Type II Diabetes: Oral Glycaemic Agents Flashcards Preview

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Flashcards in Type II Diabetes: Oral Glycaemic Agents Deck (40):
1

Which endocrine gland is not regulated by a hypothalamic-pituitary loop?

Pancreas

2

What does the pancreas directly respond to?

Plasma glucose levels

3

What are the backups for eliciting an insulin-like response?

Sympathetic > adrenal medulla > adrenaline
Anterior pituitary > adrenal cortex > cortisol

4

What are the exocrine cells of the pancreas?

Acinar cells

5

What are the endocrine cells of the pancreas?

Islets of Langerhans

6

What cells in the islets of Langerhans secrete glucagon?

Alpha cells

7

What cells in the islets of Langerhans secrete insulin?

Beta cells

8

What cells in the islets of Langerhans secrete somatostatin?

Delta cells

9

What are the responses to insulin after a meal in someone with a relative lack of insulin?

Can have higher than normal basal rate
Food taken
No initial spike
Second maintained release sub-normal to normal

10

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
Adequate exercise
Stop smoking
Reduce alcohol
Treat hypertension and lipidaemias

11

What do sulfonylureas do?

Increase insulin secretion from beta cells > restore phase 1 spike in insulin

12

How do sulfonylureas work?

Inhibit ATP-gated K channels

13

What are the pharmacokinetics of sulfonylureas?

Oral absorption
Half-life = 6-24 hours
Excreted via kidneys

14

Why aren't sulfonylureas used in pregnancy?

Cross placenta

15

What are the adverse effects of sulfonylureas?

Hypoglycaemia
Weight gain

16

What is the drug class of metformin?

Biguanides

17

What does metformin do?

Increases insulin-mediated peripheral glucose uptake
Reduces hepatic glucose production
Decreases carbohydrate absorption
Reduces LDL cholesterol level and triglycerides

18

How does metformin work?

Activation of AMP kinase

19

What are the adverse effects of metformin?

GI disturbances
- Diarrhoea
- Nausea
- Abdominal discomfort
- Anorexia
Lactic acidosis if improperly prescribed
Possible modest weight loss

20

In whom is metformin contraindicated?

Patients with impaired renal function

21

What is the drug class of acarbose?

Alpha-glucosidase inhibitors

22

How does acarbose work?

Doesn't have to enter bloodstream
Blocks enzymes that digest and promote absorption of starches in small intestine

23

What are the pharmacokinetics of acarbose?

Not absorbed from GIT

24

What are the adverse effects of acarbose?

Flatulence/abdominal discomfort
Loose stools and abdominal pain

25

In whom is acarbose contraindicated?

Patients with
- Inflammatory bowel disease
- Cirrhosis

26

What are incretins?

Gut hormones release when food is ingested
- GLP-1
- GIP

27

What do incretins do?

Increase
- Insulin release from beta cells
- Glucose uptake by muscles
Decrease
- Glucagon release from alpha cells
- Glucose production by liver

28

What is the drug class of sitagliptin?

"Gliptins"
Dipeptidyl peptidase-4 (DPP-4) inhibitors

29

What does sitagliptin do?

Increases native GLP-1 levels

30

How is sitagliptin administered?

Orally

31

What are the adverse effects of sitagliptin?

URTIs
Headaches
Hypoglycaemia when combined with insulin
Allergic/hypersensitivity reactions
Pancreatitis (rare)

32

What is the drug class of exenatide?

Glucagon-like polypeptide-1 (GLP-1) receptor agonists

33

How is exenatide administered?

Subcutaneous injection

34

What are the actions of exenatide?

Potentiate glucose-mediated insulin secretion
Suppress glucagon release
Slow gastric emptying
Loss of appetite

35

What are the adverse effects of exenatide?

Nausea
Vomiting
Diarrhoea
Weight loss
Ab formation
Immune reactions
Pancreatitis

36

What is the approach and drug class for managing a relative lack of insulin?

Stimulate pancreas to make more insulin
Sulfonylureas

37

What is the approach and drug class for managing insulin resistance?

Sensitise body to insulin and/or control hepatic glucose production
Biguanides

38

What is the approach and drug class for managing glucose absorption?

Slow absorption of starches
Alpha-glucosidase inhibitors

39

What is the approach and drug class for managing incretins?

Regulate glucagon and insulin
Incretin mimetics and enhancers

40

What is the approach and drug class for managing glucose reabsorption?

Slow renal glucose reabsorption
SGLT2 inhibitors