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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
Q

Describe the action of Pioglitazone.

A

-Modulates transcription of the insulin-sensitive genes
-Reduces insulin sensitivity in the liver and peripheral tissues
-Decreases withdrawal of glucose from the liver

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26
Q

What are some of the advantages of Pioglitazone?

A

-Good if insulin resistance is significant
-HbA1c can be reduced by 0.6-1.3%
-Cheap
-CV safe

27
Q

What are some of the disadvantages of Pioglitazone?

A

Increased risk of bladder cancer
Fluid retention
Weight gain
Fractures in females

28
Q

When would insulin be given in a type 2 diabetic patient?

A

If a severe insulin deficiency develops

-> some insulin usually produced in type 2 diabetes

29
Q

Supplementary Insulin Therapy can be used as an easy introduction to insulin. However, what can it cause to happen?

A

Weight gain

30
Q

Which med can make blood acidic?

A

Metformin

31
Q

Which medication can increase risks of retoacidosis?

A

SGLT 2 inhibitors

32
Q

List some SGLT2 inhibitors.

A

Canaglizlozin
Dapagliflozin
Empagliflozin

->end in -gliflozin

33
Q

How do SGLT2 inhibitors work?

A

Increase the excretion of glucose in the urine

34
Q

How do SGLT2 inhibitors increase glucose excretion?

A

Block sodium glucose transporter 2 in the proximal tubule of the kidney

35
Q

What are some of the side effects of SGLT2 inhibitors>

A

Gets rid of water so risks of hypotension and dehydration
Greater risk of urogenital infection

36
Q

What are some of the other benefits of SGLT2 inhibitors?

A

Helps to lose weight
Lowers systolic BP
Lowers HbA1c

37
Q

RECAP- what HbA1c confirms diabetes?

A

> 48mmol/mol

38
Q

Which drug is first line in type 2 diabetic patients at high CV risk when metformin is not tolerated?

A

SGLT2 inhibitors

39
Q

What are some of the advantages of SGLT2 inhibitors?

A

-Weight loss
-No risk of hypoglycaemia
-Good effects on glycaemic control
-Beneficial effects on CV morbidity and renal outcomes

40
Q

What are some of the disadvantages of SGLT2 inhibitors?

A

Expensive
Increased risks of UTI, fungal infections, osmotic symptoms
Risk of DKA

41
Q

Can SGLT-2 inhibitors be used in pregnancy?

A

No

42
Q

What are incretins?

A

Gut peptides which are produced when we eat
This accelerates our insulin response

42
Q

In which type of impairment can SGLT-2 inhibitors not be used?

A

Renal impairment

43
Q

List some DPPIV-inhibitors.

A

Saxagliptin
Sitagliptin
Vildagliptin

-> all end in gliptin

44
Q

How do DPPIV inhibitors work?

A

Increases the release of insulin

45
Q

What are DPPIV-inhibitors?

A

Incretin mimetics so mimic the response of incretins in the gut

46
Q

Name another type of Incretin Mimetic.

A

GLP1

47
Q

How does GLP1 drugs work?

A

Increase the release of insulin, similar to DDPIV inhibitors.

48
Q

OKAY
List the types of drug which manage type 2 diabetes by increasing the release of insulin.

A

Sulphonylureas
Metiglinides
Incretin mimetics

49
Q

OKAY
List the types of drug which manage type 2 diabetes by increasing the excretion of glucose.

A

SGLT2 inhibitors

50
Q

OKAY
List the types of drug which manage type 2 diabetes by improving the action of insulib.

A

Metformin/biguanides
Thiazolidines

51
Q

What non-pharmacological managements also help to improve the action of insulin?

A

Weight reduction
Physical activity

52
Q

Describe the action of DPP-4 and GLP-1 inhibitors.

A

-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
Q

What are some of the advantages of DPPIV inhibitors?

A

-Usually well tolerated
-Can be used in renal impairment
-No risk of hypoglycaemia
-Weight neutral

54
Q

What are some of the disadvantages of DPPIV inhibitors?

A

Nausea
Small effects of glycaemic control

55
Q

Can DPPIV inhibitors be taken in pregnancy?

A

No

56
Q

List some GLP-1 analogues.

A

Exenatide
Liraglutide
Lixisenatide

57
Q

What are some advantages of GLP-1 analogues?

A

-Weight loss
-No risk of hypoglycaemia
-Can be used w basal insulin
-Some have benefit for CVD

58
Q

What are some of the disadvantages for GLP-1 analogues.

A

Injection
Expensive
Nausea, vomiting

59
Q

Can GLP-1 analogues be taken in pregnancy?

A

No

60
Q

In diabetic reviews, which other systems are assessed?

A

CVS
Renal

61
Q

In someone with type 2 diabetes with a high CV risk, which two medications may be used a dual initial therapy?

A

Metformin
SGLT2 inhibitor

62
Q

What are the five steps to be considered when choosing a glucose lowering drug?

A
  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
Q
A

Year 2- Endocrine System (27 decks)

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