B / 19 : Oral antidiabetic

Question 1

MOA of sulfonylureas

Answer 1

• Bind to Katp-channels on B cells
• Close the channel : depolarization
• Ca2+ influx
• Triggers insulin secretion and reduced glucagon release

Question 2

Effect of sulfonylureas

Answer 2

• Enhanced insulin release
• Decreased glucagon serum level

Question 3

Oral antidiabetic agents

Answer 3

• Glipizide
• Glimepiride
• Repaglinide
• Metformin
• Vildagliptin
• Dapagliflozin
• Acarbose

2 glistening rabbits met a dapper viscount

Question 4

Glipizide, glimepiride
- MOA
- Effect
- Indication
- SE
- ROA

Answer 4

• 2nd generation sulfonylurea
• Depolarization of B cells and insulin release
• Type 2 diabetes
• Hypoglycaemia, weight gain, hematological abnormalities
• Oral

Question 5

Repaglinide
- MOA
- Effect
- Indication
- SE
- Extra
- ROA

Answer 5

• Meglitinide analog : closure of ATP dependant K+ channels in B cells
• Insulin release via depolarization of B cells
• Type 2 diabetes
• Hypoglycemia
• Rapid onset, taken with meals
• Oral

Question 6

Metformin
- MOA
- Effect
- Indication
- Contraindication
- SE
- ROA

Answer 6

• Biguanid
• Decreased insulin resistance, decreased intestinal absorption of glucose, decreased gluconeogenesis in the liver
• First drug of choice in type 2 diabetes
• Not if acute metabolic acidosis or sever kidney impairment
• Impaired B12 absorption -> anemia + lactic acidosis
• Oral

Question 7

Metformin dose

Answer 7

2-3 x 500-850mg

Question 8

Vildagliptin
- MOA
- Effect
- Indication
- SE
- Extra
- ROA

Answer 8

• DPP-4 inhibitor : raises GLP-1 levels
• Increased insulin secretion, decreased glucagon release
• For type 2 diabetes
• Nasopharyngitis, upper respiratory tract infection
• No hypoglycemia or no change in body weight
• Oral

Question 9

What is GLP-1 and its effect ?

Answer 9

Glucagon-like peptide 1, it is an incretin hormone that regulates blood glucose by stimulating insulin secretion

Question 10

Dapagliflozin
- MOA
- Effect
- Indication
- SE
- ROA

Answer 10

• SGLT2 inhibitor
• Inhibition causes glycosuria and decreased blood glucose level
• For type 2 diabetes and obese patients with HF
• UTI, risk of polyuria, hypotension, dehydration increased risk of bone fractures
• Oral

Dabbing appa : dapa li(f)lo-zin - PSG : SGLT2

Question 11

Acarbose
- MOA
- Effect
- Indication
- SE
- ROA

Answer 11

• alpha-glucosidase inhibitor : inhibits carbohydrate absorption in the intestine
• Decreased degradation of polysaccharides -> decreased glucose absorption
• Reduce post-prandial glucose level, for type 2 diabetes
• Gas accumulation in GI, abdominal pain
• Oral

(A-CARB-ose decreases CARBOhydrate reabs)