications
Cons:
- GI side effects
- Vit B12 malabsorption
- Lactic Acidosis
- Renal/hepatic failure
Example of a sulphonyurea and how they work?
Glimepiride
Glicalazide
Glipizide
Blocks ATP-sensitive K+ channels leading to increased insulin secretion
Pros and cons of sulphonyureas?
Pros:
- Rapid action so good for the acutely ill
- Well tolerated
- Cheap
- Rapid titration
Cons:
- Risk hypo
- Weight gain
- Contraindicated in pregnant/breastfeeding
- Cautioned in renal/hepatic disease
Example of Thiazolidinedione and how they work?
Pioglitazone
Increases insulin sensitivity in muscle/fat/liver by acting on PPar gamma receptors
Pros and cons of thiazolidinediones?
- Effective for insulin resistance
- Cheap
Cons:
- Weight gain
- Fluid retention
- Increases bone turnover -> fractures in females
- Bladder cancer
Example of a DPP-IV inhibitor and how they work?
Saxagliptin
DPP-IV is an enzyme that breaks down incretin hormones. (GI hormone which tells pancreas to secrete insulin)
Inhibitors extend incretin half-lives. Incretin hormones cause glucose dependant insulin release and glucagon inhibition
Pros and cons of DPP-IV?
- Well tolerated
- Usuable in renal impairment
- Weight neutral
- No Hypo risk
Cons:
- Small effects
- CI in pregnancy/breastfeeding - PAncreatitis/pancreatic cancer
- Nausea
Example and function of SGLT-2 inhibitors?
“Gliflozins” e.g.
- Empagliflozin
- Dapagliflozin
- Canagliflozin
Inhibit Sodium Glucose Transporter 2 in the proximal tubule of the kidney.
Thus increases Glc & Na excretion in urine
Effects of SGLT-2 inhibitors?
Diuretic Effect
- Postural hypotension & dehydration
Glucouric Effect
- Weight loss from pissing out so many calories Na Excretion - Lowers BP
Greater risk of urogenital infections
Which Type 2 meds are injectable and which ones oral?
Oral:
- Metformin
- Sulphonyureas
- Thiazolidinediones
- DPP-IV inhibitors
- SGLT2 Inhibitors
Injected:
- Insulin
- GLP-1 analogue
Example and function of GLP-1 analogues?
Liraglutide
Exentadide
Lixisenatide
GLP-1 is an incretin hormone.
DPP-IV resistant analogues are injected (which cause Glc dependant Insulin release & glucagon inhibition) which have a much longer biological half-life.
Pros and cons of GLP-1 Analogues
Pros:
- Weight loss
- Low risk of hypos
- Can be used with basal insulin
Cons
- N&V
- Pancreatitis/Pancreatic cancer
- Contrainidicated in pregnancy & breastfeeding
