Diabetes Mellitus Drugs Flashcards
(32 cards)
What is diabetes Mellitus
a metabolic disorder which causes hyperglycaemia (high blood glucose levels)
Where is the insulin hormone made?
in the beta-cells of the pancreas
What types of diabetes is insulin used to treat
Types 1 (absolute deficiency) and sometimes Type 2 (relative deficiency) in insulin, when resistant to oral drugs.
What is the treatment of choice in pregnant patients?
insulin
What are the 5 types of insulin formulation and how long does each last up to?
ultra-rapid acting 10-15 min onset, up to 4 hrs duration), ,short acting .5-1 hour onset, duration up to 8 hours), intermediate acting short onset (1-2 hours) up to 24 hours duration, long acting slow onset (2-4 hours) up to 36 hours duration
how is long acting Insulin often used?
to provide a basal amount of insulin, then topped up with rapid, short or intermediate acting insulin doses before meals.
What are the ADR of insulin?
hypoglycaemia most common.
In what 4 situations does hypoglycaemia from insulin often occur
meals are skipped/delayed, too little carbs eaten, too much insulin dose, increase in exercise
what are the symptoms of hypoglycaemia and what are the two reasons they arise from?
tachycardia, palpitations, nervousness, irritability, hunger, sweating (related to insulin release)
difficulty concentrating, mental confusion, headache, incoherant speech, aggression, drowsiness, unconsciousness, coma (related to decreased glucose to the brain)
what are drug interactions of insulin?
corticosteroids, B-blockers, thiazide diuretics
What is the other type of diabetes mellitus group of drugs besides insulin?
Oral Hypoglycaemic Agents (OHA’s)
What type of diabetes are OHAs used for and why?
Type 2 diabetes, as depend on some residual insulin secretion for their function.
How are OHA’s used?
as an adjunct to dietary control, weight loss and exercise, and before insulin.
What are 4 classes of Oral Hypoglycaemic Agents?
Biguanides, Sulfonylureas, Glitazones, alpha-glucosidase inhibitors,
What is the mechanism of action of OHAs generally (5 of them)
- stimulate further insulin release
- lower insulin resistance
- sensitize cells to actions of insulin
- reduce glucose load (eg inhibit gluconeogenesis)
- alter CHO absorption
How are the Biguanides generally used (eg as what type of therapy?)
1st line of therapy for type 2 diabetes
What is the drug name of a Biguanide?
Metformin
what is the mechanism of action for metformin?
it is an antihyperglycaemic not a hypoglycaemic agent. increases insulin sensitivity, increases glucose uptake into muscles, decreases gluconeogenesis
Who is metformin the preferred drug for
- obese people (no weight gain)
elderly (no hypoglycaemia when used alone)
when diabetes is not controlled by diet and exercise
What are the ADR of metformin?
GI upsets (common), lactic acidosis,
Warnings/CI for metformin
limit use in people with renal or hepatic impairment, a history of alcohol abuse or lactic acidosis. Avoid in severe liver/kidney disease, cardiac disorders.
When are sulfonylureas indicated?
for uncomplicated type 2 diabetes, second line of treatment
what is an example of a Sulfonylurea drug?
Glibenclamide
what is the mechanism of action of sulfonylureas?
Bind to receptors and block ATP-sensitive potassium channels (K_ATP) in beta pancreatic ccells, blocking outflow of K+ and causing depolarisation, which opens Ca2+ channels and causes insulin release. Increased insulin release causes increased cell sensitivity to insulin, and decreased insulin resistance.
