Anti-diabetic drugs

Question 1

Oral hypoglycemics

Answer 1

sulphonylureas, GLP-1 agonist, DDi, Meglitinides

Question 2

Insulin sensitizers

Answer 2

metformin, pioglitazone

Question 3

Metformin: MOA

Answer 3

• DEC hepatic gluconeogenesis
• INC peripheral use

Question 4

Metformin

Answer 4

First line: T2 diabetes
- Safe in pregnancy + breastfeeding
- PCOS (unlicensed)

Question 5

Metformin: side effects

Answer 5

GI disturbance: N, V + D

• Counsel: Take w or after food or meal

Lactic acidosis

• Counsel: report symptoms: dyspnoea, abdominal pain, hypothermia, asthenia

NOT for:

• Renal impairment eGFR <30: AKI risk, sepsis, shock, dehydration
• Tissue hypoxia (acute HF, resp failure, MIL, liver impairment)
• Low vitamin B12

Question 6

Sulphonylurea: MOA

Answer 6

INC insulin secretion

Question 7

Sulphonylurea: LA

Answer 7

glimepiride

Question 8

Sulphonylurea: elderly, RI

Answer 8

Gliclazide, tolbutamide

Question 9

Sulphonylurea: side effect

Answer 9

• Hypoglycaemia – treat in hospital
• Hyponatraemia – glipizide, gliclazide
• Weight gain
• Jaundice
• Allergic dermatitis

Question 10

Sulphonylurea: interaction

Answer 10

ACEi/ARB -> INC hypoglycaemia

Question 11

Pioglitazone: MOA

Answer 11

Dec peripheral resistance

Question 12

Pioglitazone: side effect

Answer 12

Heart failure
- MHRA: monitor signs of HF: oedema, dyspnoea

Bladder cancer
- MHRA: report haematuria, dysuria, urgency
- CI: investigated macroscopic haematuria

Hepatotoxicity
- Counsel: report signs of liver disorder eg. Persistent vomiting, abdominal pain, dark urine, jaundice

Question 13

SGLT2i: MOA

Answer 13

Inhibits sodium glucose co-transporter 2: INC excretion

Question 14

SGLT2i: side effect

Answer 14

Atypical diabetic ketoacidosis
- MHRA: report DKA signs, stop + test ketones
- Monitor ketones if temporarily stopped: serious illness/major surgery

Volume depletion
- Counsel: hydrate, report dizziness + postural hypotension

Fournier’s gangrene
- MHRA: report severe pain, tender, red + swollen genitals or perineum, accompanied w fever or malaise

Dapagliflozin: do not use in type 1

Canagliflozin: lower limb amputation
- Counsel: report skin ulcers, discolouration + new pain

Question 15

DPPi (gliptins): MOA

Answer 15

• Inhibit dipeptidylpeptidase-4
• INC incretin tf insulin secretion

Question 16

DPPi (gliptins): Side effects

Answer 16

Pancreatitis
- Counsel: report persistent severe abdominal pain

Hepatotoxicity (vildagliptin)
- Counsel: report signs of liver disorder (persistent vomiting, abdominal pain, dark urine, jaundice

Question 17

GLP1 agonist: MOA

Answer 17

• Acts on GLP-1 (incretin) receptors
• INC insulin secretion

Question 18

GLP1 agonist: BMI

Answer 18

• > 35: psychological/medical issue with obesity
• <35: job complications w insulin, weight loss

Question 19

Which GLP1 are not stored in the fridge?

Answer 19

exenatide and lixisenatide

Question 20

GLP1: side effects

Answer 20

Pancreatitis
- Counsel: report persistent severe abdominal pain

GI disturbance: N, V + D

Diabetic ketoacidosis:
- MHRA: when insulin stopped
- Report DKA symptom

Question 21

GLP1: on contraception

Answer 21

MR exenatide, lixisenatide

Question 22

GLP1: missed dose

Answer 22

do not administer after a meal

• If >12H late, continue next dose (liraglutide)
• Inject <1H before next meal (lixisenatide)
• Continue with next dose (exenatide)
• Inject <3 days of next weekly dose (dulaglutide)

Question 23

Acarbose: MOA

Answer 23

• Inhibits a-glucosidase
• DEC starch + sucrose absorption

Question 24

Acarbose: side effect

Answer 24

• Flatulence – improves w time, antacids do not help
• Diarrhoea – red dose or w/draw
• Counsel: chew w first mouthful of food or swallow whole w little liquid immediately before food, carry glucose (not sucrose) to counteract hypo

Question 25

Meglitinide: MOA

Answer 25

INC insulin secretion

Question 26

Meglitinide: side effect

Answer 26

• Hypoglycaemia
• Diarrhoea (common)
• Counsel: 30 min before main meal