Anti-diabetic drugs

Question 1

Metformin

Mechanism
SE
Lower doses/monitoring in which patient populations

Answer 1

Mechanism

• Inhibits glucose output from the li version (unknown)
• Lowers plasma glucose

SE

• G.I.
• Lactic acidosis

Minimize SE by
- Minimized by taking medication with meals (before of after

Lower doses/monitoring in which patient populations
- Impaired hepatic/renal function and in alcoholics & cardiac insufficiency
Dehydration

Question 2

Benefits of metformin over insulin

Answer 2

No risk of weight gain or hypoglycemia

Question 3

Sulfonylurea
Mechanism
SE

Answer 3

Mechanism
- Bind to receptor that regulates and block K channels in pancreatic B-cell so intracellular K rises, Ca channel opens & triggers insulin release

SE

• Hypoglycemia
• Difficulty losing weight
• Some patients do not respond to sulfonylureas (primary failure). In addition, diabetes generally progresses in patients that do demonstrate an initial response (~5% per year secondary failure).
• Rare side effects include hematological or hepatic effects, CNS effects (dizziness, confusion), and dermatological effects (rash).

Question 4

Metformin can be used with

Answer 4

sulfonylureas

Question 5

Longest acting sulfonylurease

Answer 5

Glyburide

Question 6

Shortest acting sulfonylurease

Answer 6

glipizide

Question 7

Exenatide
Mechanism
Used in combination with

Answer 7

Mechanism
- Analog to incretinGLP-1 which increases insulin secretion

Combination
- Metformin & sulfonylureas

Question 8

Thiazonlidinedione
Mechanism
SE

Answer 8

Mechanism

• Sensitize muscles, fat & liver to actions of insulin using
• GLUT 2 inhibitors
• Activates PPAR gamma & RXR

SE

• Weight gain
• Fluid retention

Question 9

Best initial therapy

Answer 9

Metformin

Question 10

Lowest cost add on drug

Answer 10

sulfonylurea

Question 11

Second line add on drug

Answer 11

Thiazolidinedione