Diabetic Medications

Question 1

What are the main classes of oral diabetic medications?

Answer 1

Biguanides
Sulphonylureas
Thiazolidinediones 
DPP4 inhibitors
α-glucosidase inhibitors 
SGLT2 inhibitors 
GLP1 analogues

Question 2

What is the target HbA1c for diabetics?

Answer 2

6.5-7.5%

Question 3

What is the recommended management if the HbA1c is 6.5%?

Answer 3

Diet 
\+ 
metformin 
OR
metformin + sulphoylurea/glitazone

Question 4

What is an example of a biguanide?

Answer 4

Metformin

Question 5

What is the route of administration of metformin?

Answer 5

Oral

Question 6

What is the mechanism of metformin?

Answer 6

Decrease gluconeogenesis

Decrease insulin resistance

Question 7

What are the side effects of metformin?

Answer 7

Nausea
D+V
Loss of appetite
Lactic acidosis

Question 8

When is metformin contraindicated?

Answer 8

eGFR <30

Metabolic acidosis

Question 9

What is an example of a Sulphonylurea?

Answer 9

Gliclazide

Question 10

What is the route of administration of gliclazide?

Answer 10

Oral

Question 11

What is the mechanism of gliclazide?

Answer 11

ATP sensitive potassium channel blocer -> stimulates beta cell to release insulin

Question 12

What are the side effects of gliclazide?

Answer 12

Weight gai
Hypoglycaemia
Constipation

Question 13

When is gliclazide contraindicated?

Answer 13

Hepatic impairment

NBM

Question 14

What are examples of Thiazolidinediones?

Answer 14

Pioglitazone

Rosiglitazone

Question 15

What is the route of administration of pioglitazone?

Answer 15

Oral

Question 16

What is the mechanism of pioglitazone?

Answer 16

PPARγ receptor agonist -> increases insulin sensitivity

Reduces insulin resistance

Question 17

What are the side effects of pioglitazone?

Answer 17

Weight gain
Fluid retention
Heart failure
Eye problems

Question 18

When is pioglitazone contraindicated?

Answer 18

Hepatic impairment
Heart failure
NBM

Question 19

What are examples of DPP4 inhibitors?

Answer 19

Sitagliptin

Linagliptin

Question 20

What is the route of administration of DPP4 inhibitors?

Answer 20

Oral

Question 21

What is the mechanism of DPP4 inhibitors?

Answer 21

Inhibit DPP4 activity

Stops breakdown of incretin

Increases GLP1 concentrations

Question 22

What are the side effects of DPP4 inhibitors?

Answer 22

GI symptoms

Pancreatitis

Question 23

When are DPP4 inhibitors contraindicated?

Answer 23

History of excessive alcohol
Pancreatitis
Gall stones
NBM

Question 24

What is an example of an α-glucosidase inhibitor?

Answer 24

Acarbose

Question 25

What is the route of administration of acarbose?

Answer 25

Oral

Question 26

What is the mechanism of acarbose?

Answer 26

Inhibits breakdown of carbs to glucose

Question 27

What are the side effects of acarbose?

Answer 27

Flatulence | Diarrhoea

Question 28

When is acarbose contraindicated?

Answer 28

IBD Hernias Predisposition to bowel obstruction

Question 29

What is are examples of SGLT2 inhibitors?

Answer 29

Canagliflozin | Dapagliflozin

Question 30

What is the route of administration of SGLT2 inhibitors?

Answer 30

Oral

Question 31

What is the mechanism of SGLT2 inhibitors?

Answer 31

Selectively inhibit SGLT2 in the PCT Increased urinary excretion of glucose

Question 32

What are the side effects of SGLT2 inhibitors?

Answer 32

Polyuria UTIs Back pain Dizziness

Question 33

When are SGLT2 inhibitors contraindicated?

Answer 33

eGFR <60 NBM History of Fournier's gangrene

Question 34

What are examples of GLP1 analogues?

Answer 34

Liraglutide Exanatide Ozempic

Question 35

What is the route of administration of GLP1 analogues?

Answer 35

SC

Question 36

What is the mechanism of GLP1 analogues?

Answer 36

``` Increase insulin secretion Decrease glucagon secretion Decrease gluconeogenesis Decreased food intake Decreased gastric emptying ```

Question 37

What are side effects of GLP1 analogues?

Answer 37

GI symptoms | GORD

Question 38

When are GLP1 analogues contraindicated?

Answer 38

eGFR <50 NBM History of excessive alcohol/pancreatitis