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Year 2- Endocrine System > Pharmacology- Management of Type 2 Diabetes > Flashcards

Pharmacology- Management of Type 2 Diabetes Flashcards

1
Q

Is type 2 diabetes usually managed in primary or secondary care?

A

Primary

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2
Q

Which member of the primary care team is most commonly involved in treating and managing those with type 2 diabetes?

A

Practice nurse

-> important to note many members of the team involved, GP’s, dietician, etc.

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3
Q

What is the first step when choosing a glucose lowering drug?

A

Set a target HbA1c

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4
Q

Which drug is first choice in the management of type 2 diabetes?

A

Metformin

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5
Q

What are the pros of metformin indicating why it is first choice?

A

-Improves outcomes
-Well tolerated
-Cheap

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6
Q

How does metformin help manage type 2 diabetes?

A

Improves insulin sensitivity

-> this is because it affects insulin production, decreases fatty acid synthesis and improves receptor functions. Also inhibits gluconeogenic pathways

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7
Q

What class of drugs is metaformin?

A

Biguanide

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8
Q

What is the half life of metformin?

A

6hrs

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9
Q

What are some of the disadvantages of metformin?

A

Risk of GI side effects (20-30%)
Risk of lactic acidosis by inhibiting lactic acid uptake in liver
Risk of vitamin B12 malabsorption

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10
Q

Can metformin be taken in pregnancy?

A

Yes

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11
Q

Give some examples of sulphonylureas.

A

Remember as Gli-ides

Glimepiride
Gliclazide
Glipizide

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12
Q

When are sulphonylureas used?

A

If osmotic symptoms
If HbA1c increasing rapidly

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13
Q

How do sulphonylureas work?

A

Increases the release of insulin

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14
Q

Describe the mechanisms of action of sulphonylureas.

A

Binds to SUR-1 receptors on functioning pancreatic beta cells
This closes the ATP-sensitive potassium channels
Decreased potassium influx depolarises the beta-cell membrane
Voltage gated calcium channels open and influx of calcium
Translocation and exocytosis of secretory granules of insulin

-> wordy but read through and try to understand

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15
Q

What is the first line management for type 2 diabetes?

A

Lifestyle manifestations

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16
Q

Out of the sulphonylureas mentioned previously, which is the longest acting?

A

Glimepiride

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17
Q

Which sulphonylureas requires the largest dose?

A

Gliclazide

-> 40-320mg, twice a day

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18
Q

Where in the body does the metabolism of sulphonylureas take place?

A

Liver

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19
Q

What are some the advantages of sulphonylureas ?

A

-Rapid improvement in control
-Rapid improvement if symptomatic
-Cheap
-Generally well tolerated

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20
Q

What are some of the disadvantages of sulphonylureas?

A

-Risk of hypoglycaemia
-Weight gain
-Caution in renal and hepatic disease

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21
Q

Can sulphonylureas be taken in pregnancy?

A

No

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22
Q

What are some of the side effects of sulphonylureas?

A

Hypersensitivity and photosensitivity reactions
Blood disorders

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23
Q

What is the only thiazolidinedione’s available?

A

Pioglitazone

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24
Q

How does Pioglitazone work?

