Diabetes Drugs

Question 1

Name a rapid acting insulin

Answer 1

Insulin aspart (Novorapid)

Question 2

Name a short acting insulin

Answer 2

Soluble insulin (Actrapid, Humulin S)

Question 3

Name an intermediate acting insulin

Answer 3

Isophane insulin (NPH)

Question 4

Name a long acting insulin

Answer 4

Insulin degludec

Insulin glargine

Question 5

What are some side effects of insulin?

Answer 5

Hypoglycaemia - renal impairment increases risk
Lipohypertrophy
Lipoatrophy

Question 6

When a patient is on steroids, what should you do with the insulin dose?

Answer 6

Increase it

Question 7

Name a biguanide

Answer 7

Metformin

Question 8

How does metformin work?

Answer 8

Decreases hepatic glucose output (gluconeogenesis, glycogenolysis)
Increases glucose utilization in skeletal muscle

Question 9

Does metformin cause weight gain? Why?

Answer 9

No because it suppresses appetite

Question 10

What are side effects of metformin?

Answer 10

GI upset

Question 11

What are some contraindications/warnings with metformin?

Answer 11

If eGFR<30 as excreted unchanged by kidneys

ACEi, diuretics, NSAID’s can impair renal function

Thiazides can cause hyperglycaemia

Question 12

Name a sulphonylurea

Answer 12

Gliclazide

Question 13

How do sulfonylureas work?

Answer 13

Stimulate B cell pancreatic insulin secretion blocking ATP dependent K+ channels

Question 14

Do sulfonylureas cause weight gain and hypoglycaemia?

Answer 14

Yes because of anabolic effects of insulin

Question 15

What are side effects of gliclazide?

Answer 15

Mild GI upset

Hypersensitivity

Question 16

What are some warnings with gliclazide?

Answer 16

Caution with other hypoglycaemic agents, hepatic or renal impairment

Thiazide like diuretics cause hyperglycaemia

Question 17

Name two thiazolidinediones/glitazones

Answer 17

Pioglitazone

Rosiglitazone

Question 18

How do thiazolidinediones/glitazones work?

Answer 18

Increase insulin sensitivity of muscle and adipose by activating PPAR-y

Question 19

Do glitazones cause weight gain and hypoglycaemia?

Answer 19

Yes because of fat cell differentiation

Yes they cause hypoglycaemia

Question 20

What are the side effects of glitazones?

Answer 20

GI upset
Fluid retention
Fracture risk
CVD concerns
Bladder cancer

Question 21

Name two SGLT-2 inhibitors

Answer 21

Dapaglifozin

Canaglifozin

Question 22

How do SGLT-2 inhibitors work?

Answer 22

They decrease glucose absorption in the kidneys and excrete it out in the urine

Question 23

Do SGLT-2 inhibitors cause weight gain?

Answer 23

No, weight loss

Question 24

What are the side effects of SGLT-2 inhibitors?

Answer 24

UTI
Genital infections
Thirst
Polyuria

Question 25

What are some warnings with SGLT-2 inhibitors?

Answer 25

Antihypertensives | Other hypoglycaemic agents

Question 26

Name 2 DPP-4 inhibitors

Answer 26

Sitagliptin | Saxagliptin

Question 27

How do DPP-4 inhibitors work?

Answer 27

They prevent GLP-1 degradation

Question 28

Do DPP-4 inhibitors cause weight gain or hypoglycaemia?

Answer 28

No - GLP-1 is glucose dependent so postprandial action, insulin wont be stimulated at low blood sugar levels No - Suppresses appetite

Question 29

What are the side effects of DPP-4 inhibitors?

Answer 29

GI upset Pancreatitis risk Avoid in pregnancy

Question 30

What are cautions with DPP-4 inhibitors?

Answer 30

Other hypoglycaemic agents | Drugs that oppose - thiazide, loop diuretics

Question 31

Name two GLP-1 receptor agonists

Answer 31

Exenatide | Liraglutide

Question 32

How do GLP-1 receptor agonists work?

Answer 32

Increase glucose dependent synthesis of insulin secretion from B-cells by activating the GLP-1 receptor

Question 33

How is exenatide/liraglutide given?

Answer 33

SC injection

Question 34

Do GLP-1 receptor agonists cause weight gain?

Answer 34

No as promote satiety

Question 35

What are side effects of GLP-1 receptor agonists?

Answer 35

GI upset | GORD

Question 36

What are contraindications to GLP-1 receptor agonists?

Answer 36

Stop if eGFR<30

Question 37

What is the guideline for treating type 2 diabetes?

Answer 37

1. If HbA1c rises to 6.5% on lifestyle measures, offer standard release metformin to a target of 6.5% 2. If HbA1c rises to 7.5%, add DPP-4i/glitazone/SU/SGLT-2i. Aim for target of 7% 3. If HbA1c rises to 7.5%, consider triple therapy. Aim for a target of 7%