Antidiabetic medication

Question 1

when will metformin (biguanide) only work?

Answer 1

if some Bcells work in islet of langherhans

Question 2

how does metformin (biguanide) work

Answer 2

decreases glucogensis and increases peripheral utilisation of glucose

Question 3

s/e of metformin (biguanide)

Answer 3

-lactic acidosis - avoid if EGFR <30
-GI s/e = high dose slowly or give MR
-can lower vit B12
-stop if pt = AKI

Question 4

sulphonylureas MoA

Answer 4

Augments insulin secretion

Question 5

examples of short acting sulphonylureas

Answer 5

gliclazide
tolbutamide

Question 6

examples of long-acting sulphonylurea

Answer 6

glibericlamide
glimepiride

Question 7

why should you avoid long-acting sulphonylurea in elderly?

Answer 7

it is assoc with prolonged and fatal cases of hypoglyc

Question 8

s/e sulphonylurea

Answer 8

high risk of hypoglyc
tx in hosp (target = 7.0% x 6.5%)

Question 9

when should you avoid sulphonylureas?

Answer 9

-avoid in acute porphyria
-avoid in hepatic + renal failure

Question 10

MoA of pioglitazone

Answer 10

decreases peripheral insulin resistance

Question 11

when should you avoid pioglitazone

Answer 11

in pts with history of HF

Question 12

high risk of?

pioglitazone S/E

Answer 12

-high risk of bladder cancer
-high risk of bone factors
-high risk of liver toxicity

Question 13

pioglitazone s/e

what should you review with bladder cancer and when

Answer 13

safety and efficacy after 3-6MT

Question 14

s/e pioglitazone

when should you not tx pt who develop bladder cancer

Answer 14

if they have an inadequate response

Question 15

pioglitazone s/e

what signs should you report if bladder cancer is suspected

Answer 15

haematuria
dysuria
urinary urgency

Question 16

pioglitazone S/E

What sings of liver toxicity should you report?

Answer 16

nausea, vomiting, abdominal pain, fatigue + dark urine

Question 17

examples of Dipeptidyl peptidase 4- inhibitors (DPP-4i)

Answer 17

vildagliptin
aloglipitin
linagliptin
saxagliptin
sitagliptin

Question 18

vildagliptin, aloglipitin, linagliptin, saxagliptin, sitagliptin

MoA of DPP-4i

Answer 18

inhibits DPP-4i to inc insulin secretion and lower glucagon secretion

Question 19

vildagliptin, aloglipitin, linagliptin, saxagliptin, sitagliptin

what can DPP-4i cause and the symptoms

Answer 19

pancreatitis
-x treat if symptoms of acute pancreatitis develop
-persistent, severe, abdominal pain

Question 20

vildagliptin, aloglipitin, linagliptin, saxagliptin, sitagliptin

which DPP-4i is most hepatotoxic?

Answer 20

vildagliptin

Question 21

Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin

MoA of sodium glucose co-transporter 2 inhibitors (SGLT-2i)

Answer 21

inhibit sodium glucose co-transporter 2 in renal proximal convulated tubule = more urine = less blood glucose level

Question 22

Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin

MHRA warnings with SGLT-2i

Answer 22

-life-threatening + cases of diabetic ketoacidosis
-if tx interrupted for surgery/illness then monitor ketones
-Fournier’s gangrene (necrotising fasciitis of genitalia or perineum)
-canagliflozin only: risk of lower-limb amputation (toes)

Question 23

Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin

monitoring for SGLT-2i

Answer 23

renal function

Question 24

Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin

tx if volume depletion occurs with SGLT-2i

Answer 24

volume depletion correct hypovolaemia before starting tx

Question 25

# dulaglutide, exenatide, liraglutide, lixesenatide MoA of GLP-1 agonist

Answer 25

inc insulin secretion supress glucagon secretion slows gastric emptying

Question 26

# dulaglutide, exenatide, liraglutide, lixesenatide MHRA warning of GLP-1 agonist

Answer 26

risk of **diabetic ketoacidosis** when concimitant insulin was dec rapidly

Question 27

# dulaglutide, exenatide, liraglutide, lixesenatide GLP-1 agonist s/e

Answer 27

-**acute pancreatitis** - pt warned of severe abdominal pain -**dehydration** risk due to GI s/e avoid fluid deplation

Question 28

examples of GLP-1 agonist

Answer 28

dulaglutide exenatide liraglutide lixesenatide

Question 29

MoA of acarbose

Answer 29

delays digestion + absorption of starch and sucrose

Question 30

acarbose s/e

Answer 30

-high risk of GI s/e may decrease dose

Question 31

examples of meglitides

Answer 31

nateglinide repaglinide

Question 32

# nateglinide repaglinide MoA of meglitides

Answer 32

stimulatess insulin secretion

Question 33

# nateglinide, repaglinide s/e and tx of meglitides

Answer 33

stress exposure = tx with interruption + replacement with insulin to **maintain glycaemic control**

Question 34

Which antidiabetics increase weight?

Answer 34

**PIS** sulphonylureas insulin pioglitazone

Question 35

Which antidiabetics has neutral effect on weight?

Answer 35

DPP-4i metformin

Question 36

Which antidiabetics lowers weight?

Answer 36

GLP-1 + SGLT-2i