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12 Cards in this Set
- Front
- Back
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What are the target capillary glucose values, and recommended testing regime |
- Fasting: <5.0mmol/L, 2 hour postprandial <6.0mmol/L -Test: before breakfast, and two hours after the start of a meal |
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What type of drug is metformin |
-Oral biguanide hypoglycaemic agent |
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What non-pharmacological interventions are appropriate |
-Low glycaemic index diet -Maintain physical activity: walk/swim -Monitor for complications: PET, fetal movements |
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Pharmacodynamics of metformin |
-Hypoglycaemic agent. Primarily reduces production of glucose in the liver (reducing gluconeogenesis). Reduces basal and post-prandial BG levels, decreases fatty acids and cholesterol in the blood -Increases insulin receptor sensitivity (not amount secreted) & increases use of glucose by cells -Delay in glucose absorption fro the GIT, Increase in peripheral uptake of glucose into cells (by enhanced insulin-receptor binding), some evidence inhibition of glucagon secretion, increases glycogenesis -All thought to be partly induce by activating the enzyme AMPK |
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What type of drug is glibenclamide |
-sulphanylureas -Also known as insulin secretagogues, Oral hypoglycaemic drug |
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Pharmacodynamics of glibenclamide |
-Releasing stored insulin from beta cells in the pancreas -inhibits the process of gluconeogenesis -Increases the number of insulin receptors -Bind to and close ATP dependent potassium channels in the pancreatic beta islet cell membrane, inhibiting potassium efflux resulting in depolarisation of the cell membrane, calcium ion influx and the release of stored insulin from beta cells by exocytosis - It acts in concert with glucose (improved sensitivity of beta cells to physiological glucose stimulus). Encourages uptake of glucose by cells
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Advantages/disadvantages of metformin (vs. glibencamide) |
-Advantages: won't cause weight gain -Doesn't effect insulin secretion so no hypo -Disadvantages: slower action - can cause GI effects (Vitamin B12 deficiency/depletion) - Transient GI disturbances (nausea/vomiting) -Can't be used if adrenal function compromised e.g Kidney failure
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Advantages/disadvantages of glibenclamide (vs. metformin) |
-Advantages: better, faster control/action, its nearly completely absorbed after oral administration and excessively bound to serum proteins so immediate onset, can be used if the patient has kidney disease -Disadvantages: Hypoglycaemia, weight gain. Side effects: liver and GI disturbances. Not recommended in pregnancy according to medsafe because of the risk of neonatal hypoglycaemia, animal embryotoxicity and/or birth defects (insulin preferred) but is category C so not completely contraindicated, needs functioning pancreas if beta cells damaged drug not effective, renal impairment can cause toxicity |
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Risk/benefits of insulin |
-Benefits: intensive treatment can improve blood sugar control, reduce trend in macrosomia and associated risks e.g still birth, insulin is more effective than other drugs & safer in pregnancy than other drugs -Risks: Adverse effects: hypoglycaemia, weight gain, may have in-compliance due to injection or not understanding complex regime of doses or denial of condition (psychological issues with commencement), overdose more likely, need strict blood glucose monitoring |
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Outline the difference in structures of actrapid and rapid acting insulin |
-Actrapid: neutral insulin -dimer molecular structure, Bigger, Takes longer to diffuse across the membrane due to size -Onset: 30 min, peak 1-4 hours, duration 6-8hours -Rapid acting: monomer structure (smaller) diffuses rapidly across the capillary barrier increasing the rate of absorption -Onset: 0-25 min, peak 1 hour, duration 3.5-5hours |
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Advantages of continuing with metformin (as well as insulin) |
-Objective of combination drug is to have maximum therapy efficacy, adding metformin to the regiment also means reducing the dose required for insulin -Better therapeutic outcome and less side effects: less likely to have hypo and less likely to gain weight -they workin different ways -Reduces risk of GDM complications by achieving normoglycaemic blood sugars. Reduces trend in macrosomia |
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Drug in phase two of clinical trials, what does this mean for Sonia who is asking about one |
-Can't be prescribed currently as being tested on limited number of people -This trial could go on for several more years -High chance of drug failure and not being funded -Could have adverse effects not yet detected -Company must apply fr approval after trial before the drug can be brought to market and approval isn't guaranteed -She should continue with her current regime |
