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Diabetes Flashcards

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1
Q

What is the rationale for drug use in T2DM? (3)

A
  • Control symptoms
  • Control BGLs
  • Delay microvasculature and macrovasculature complications
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2
Q

What is the pathophysiology of T1DM?

A

Autoimmune destruction of Beta cells

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3
Q

What is the pathophysiology of T2DM?

A

Resistance to insulin and inadequate secretion of insulin response by the Beta cells

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4
Q

What are 5 symptoms of diabetes?

A

Lethargy, polyuria, polydipsia, blurred vision, dizziness, tremor, loss of sensation, poor wound healing, fungal/bacterial infection, ketosis and ketonuria

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5
Q

How many months might lifestyle alterations be trialled before starting drug treatment for T2DM?

A

2-3 months

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6
Q

What are 4 tests for diabetes?

A

BGLs, fasting BGLs, oral glucose tolerance test, glycosated haemoglobin

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7
Q

What are 2 risk factors of T2DM?

A

CVD, PCOS, being in particular ethnic groups, being overweight, anipsychotics, steroids, and IGT + IFG

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8
Q

What might you give someone with T2DM and atherosclerotic cardiovascular disease, heart failure or CKD? (2 drug classes)

A

SGLT2 inhibitor or GLP-1 analogue

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9
Q

How do you do an oral glucose test?

A

Fast and then do a BGL, have a sugary drink and then have BGLs tested after 1 hour and then 2nd hour.

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10
Q

What are 3 main areas of chronic complications of diabetes relating to microvasculture?

A

Eye disease, nephropathy and neuropathy

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11
Q

What are 2 pros and 2 cons to short acting insulins?

A

Flexible and better control by more of a risk of hypos and more injections

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12
Q

What are 2 pros and 2 cons to split mixed regimens?

A

Simple and convenient but not as flexible and cannot skip meals

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12
Q

What are 2 pros and 2 cons to longer acting insulins?

A

Lower risk of hypos and less injections but less flexible and less control

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13
Q

What are 2 pros and 2 cons to basal bolus injections?

A

They are more flexible and have better BSL control but requires more monitoring, does not cover snacks and higher risk of hypos

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13
Q

How should you treat a conscious vs an unconscious patient with hypoglycaemia?

A

A conscious patient should have oral glucose or sucrose, wait 10-15 minutes and then if responsive, have a longer acting carb. An unconscious patient should have an IM or iV injection of glucagon.

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14
Q

By how much do you bring down insulin if it is too high?

A

2-4 units

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15
Q

What are three chronic complications relating to macrovasculature in diabetes?

A

Coronary artery disease, pulmonary artery disease and cerebrovascular disease

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15
Q

What are 4 other chronic complications of diabetes?

A

Infections, genitourinary complications, dermatologic complications, glaucoma, periodontal disease, gastrointestinal complications.

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15
Q

What are 2 pros of metformin?

A

Low risk of hypos, does not affect weight, cardiovascular and renal benefits

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16
Q

What are 2 pros of SGLT2 inhibitors?

A

Weight loss and low risk of hypos

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17
Q

What are the 2 cons of sulfonylureas?

A

Weight gain and increased risk of hypos

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17
Q

What are two pros and one con for acarbose?

A

Weight loss and low risk of hypos but increased risk of GIT complications

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18
Q

What are the cons of insulin?

A

Weight gain and risk of hypos

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18
Q

What are the 2 pros and 1 con of DPP-4 inhibitors?

A

Weight loss and low risk of hypos but they are cleared by the kidney

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19
After giving an oral administration of glucose or sucrose, what do you do?
Response should occur within 10 minutes for glucagon and within 4-5 minutes for glucose. Give longer acting carbohydrates if they respond
20
If you were commencing insulin for a patient starting with an overnight dose. What type of insulin would you use?

