Year 3 Diabetes Drugs

Question 1

Management of Hyperglycaemia

Answer 1

0) Diet and Exercise
1) Biguanides - METFORMIN
2) Sulphonylureas - GLICLAZIDE, GLIBENCLAMIDE
3) Thiozolidinediones - PIOGLITAZONE
4) GLP-1 analogues (incretins) - EXANATIDE, LIRAGLUTIDE
5) DPP4 inhibitors (gliptins) - SITAGLIPTIN, LINAGLIPTIN
6) SGLT2 inhibitors - CANAGLIFLOZIN, EMPAGLIFLOZIN (trial –> make you pee glucose, also diuretic)
7) Insulin

Question 2

Pre-drug management

Answer 2

0) Diet and exercise

Question 3

Stage 1 drug management

Answer 3

1) Biguanides - METFORMIN
METFORMIN MR (modified release)

Question 4

Stage 2 drug management

Answer 4

Add to metformin

2) Sulphonylureas - GLICLAZIDE, GLIBENCLAMIDE
3) Thiozolidinediones - PIOGLITAZONE (??link to bladder cancer)
5) DPP4 inhibitors (gliptins) - SITAGLIPTIN, LINAGLIPTIN

Question 5

Stage 3 drug management

Answer 5

Injectables

4) GLP-1 analogues (incretins) - EXANATIDE, LIRAGLUTIDE

Question 6

Stage 4 drug management

Answer 6

7) Insulin

Question 7

Trial medications

Answer 7

6) SGLT2 inhibitors - CANAGLIFLOZIN, EMPAGLIFLOZIN (trial –> make you pee glucose, also diuretic)

Question 8

What class is METFORMIN?

Answer 8

Biguanide

Question 9

What class are GLICLAZIDE, GLIBENCLAMIDE?

Answer 9

Sulphonylurea

Question 10

What class is PIOGLITAZONE?

Answer 10

Thiozolidinediones

Question 11

What class are EXANATIDE, LIRAGLUTIDE?

Answer 11

GLP-1 analogues (incretins)

Question 12

What class are SITAGLIPTIN, LINAGLIPTIN?

Answer 12

DPP4 inhibitors (gliptins) [Dipeptidyl peptidase 4 inhibitors]

Question 13

What class are CANAGLIFLOZIN, EMPAGLIFLOZIN?

Answer 13

SGLT2 inhibitors (trial –> make you pee glucose, also diuretic)

Question 14

Name a Biguanide drug:

Answer 14

METFORMIN

Question 15

Name a Sulphonylurea drug:

Answer 15

GLICLAZIDE, GLIBENCLAMIDE

Question 16

Name a Thiozolidinediones drug:

Answer 16

PIOGLITAZONE

Question 17

Name a GLP-1 analogue drug:

Answer 17

EXANATIDE, LIRAGLUTIDE (Incretins)

Question 18

Name a DPP4 inhibitors drug:

Answer 18

SITAGLIPTIN, LINAGLIPTIN (Gliptins)

Question 19

Name a SGLT2 inhibitors drug:

Answer 19

CANAGLIFLOZIN, EMPAGLIFLOZIN (Flozins)

Question 20

What do biguanides do?

Answer 20

Reduce insulin resistance

Question 21

What do sulphonylureas do?

Answer 21

Increase insulin release

Question 22

What do thiozolidinediones do?

Answer 22

Reduce insulin resistance

Question 23

What do GLP-1 analogues (incretins) do?

Answer 23

Increase glucose stimulated insulin release
Reduce gastric emptying
Reduce appetite

Question 24

What do DPP4 inhibitors (gliptins) do?

Answer 24

Reduce GLP-1 breakdown

Question 25

What do SGLT2 inhibitors (flozins) do?

Answer 25

Inhibit Sodium GLucose coTransporter 2 Reduce glucose re-absorption = pee glucose Diuretic effects

Question 26

Side effect of METFORMIN

Answer 26

GI upset

Question 27

Side effect of sulphonylureas

Answer 27

Hypoglycaemia

Question 28

Side effect of thiozolidinediones

Answer 28

Fluid retention (CI: Cardiac failure) ?MI ?Osteoporosis

Question 29

Types of Insulin replacement

Answer 29

``` BASAL > Slow absp/release > Long duration of action BOLUS > Rapid onset > Short duration of action ```

Question 30

Basal insulin replacements

Answer 30

Insulatard - Isophane insulin or NPH (Neutral Protamine Hagedorn) Insulin+Protamine from fish semen 12-18hrs Glargine - change in amino acid composition --> aggregate formation (slow-release) lasting up to 24hr Detemir - free fatty acid chain that binds to albumin

Question 31

Bolus insulin replacements

Answer 31

1 Actrapid - (Soluble insulin) 30min delay ``` V.Rapid acting so can be taken just before snack 2i Humalog (insulin lipro) 2ii Novorapid (insulin aspart) ```

Question 32

Insulin side effects

Answer 32

Hypoglycaemia Weight gain Can't drive HGV --> can't work

Question 33

Side effects of SGLT2 inhibitors

Answer 33

``` Hypoglycaemia (with insulin or SUs) Urogenital infections (vulvovaginal candiasis, UTI, balanitis) ```

Question 34

Three C's in diabetes clinic

Answer 34

Control (over last 3 months --> HbA1c) Complications (micro/macro) Cardiovascular risk - BP/Cholesterol