Diabetes Drugs

Question 1

example of biguanide

Answer 1

metformin

Question 2

first line treatment

Answer 2

metformin

Question 3

mechanism of action of metformin

Answer 3

reduce gluconeogenesis
suppress hepatic glucose output
increase fatty acid oxidation
increase insulin sensitivity

Question 4

benefits of metformin

Answer 4

manages hyperglycaemia
does not cause hypoglycaemia
weight neutral
reduces triglycerides and LDL

Question 5

complications prevented by metformin

Answer 5

microvascular

macrovascular

Question 6

is metformin safe in pregnancy

Answer 6

yes

Question 7

other conditions which may benefit from metformin therapy

Answer 7

PCOS

NAFLD

Question 8

adverse effects of metformin

Answer 8

GI upset
interferes with B12 and folic acid absorption
lactic acidosis

Question 9

when is lactic acidosis more likely

Answer 9

existing renal or hepatic disease

Question 10

2nd line treatment

Answer 10

sulphonylureas

Question 11

examples of first gen SUs

Answer 11

tolbutamide

chlorpropramide

Question 12

examples of second gen SUs

Answer 12

gliclazide
glipizide
glibencamide
glimepride

Question 13

mechanism of action of SUs

Answer 13

close ATP sensitive K+ channels on B cells

promotes Ca2+ influx which signals insulin release

Question 14

benefits of SUs

Answer 14

manages hyperglycaemia

more rapid reduction in hyperglycaemia than insulin sensitisers

Question 15

adverse effects of SUs

Answer 15

hypoglycaemia 
weight gain 
GI upset 
headache 
avoid in severe renal or hepatic failure

Question 16

example of thiazolidinediones

Answer 16

pioglitazone

Question 17

mechanism of action of pioglitazone

Answer 17

lipophilic so enters cells and binds to PPARy
PPARy complexed with RXR
transcription modulator binds to DNA to promote expression of genes encoding proteins involved in insulin signalling
promote fatty acid uptake in adipocytes
reduce hepatic glucose output
increase insulin sensitivity

Question 18

benefits of TZDs

Answer 18

manages hyperglycaemia

no hypoglycaemia

Question 19

complications prevented by SUs

Answer 19

microvascular

Question 20

adverse effects of TZDs

Answer 20

weight gain

increased risk of hip fracture (osteoporosis)

Question 21

contraindications to TZDs

Answer 21

heart failure

osteoporosis

Question 22

complications prevented by TZDs

Answer 22

macrovascular

Question 23

what do incretin hormones do

Answer 23

control the effect sugar has on the GI tract
slow gastric emptying to increase satiety
stimulate insulin secretion
reduce hepatic glucose output
decrease glucagon production
make beta cell more sensitive to glucose

Question 24

2 therapies based on incretins

Answer 24

GLP 1 receptor agonists

DPP 4 inhibitors

Question 25

examples of GLP 1 agonists

Answer 25

exenatide liraglutide lixisenatide

Question 26

mechanism of action of GLP 1 agonists

Answer 26

mimic action of GLP 1 bind to GPCR which increase intracellular cAMP concentration acts as incretin hormones do reduce hepatic fat accumulation

Question 27

benefits of GLP 1 agonists

Answer 27

promote insulin secretion from pancreas without hypoglycaemia modest weight loss reduce appetite

Question 28

adverse effects of GLP 1 agonists

Answer 28

nausea | pancreatitis

Question 29

examples of DPP 4 inhibitors

Answer 29

sitagliptin vildagliptin saxagliptin linagliptin

Question 30

mechanism of action of DPP 4 inhibitors

Answer 30

also manipulate the incretin pathway but less potent than GLP 1 agonists inhibits enzyme DPP4, thus prolonging the actions of GLP1 and GIP

Question 31

benefits of DPP4 inhibitors

Answer 31

promote insulin secretion without hypoglycaemia weight neutral limited side effects as not that potent

Question 32

side effects of DPP4 inhibitors

Answer 32

rarely pancreatitis

Question 33

examples of SGLT2 inhibitors

Answer 33

dapagliflozin

Question 34

mechanism of action of SGLT2 inhibitors

Answer 34

selectively block reabsorption of glucose by SGLT2 in the proximal tubule of the kidney nephron to deliberately cause glycosuria

Question 35

benefits of SGLT2 inhibitors

Answer 35

weight loss no hypoglycaemia cardiovascular benefit

Question 36

adverse effects of SGLT 2 inhibitors

Answer 36

sugar in urine creates ideal conditions for bacterial or fungal overgrowth so thrush is a side effect

Question 37

examples of alpha-glucosidase inhibitors

Answer 37

acarbose

Question 38

mechanism of action of acarbose

Answer 38

delay absorption of glucose thus reducing postprandial increase in blood glucose stops the enzyme which mediates the final step in carbohydrate digestion

Question 39

benefits of acarbose

Answer 39

no risk of hypoglycaemia

Question 40

adverse effects of acarbose

Answer 40

abdominal discomfort, flatulence, diarrhoea

Question 41

drugs which increase secretion of insulin | action is insulin dependent

Answer 41

SUs incretin mimetics glinides DPP4 inhibitors

Question 42

drugs which decrease insulin resistance and reduce hepatic glucose output action is insulin dependent

Answer 42

biguanides | TZDs

Question 43

drugs which slow glucose absorption from the GI tract | action is insulin independent

Answer 43

alpha-glucosidase inhibitors

Question 44

drugs which enhance glucose excretion by kidneys | action is insulin independent

Answer 44

SGLT2 inhibitors