Intermediate acting
20
What are the second line agents to T2DM?
GLP1 agonists/ DPP-4 inhibitors and SGLT2 inhibitors
21
What are 3 signs of lactic acidosis?
Anorexia, nausea, vomiting, ab pain, cramps, malaise and weight loss
21
How does a basal bolus regime work?
Three daily short acting before meals and one daily night time insulin injection
22
If you are having a contrast scan and have metformin what do you need to do?
Withhold 24 hours beforehand
23
What is the role of DPP-4 inhibitors in T2DM management?
The inhibit DPP-4 which breaks down incretin hormones meaning that they last longer and continue to produce insulin and increase fullness.
24
If a drug ends in gliptin what does it mean?
It is a Dpp-4 inhibitor
25
Why don’t incretin hormones cause hypos?
Because insulin is released wth meals
26
If a drug ends with -tide, what are they?
GLP-agonists
27
Which DPP-4 inhibitor is cleared by the liver?
Linaglyptin
28
What is a con to GLP-analogues?
Eliminated by kidney and may cause nausea and vomiting
29
Do GLP-1 agonists cause hypos?
No
30
Which 2 GLP analogues reduce strokes and renal disease risks?
Semaglutide and Dulaglutide
31
Name 2 SGLT2 drugs?
Answer includes Dapagliflozon, Empagliflozin and Ertugliflozin
32
What do SGLT2 drugs do?
Reduce reabsorption of glucose in the kidney and excretion of glucose
33
Diabetes is the number one reason for which disease?
Kidney disease
34
What drug may cause euglycaemic DKA?
SGLT2 inhibitors
35
If a drug starts with gli, what are they?
Sulfonylureas
36
What is the Moa of sulfonylureas?
Increase pancreatic insulin secretion
37
If a drug ends with glitazones what is it?
Thiazolidinediones
38
Why are Thiazolidinediones not used very much?
 (3 reasons)
associated with heart failure, osteoporosis and bladder cancer
39
What is the MOA of Acarbose?
Inhibits carb digestion in the GIT thus increasing rate of glucose delivery in the blood.
40
When starting insulin, how do you do it?
10 units at bedtime (intermediate acting) in addition to oral medications
41
What is the MOA of Thiazolidinediones?
Increases insulin sensitivity
42
What is the MOA of Metformin?
Reduces hepatic glucose production and increases insulin use. Thereby increasing insulin sensitivity
43
What are two adverse effects to Thiazolidinediones?
MI, bone fracture, macular oedema and bladder cancer
44
What are two adverse effects to Acarbose?
Flatulence and bloating
45
What is the effect of DPP-4s? (3)
Increases glucose dependent insulin secretion, reduces glucagon production and delays gastric emptying.
46
What are 2 side effects of Metformin?
Nausea, vomiting, anorexia, ab pain, cramps, malaise and weight loss.
47
What are 2 adverse effects of GLP-1 analogues?
Nausea and vomiting, CKD, CVD and stroke
48
What is the MOA of GLP-1 analogues?
Mimics the effect of GLP-1
49
What is the MOA of SGLT2 inhibitors?
Inhibits glucose resorption in the kidney
50
What are 2 side effects of SGLT2 inhibitors?
Urinary and genital infections and euglycaemic DKA
51
If a drug ends in tide what class is it?
GLP-1 agonist
52
if a drug ends in flozin what class is it?
SGLT2
53
if a drug starts with gli what class is it?
sulfonylureas
54
if a drug ends in glitazone what class is it?
thiazolidinones
55
if a drug ends in glyptin what class is it?
DPP-4Is
56
Name 2 GLP-1 agonists?
Semaglutide and dulaglutide
57
Name 2 sulfonylureas
glibenclamide and glipizide
58
Name 2 DPP-4Is
linaglyptin and aloglyptin
59
Name 2 SGLT2Is?
dapagliflozin and empagliflozin
60
Name 1 thiazolidinones
pioglitazone
61
What drug class is acarbose?
alpha glucosidase inhibitor
62
What are two drug classes and 1 examples of them which can increase BSLs?
Atypical antipsychotics (olanzapine and clozapine) Glucocorticoids (prednisone and prednisolone)
63
Why do people with diabetes experience symptoms?
Hyperosmolar effects of excessive glucose in the bloodstream
64
What are 3 symptoms are specific to T1DM?
Ketosis/ketonuria, polyuria, polydypsia, weight loss, rapid onset of symptoms and family history
65
What are 3 signs of insulin resistance?
Acanthosis nigricans, skin tags, hyperpigmentation of the skin, central obesity, menstrual irregularities and hirsuitism
66

Pharmacology (23 decks)

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