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14 Cards in this Set
- Front
- Back
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Insulin
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Type I Diabetics
- juvenille onset - hormone released from B cells in pancreas |
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Metformin
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-Biguanide drugs
- can normalize elevated blood glucose levels in presence of insulin- mechanism underlying this is not yet understood - mediated by AMP kinase - reduces hepatic glucose reduction -first line drug in obese patients |
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Metformin Issues
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- Side Effects: nausea, vommiting, diarrhoea, rash, lactic acidosis
-Contraindications: renal insufficiency and therefore should be avoided by elderly patients - can be combined with other drugs |
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Glibencamide
(other drugs: glipizide) |
-Sulphonylurea drugs
- stimulates insulin secretion from pancreas by blocking ATP sensitive K+ channels |
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Glibencamide issues
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-Side effects: hypoglycaemia, GIT effects, weight gain, drug interactions (NSAIDs)- however beneficial interaction with metformin
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Acarbose
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-Alpha glucosidase inhibitor- frees glucose from disaccharides- found in brush border intestinal epithelium
- retards the breakdown of carbs hence absorbs glucose |
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Acarbose Issues
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Side effects: flatulence and diarrhea, abdominal pain,
- Contraindications: bowel disease, renal impairment, pregnancy |
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Pioglitazone
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-Glitazone - thiazolidinedione derivative
- increase glucose uptake by increasing sensitivity to insulin -agonist which binds to nuclear receptor - PPAR gamma --> promote maturation of preadipocytes into adipocytes, increase glucose sensitivity and enhance cellular glucose uptake |
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what is PPAR-gamma and what do they do?
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- Peroxisome Proliferator- Activated Receptor- Gamma
- promotes maturation of preadipocytes into adipocytes, increase glucose sensitivity and enhance cellular glucose uptake |
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Pioglitazone Issues
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- Side effects: causes weight gain in 1/3 patients, increased fracture risk
- Indication: can be used alone or in combination - liver function monitored |
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Sitagliptin (New therapy)
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- Gliptins
- incretin- enzyme which releases insulin-enhancers -oral administration- slow endogenous breakdown of GLP1 (by inhibiting DPP-IV) |
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What is GLP 1?
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-Glucagon Like Peptide 1
--> it increases meal induced insulin secretion --> is rapidly destroyed by DPP-iv (dipeptide protease 4) |
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What is Expendin 4 (exenatide) and its issues?
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- GLP1 agonist
-derived from salivary gland of the glia monster (animal) - Side effects: nausea/vomiting, aid weight loss (which is a good thing) - can be combined with metformin or sulphonylurea |
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Sitagliptins issues
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- Side effects: weight neutral, headache, nausea, DPP-iv may cause CVD in young people (based on meta analysis)
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