Flashcards in Type II Diabetes: Oral Glycaemic Agents Deck (40):
Which endocrine gland is not regulated by a hypothalamic-pituitary loop?
What does the pancreas directly respond to?
Plasma glucose levels
What are the backups for eliciting an insulin-like response?
Sympathetic > adrenal medulla > adrenaline
Anterior pituitary > adrenal cortex > cortisol
What are the exocrine cells of the pancreas?
What are the endocrine cells of the pancreas?
Islets of Langerhans
What cells in the islets of Langerhans secrete glucagon?
What cells in the islets of Langerhans secrete insulin?
What cells in the islets of Langerhans secrete somatostatin?
What are the responses to insulin after a meal in someone with a relative lack of insulin?
Can have higher than normal basal rate
No initial spike
Second maintained release sub-normal to normal
What are the therapeutic lifestyle changes that can be made in type 2 diabetes?
Aim for ideal body weight
- Restrict refined sugars
- Reduce saturated fats
Treat hypertension and lipidaemias
What do sulfonylureas do?
Increase insulin secretion from beta cells > restore phase 1 spike in insulin
How do sulfonylureas work?
Inhibit ATP-gated K channels
What are the pharmacokinetics of sulfonylureas?
Half-life = 6-24 hours
Excreted via kidneys
Why aren't sulfonylureas used in pregnancy?
What are the adverse effects of sulfonylureas?
What is the drug class of metformin?
What does metformin do?
Increases insulin-mediated peripheral glucose uptake
Reduces hepatic glucose production
Decreases carbohydrate absorption
Reduces LDL cholesterol level and triglycerides
How does metformin work?
Activation of AMP kinase
What are the adverse effects of metformin?
- Abdominal discomfort
Lactic acidosis if improperly prescribed
Possible modest weight loss
In whom is metformin contraindicated?
Patients with impaired renal function
What is the drug class of acarbose?
How does acarbose work?
Doesn't have to enter bloodstream
Blocks enzymes that digest and promote absorption of starches in small intestine
What are the pharmacokinetics of acarbose?
Not absorbed from GIT
What are the adverse effects of acarbose?
Loose stools and abdominal pain
In whom is acarbose contraindicated?
- Inflammatory bowel disease
What are incretins?
Gut hormones release when food is ingested
What do incretins do?
- Insulin release from beta cells
- Glucose uptake by muscles
- Glucagon release from alpha cells
- Glucose production by liver
What is the drug class of sitagliptin?
Dipeptidyl peptidase-4 (DPP-4) inhibitors
What does sitagliptin do?
Increases native GLP-1 levels
How is sitagliptin administered?
What are the adverse effects of sitagliptin?
Hypoglycaemia when combined with insulin
What is the drug class of exenatide?
Glucagon-like polypeptide-1 (GLP-1) receptor agonists
How is exenatide administered?
What are the actions of exenatide?
Potentiate glucose-mediated insulin secretion
Suppress glucagon release
Slow gastric emptying
Loss of appetite
What are the adverse effects of exenatide?
What is the approach and drug class for managing a relative lack of insulin?
Stimulate pancreas to make more insulin
What is the approach and drug class for managing insulin resistance?
Sensitise body to insulin and/or control hepatic glucose production
What is the approach and drug class for managing glucose absorption?
Slow absorption of starches
What is the approach and drug class for managing incretins?
Regulate glucagon and insulin
Incretin mimetics and enhancers