Type 2 diabetes antidiabetics

Question 1

Metformin

Answer 1

Biguanide
First line treatment
No weight gain
No hypoglycaemia

Question 2

Metformin MOA

Answer 2

Reduces hepatic glucose production

Inhibition of mitochondrial respiratory-chain complex 1

Inhibition of ATP synthesis
Increase in AMP
Activation of AMPK
Phosphorylation and inhibition of CRTC2
Inhibition of gluconeogenic gene expression

Question 3

Metformin side effects

Answer 3

GI: diarrhoea, nausea, vomiting, gas, reduced appetite

Vitamin B12 deficiency: reduces intestinal absorption

Rare: lactic acidosis

Question 4

Metformin brands

Answer 4

Bolamyn
Diagment
Glucient
Glucophage
Metabet

Question 5

Sulfonylureas brands

Answer 5

Glibenclamide - Danol
Gliclazide - Diamicron
Glipizide - Glibenese, minodiab
Glimepiride - Amaryl
Tolbutamide

Question 6

Sulfonylureas side effects

Answer 6

Hypoglycaemia
Weight gain

Question 7

Sulfonylureas MOA

Answer 7

Stimulate insulin secretion from pancreatic beta cells
Bind to ATP gated K channel > leads to insulin secretion

Not effective for type 1 diabetes

Question 8

Meglitinides brands

Answer 8

Repaglinide - Prandin
Nateglinide - Starlix

Take before meals

Question 9

Maglitinides MOA

Answer 9

Prandial glucose regulators
Rapid onset
Short duration

Stimulate insulin secretion from pancreatic beta cells
Bind to ATP gated K channel > leads to insulin secretion

Question 10

Thiazolidinediones

Answer 10

Glitazones
-Pioglitazine - Actos

Pioglitazine + metformin - Competact

Question 11

Thiazolidinediones MOA

Answer 11

Increase insulin sensitivity by stimulating expression of insulin sensitive genes

Bind and activate nuclear receptor PPAR gamma

Question 12

Thiazolidinediones side effects

Answer 12

Water retention
Weight gain

Question 13

GLP1

Answer 13

Incretin

Stimulate beta cells to secrete insulin
Short half life
Degraded by peptidases

Question 14

GLP1 mechanism

Answer 14

Food > release active GLP1 and GIP > DPP4 rapidly degrades incretins within minutes > Incretin effect > insulin release

Question 15

GLP1 brands

Answer 15

Exenatide - Byetta, Bydureon
Liraglutide - Victoza
Lixisenatide - Lixumia
Dulaglutide - Trulicity
Semaglutide - Ozempic

Question 16

DPP4 inhibitors

Answer 16

Gliptins

Inhibit activity of GLP1 and DPP4

Question 17

DDP4 brands

Answer 17

Sitagliptin - Januvia
Sitagliptin + metformin - Janumet
Vildagliptin - Galvus
Vildagliptin + metformin - Eucreas
Saxagliptin - Onglyza
Alogliptin - Vipidia
Alogliptin + metformin - Vipdomet
Lingaliptin - Trajenta
Lingaliptin + metformin - Jentadueto
Saxagliptin + metformin - Kombolyze

Question 18

Alpha glucosidase inhibtor MOA

Answer 18

Slows down absorption of starchy foods by intestine

Question 19

Alpha glucosidase inhibitor brand

Answer 19

Acarbose - precose
Miglitol - glyset

Question 20

SGLT2 inhibitors MOA

Answer 20

Inhibits glucose transporter, less glucose in urine

Question 21

SGLT2 inhibitors brand

Answer 21

Dapagliflozin - Forxiga
Canaglifozin - Invokana
Empaglifozin - Jardiance

Question 22

Therapy

Answer 22

Monotherapy
- Metformin
- DDP/ PIO / SU

Dual therapy
- Metformin + DDP/ PIO / SU/ SGLT
- DDP + PIO
- DPP + SU
- PIO + SU

Triple therapy
- Metformin + SU + DPP/ PIO/ SGLT
- Metformin + PIO/ SGLT
- Insulin therapy

Failed triple therapy
- Metformin + SU + GLP1

If hypoglycaemic
- SU
- Short acting insulin

Question 23

Surgery for type 2 diabetes

Answer 23

Over 35 BMI

Question 24

Protein Kinase C

Answer 24

Serine phosphorylation on IRS inhibits insulin signalling

Question 25

Tyrosine kinase

Answer 25

Phosphorylation on IRS inhibits insulin signalling