DM- Pharmacology

Question 1

What is the first line medication for T2DM?

Answer 1

Metformin

Question 2

What are the second line medications for T2DM?

Answer 2

Added to metformin:

• Sulfondylurea (Gliclazide)
• Pioglitazone (Thiazolidinedione)
• Incretins (GLP-1)
• SGLT-2 inhibitor (empagliflozin)

Question 3

How does metformin work?

Answer 3

• Biguanide

- Increases insulin sensitivity and decreases hepatic gluconeogenesis

Question 4

What is important about metformin?

Answer 4

Weight neutral

Question 5

What side effects are there to metformin?

Answer 5

• LACTIC ACIDOSIS

- Diarrhoea and abdo pain

Question 6

Can metformin cause hypoglycaemia?

Answer 6

No

Question 7

How is the GI upset with metformin relieved?

Answer 7

Dose-dependent

Question 8

What are the contraindications of metformin?

Answer 8

Liver and renal dysfunction

Question 9

How does pioglitazone (a type of thiazolidinedione) work?

Answer 9

• Increase insulin sensitivity
• Decrease hepatic gluconeogenesis
• Decrease FFA release

Question 10

What are the side effects of pioglitazone?

Answer 10

• Weight gain
• Anaemia
• Fractures
• HF and peripheral oedema (fluid ret.)

Question 11

Does pioglitazone cause hypoglycaemia?

Answer 11

No

Question 12

When is pioglitazone contraindicated?

Answer 12

Heart Failure

Liver Failure

Question 13

How do sulfonylureas (gliclazide) work?

Answer 13

Stimulate B cells to release insulin

Question 14

What are the side effects of sulfonylureas (gliclazide)?

Answer 14

• Weight gain

- Hypoglycaemia

Question 15

Why shouldn’t sulfonylureas (gliclazide) be given as a monotherapy?

Answer 15

CVD and MI risk when used alone

Question 16

What are incretins?

Answer 16

Hormones produced by the GI tract

Question 17

What do incretins do?

Answer 17

• Increase insulin secretion
• Inhibit glucagon
• Slow GI absorption

Question 18

What inhibits incretins?

Answer 18

DPP-4

Question 19

What is the most common incretin?

Answer 19

GLP-1

Question 20

Name a GLP-1 analogue.

Answer 20

Exenatide

Question 21

What are the side effects of a GLP-1 analogue?

Answer 21

• GI upset
• Weight loss
• Dizziness/Headaches

Question 22

Can GLP-1 analogues cause hypoglycaemia?

Answer 22

Yes, but low risk

Question 23

How are GLP-1 analogues administered?

Answer 23

SC Injection, either BD or once weekly

Question 24

Name a DPP-4 inhibitor.

Answer 24

Sitagliptin

Question 25

What are the side effects of DPP-4 inhibitors?

Answer 25

- GI upset - URTIs - Pancreatitis

Question 26

How do DPP-4 inhibitors work?

Answer 26

Inhibit DPP-4, increasing GLP-1 activity.

Question 27

How do SGLT-2 inhibitors work?

Answer 27

Inhibit SGLT-2 in the proximal tubules of the nephron, reducing glucose reabsorption, increasing excretion

Question 28

Name some SGLT-2 inhibitors.

Answer 28

- Empagliflozin - Canagliflozin - Dapagliflozin

Question 29

What does SGLT-2 inhibition cause?

Answer 29

Glycosuria

Question 30

What effect do SGLT-2 inhibitors also have?

Answer 30

Reduce risk of cardiovascular disease e.g. CVA, MI, HF

Question 31

What are the side effects of SGLT-2 inhibitors?

Answer 31

- Weight loss - UTIs - DKA (Rare)

Question 32

How does insulin work?

Answer 32

- Causes cells to take in glucose | - Increases glycogenesis in the liver and muscles

Question 33

Name two rapid-acting insulins.

Answer 33

10 mins onset, 4 hours duration - Novorapid - Humalog

Question 34

Name two short-acting insulins.

Answer 34

30 mins onset, 8 hours duration - Actrapid - Humulin S

Question 35

Name two intermediate-acting insulins.

Answer 35

1 hour onset, 16 hours duration - Insulatard - Humilin I

Question 36

Name two long-acting insulins.

Answer 36

1 hour onset, 24 hour duration - Degludec (lasts 40 hours) - Levemir

Question 37

Name three combination insulins and their ratios.

Answer 37

Humalog 25 (25:75) Humalog 50 (50:50) Novomix (30:70) (Long acting:Short acting)