A

Improves insulin action

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25
Describe the action of Pioglitazone.
-Modulates transcription of the insulin-sensitive genes -Reduces insulin sensitivity in the liver and peripheral tissues -Decreases withdrawal of glucose from the liver
26
What are some of the advantages of Pioglitazone?
-Good if insulin resistance is significant -HbA1c can be reduced by 0.6-1.3% -Cheap -CV safe
27
What are some of the disadvantages of Pioglitazone?
Increased risk of bladder cancer Fluid retention Weight gain Fractures in females
28
When would insulin be given in a type 2 diabetic patient?
If a severe insulin deficiency develops -> some insulin usually produced in type 2 diabetes
29
Supplementary Insulin Therapy can be used as an easy introduction to insulin. However, what can it cause to happen?
Weight gain
30
Which med can make blood acidic?
Metformin
31
Which medication can increase risks of retoacidosis?
SGLT 2 inhibitors
32
List some SGLT2 inhibitors.
Canaglizlozin Dapagliflozin Empagliflozin ->end in -gliflozin
33
How do SGLT2 inhibitors work?
Increase the excretion of glucose in the urine
34
How do SGLT2 inhibitors increase glucose excretion?
Block sodium glucose transporter 2 in the proximal tubule of the kidney
35
What are some of the side effects of SGLT2 inhibitors>
Gets rid of water so risks of hypotension and dehydration Greater risk of urogenital infection
36
What are some of the other benefits of SGLT2 inhibitors?
Helps to lose weight Lowers systolic BP Lowers HbA1c
37
RECAP- what HbA1c confirms diabetes?
>48mmol/mol
38
Which drug is first line in type 2 diabetic patients at high CV risk when metformin is not tolerated?
SGLT2 inhibitors
39
What are some of the advantages of SGLT2 inhibitors?
-Weight loss -No risk of hypoglycaemia -Good effects on glycaemic control -Beneficial effects on CV morbidity and renal outcomes
40
What are some of the disadvantages of SGLT2 inhibitors?
Expensive Increased risks of UTI, fungal infections, osmotic symptoms Risk of DKA
41
Can SGLT-2 inhibitors be used in pregnancy?
No
42
What are incretins?
Gut peptides which are produced when we eat This accelerates our insulin response
42
In which type of impairment can SGLT-2 inhibitors not be used?
Renal impairment
43
List some DPPIV-inhibitors.
Saxagliptin Sitagliptin Vildagliptin -> all end in gliptin
44
How do DPPIV inhibitors work?
Increases the release of insulin
45
What are DPPIV-inhibitors?
Incretin mimetics so mimic the response of incretins in the gut
46
Name another type of Incretin Mimetic.
GLP1
47
How does GLP1 drugs work?
Increase the release of insulin, similar to DDPIV inhibitors.
48
OKAY List the types of drug which manage type 2 diabetes by increasing the release of insulin.
Sulphonylureas Metiglinides Incretin mimetics
49
OKAY List the types of drug which manage type 2 diabetes by increasing the excretion of glucose.
SGLT2 inhibitors
50
OKAY List the types of drug which manage type 2 diabetes by improving the action of insulib.
Metformin/biguanides Thiazolidines
51
What non-pharmacological managements also help to improve the action of insulin?
Weight reduction Physical activity
52
Describe the action of DPP-4 and GLP-1 inhibitors.
-Normally, when we eat, carbs enter the gut and incretin hormones are released -DPP-4 inhibitors inhibit the enzyme DPP-4 which usually breaks down the hormones -Therefore, more insulin secreted
53
What are some of the advantages of DPPIV inhibitors?
-Usually well tolerated -Can be used in renal impairment -No risk of hypoglycaemia -Weight neutral
54
What are some of the disadvantages of DPPIV inhibitors?
Nausea Small effects of glycaemic control
55
Can DPPIV inhibitors be taken in pregnancy?
No
56
List some GLP-1 analogues.
Exenatide Liraglutide Lixisenatide
57
What are some advantages of GLP-1 analogues?
-Weight loss -No risk of hypoglycaemia -Can be used w basal insulin -Some have benefit for CVD
58
What are some of the disadvantages for GLP-1 analogues.
Injection Expensive Nausea, vomiting
59
Can GLP-1 analogues be taken in pregnancy?
No
60
In diabetic reviews, which other systems are assessed?
CVS Renal
61
In someone with type 2 diabetes with a high CV risk, which two medications may be used a dual initial therapy?
Metformin SGLT2 inhibitor
62
What are the five steps to be considered when choosing a glucose lowering drug?
1. Set a goal relating to HbA1c 2. Are there any other risk factors which should be prioritised over HbA1c? 3. Are the current treatments optimised e.g. maximum dose, tolerated, taken etc. 4. What are the glucose lowering options? (assess regarding CV risk and any contraindications) 5. Agree a review date and target Hb1Ac
63

Year 2- Endocrine System (27 decks)

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