anti-diabetic drugs

Question 1

what are the classes of anti-diabetic drugs?

Answer 1

biguanides
sulfonylureas
thiazolidinediones
SGLT2 inhibitors
DPP4 inhibitors
GLP1 analogues
intestinal alpha-glucosidase inhibitors

Question 2

what is an example of a biguanide used in diabetes?

Answer 2

metformin

Question 3

what is the MOA of metformin?

Answer 3

increases peripheral insulin sensitivity and enhances glucose uptake

Question 4

what effect does metformin have on glucose levels in the body?

Answer 4

lowers them

Question 5

what are the side effects of metformin?

Answer 5

N + V
abdo discomfort
diarrhoea
lactic acidosis

Question 6

what is metformin contraindicated in?

Answer 6

severe renal or hepatic impairment
conditions that affect kidney function or cause risk of hypoxia or dehydration

Question 7

what is the starting dose of metformin and what is the max dose?

Answer 7

500mg once or twice daily
max dose 2000mg daily

Question 8

what is an example of a sulfonylurea?

Answer 8

gliclazide

Question 9

what is the MOA of gliclazide?

Answer 9

stimulate pancreatic beta cells, promoting release of insulin

Question 10

is gliclazide used in type 1 or type 2 diabetes and why that type? `

Answer 10

type 2 as in type 1 there are no pancreatic beta cells for it to stimulate so wouldn’t work

Question 11

what are the side effects of gliclazide?

Answer 11

hypoglycaemia
weight gain
nausea
diarrhoea
allergic reactions

Question 12

what is gliclazide contraindicated in?

Answer 12

type 1 diabetes
diabetic ketoacidosis
severe renal or hepatic impairment

Question 13

what is the starting dose of gliclazide and what is the maximum dose?

Answer 13

40-80mg daily
max dose of 320mg daily

Question 14

what is an example of a thiazolidinedione?

Answer 14

pioglitazone

Question 15

what is the MOA of pioglitazone?

Answer 15

increase peripheral insulin sensitivity

Question 16

what effect does pioglitazone have on blood glucose levels?

Answer 16

lowers them

Question 17

what are the side effects of pioglitazone?

Answer 17

weight gain
fluid retention leading to HF
inc. risk of fractures
inc. risk of bladder cancer

Question 18

what are the contraindications of pioglitazone?

Answer 18

HF
hepatic impairment
bladder cancer or un-investigated macroscopic haematuria

Question 19

what is the starting dose and max dose of pioglitazone?

Answer 19

15-30md once daily
max dose 45mg once daily

Question 20

what is an example of an SGLT2 inhibitor?

Answer 20

dapagliflozin

Question 21

what is the MOA of dapagliflozin?

Answer 21

increase urinary glucose excretion, reducing glucose levels

Question 22

what are the side effects of dapagliflozin?

Answer 22

genital mycotic infections
UTIs
euglycemic diabetic ketoacidosis
inc. risk of lower limb amputation

Question 23

what are the contraindications of dapagliflozin?

Answer 23

severe renal impairment or end-stage renal disease

Question 24

what is the dose of dapagliflozin?

Answer 24

10mg once daily

Question 25

what is an example of DPP4-inhibitor?

Answer 25

sitagliptin

Question 26

what is the MOA of sitagliptin?

Answer 26

inhibit enzyme DPP4 which breaks down incretin hormones

Question 27

what effect do DPP4 inhibitors have on insulin production and glucagon in the body?

Answer 27

increase insulin production decreased glucagon release

Question 28

what are the side effects of sitagliptin?

Answer 28

nasopharyngitis URTI headache pancraetitis

Question 29

what are the contraindications of sitagliptin?

Answer 29

used with caution in patients with history of pancreatitis dose should be adjusted in patients with renal impairment

Question 30

what is the dose of sitagliptin?

Answer 30

100mg once daily

Question 31

what is an example of GLP1 analogue?

Answer 31

exenatide

Question 32

what is the MOA of exenatide?

Answer 32

stimulate insulin secretion and reduce glucagon secretion in a glucose-dependent manner

Question 33

what effect does exenatide have on gastric emptying and appetite?

Answer 33

delays gastric emptying and reduces appetite

Question 34

what are the side effects of exenatide?

Answer 34

GI disturbances hypoglycaemia pancreatitis

Question 35

what is exenatide contraindicated in?

Answer 35

patients with history of pancreatitis and severe renal impairment

Question 36

what is the dosage of exenatide?

Answer 36

start 5mcg injected subcutaneously twice daily can be increased to 10mcg twice daily

Question 37

what is an example of intestinal alpha-glucosidase inhibitors?

Answer 37

acarbose

Question 38

what is the MOA of acarbose?

Answer 38

delay digestion of carbohydrates in small intestine, slow glucose absorption and reduce postprandial glucose peaks

Question 39

what are the side effects of acarbose?

Answer 39

GI disturbances - flatulence, diarrhoea, abdo discomfort

Question 40

what is acarbose contraindicated in?

Answer 40

IBD colonic ulceration partial intestinal obstruction or predisposition to intestinal obstruction severe hepatic impairment

Question 41

what is the dosage of acarbose?

Answer 41

starts 50mg 3x daily can be increased to 100mg