antidiabetic drugs 2

Question 1

how does acarbose work

Answer 1

delays digestion and absorption or starch and sucrose
small but significant effect in lowering BG

Question 2

how to take acarbose tabs

Answer 2

chew with first mouthful of food or swallow while with a little liquid immediately before food

Question 3

common SE of acarbose include GI disorders. would you recommend antacids?

Answer 3

they are unlikely to be beneficial in treatment of SE

Question 4

acarbose may enhance hypo effects of insulin and SUs. to counteract hypo, pt should carry

Answer 4

glucose with them

3-4 heaped teaspoonfuls of sugar dissolved in water is not effective for hypo because acarbose interferes with sucrose absorption

Question 5

how do the gliptins work

Answer 5

DDP4 inhibitor so increases insulin secretion and lowers glucagon secretion

Question 6

pt on alogliptin, metformin, omeprazole.

they present to pharmacy for some indigestion tabs and pain killers. upon questioning they tell you they have persistent, severe abdominal pain. what do you do

Answer 6

DDP4 inhibitors - pancreatitis!! discontinue if symptoms occur and seek medical advice

Question 7

caution for all DDP4 inhibitors (1)

Answer 7

Hx pancreatitis

Question 8

Alogliptin dose adjustment in RI

Answer 8

reduce dose to 12.5mg OD if CrCl 30-50ml/min

Question 9

sitagliptin dose adjustment in RI

Answer 9

50mg OD if eGFR 30-45

25mg OD if eGFR <30

Question 10

before starting treatment with saxagliptin, vildagliptin or alogliptin check

Answer 10

LFTs and RFTs

vildagliptin: LFT 3 monthly during first year, periodically thereafter

saxa: renal function periodically

alog: renal function periodically

Question 11

Avoid these 2 DDP4 inhibitors in HF

Answer 11

avoid vildagliptin if severe heart failure; avoid alogliptin if moderate-to-severe heart failure.

Question 12

what effect will alcohol consumption have on pt who takes just metformin

Answer 12

Alcohol (excessive consumption) potentially increases the risk of lactic acidosis when given with Metformin. Manufacturer advises avoid excessive alcohol consumption.

NOT HYPO BC METFORMIN CANNOT CAUSE HYPO

Question 13

clarithromcyin and pioglitazone

Answer 13

Clarithromycin might cause hypoglycaemia when given with Pioglitazone. Manufacturer advises monitor blood glucose.

Question 14

pioglitazone and this antiplatelet interact

Answer 14

Clopidogrel increases the exposure to Pioglitazone. Manufacturer advises monitor blood glucose and adjust dose.

Question 15

pioglitazone and this fibrate interact

Answer 15

Gemfibrozil increases the exposure to Pioglitazone. Manufacturer advises monitor blood glucose and adjust dose.

Question 16

which GLP1 agonist has proven CV benefit

Answer 16

liraglutide

Question 17

how do GLP1 agonists work

Answer 17

binidng to the activator increases insulin secretion, supressed glucagon secretion and slows gastric emptying

Question 18

what is the MHRA advice about re glp1 agonists

Answer 18

reports of DKA when concomitant insulin was rapidly reduced or discontinued

Question 19

if a pt has severe abdominal pain with GLP1 agonists this could be

Answer 19

acute pancreatitis

Question 20

important advice to give to pt who are taking GLP1 agonists re dehydration

Answer 20

potential risk of dehydration in relation to GI SE
ensure u avoid fluid depletion, stay hydrated

Question 21

MHRA advice about ozempic (semglutide)

Answer 21

Vigilance required due to potentially harmful falsified products

Suspected falsified preparations should be quarantined and reported to the Yellow Card scheme.

Question 22

contraindications to semaglutide when used for T2D

Answer 22

DKA

Question 23

Missed doses - semaglutude SC and oral

Answer 23

SC: If a dose is more than 5 days late, the missed dose should not be taken and the next dose should be administered at the normal time.

oral: If a dose is missed, the missed dose should not be taken and the next dose should be taken at the normal time.

Question 24

dulaglutide missed doses

Answer 24

If a dose is missed, it should be administered as soon as possible only if there are at least 3 days until the next scheduled dose; if less than 3 days remain before the next scheduled dose, the missed dose should not be taken and the next dose should be taken at the normal time.

Question 25

Main 2 contraindications to most GLP1-R agonists

Answer 25

ketoacidosis
severe GI disease

Question 26

Exenatide SC injection using IR medicine - what is the dosage frequency

Answer 26

BD!
Dose to be taken within 1 hour before 2 main meals ( at least 6h apart)

Question 27

Lixisenatide - SC dosing frequency

Answer 27

OD! SC injection
Take dose within 1h before meal

Question 28

Liraglutide - dosing frequency

Answer 28

OD!

Question 29

Discontinue Saxenda (liraglutide) if the following does not improve

Answer 29

Discontinue if at least 5% of initial body-weight has not been lost after 12 weeks at maximum dose

Question 30

name the only meglitinide in the UK and state its MOA

Answer 30

repaglinide
stimulates insulin secretion

Question 31

name the dual GIP receptor and GLP1 receptor agonsist and how does it work

Answer 31

increases insulin sensitivity and secretion
suppresses glucagon secretion and slows gastric emptying

Question 32

what is the MHRA advice re tirzetapide about

Answer 32

GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

Question 33

Tirzetapide delays gastric emptying, esp after the first dose. What does this mean

Answer 33

Has the potential to slow the rate of absorption of concomitant oral medicines.
The risk of a delayed effect should be considered for oral medicines where a rapid onset of action is important. Monitor patients on oral medicines with a narrow therapeutic index, especially at the start of tirzepatide treatment and after dose increases.

Question 34

Mounjaro missed dose

Answer 34

If a dose is more than 4 days late, the missed dose should be omitted and the next dose administered at the normal time.

Question 35

patient is on an SGLT2i and tells you they feel dizzy. what does this mean

Answer 35

sign of volume depletion - report these e.g. postural hypotension and dizziness

Question 36

how do sulphonylyreas work

Answer 36

mainly act by augmenting insulin secretion and consequently re effective only when there is some residual pancreatic beta cell activity present

during long term admin they also have an extrapancreatic action

Question 37

when are SUs CI

Answer 37

presence of ketoacidsosis

Question 38

max dose gliclazide IR

Answer 38

320mg a day

Question 39

max dose gliclazide MR

Answer 39

120mg a day

Question 40

this abx is predicted to increase the exposure to gliclazide - monitor BG levels.

hint: Ch

Answer 40

chloramphenicol

Question 41

interaction with gliclazide and fibrates

Answer 41

increased risk of hypo
no recommendation or class of severity

Question 42

gliclazide and azoles (miconazole, fluconazole, voriconazole) interaction

Answer 42

Miconazole is predicted to increase the exposure to Gliclazide. Manufacturer advises use with caution and adjust dose.

Question 43

4 common SE for all SU

Answer 43

Abdominal pain; diarrhoea; hypoglycaemia; nausea

Question 44

if necessary, this SU which is principally metabolised in the liver can be used in RI but careful monitoring of BGC is essential

Answer 44

gliclazide

Question 45

all SU have the following 3 cautions

Answer 45

Can encourage weight gain; elderly; G6PD deficiency

Question 46

Sulfonylureas should be avoided where possible in acute porphyrias but this one is thought to be safe.

Answer 46

glipizide