Diabetes

Question 1

Classes of oral hypoglycemia used in type II diabetes?

Answer 1

Sulfonylurea, Meglitinides, Biguanides, Thiazolidinediones, GLP RA, SGLT

Question 2

Why is sulfonylurea not the best option for elderly patients

Answer 2

High risk of hypoglycemia, weight gain, CV risk

Question 3

Pros of sulfonylureas?

Answer 3

• Low cost

- Effective in Combo Therapy

Question 4

MOA OF biguanides?

Answer 4

• Metformin: Increases insulin ability to move to glucose

- stimulates the hepatic enzyme AMPactivated protein kinase

Question 5

Boxed warning of metformin?

Answer 5

Lactic Acidosis

Question 6

Precautions of metformin?

Answer 6

• B12 deficiency
• Elderly patients
• peripheral neuropathy
• Patients with Anemia

Question 7

counselling point for metformin?

Answer 7

• Don’t split the tablet (extended-release)
• Metallic after taste
• Take with food
• ## tablet remnant may remain in the stool

Question 8

Metformin is contra in?

Answer 8

Renal disease, metabolic diseases, heart failure, acute liver disease

Question 9

Examples of Thiazolidinediones?

Answer 9

Pioglitazone & Rosiglitazone

Question 10

benefits of thiazolidinediones?

Answer 10

Favorable lipid profile, neutral GIT effects, HbA1c lowering potential low to high

Question 11

MOA of Meglitinides?

Answer 11

Stimulates more insulin production

Question 12

Examples of Meglitinides?

Answer 12

Repaglinide & Nateglinide

Question 13

GLP RA Drugs?

Answer 13

Exentide

Question 14

Oral Semaglutide is wrapped with?

Answer 14

SNAC

Question 15

Counselling for semaglutide?

Answer 15

• Not the first option for t2DM
• Should be administered in fasting state to faciltie absorption in morning
• Do not eat for 3omins
• No recommended dose adjustment for renal patients

Question 16

Boxing Warning for Semaglutide?

Answer 16

Thyroid c-cell, pancreatitis, diabetic retinopathy, hypoglycemia

Question 17

Most common side effects of semaglutide?

Answer 17

Nausea, vomiting, Diarrhea, increased appetite, indigestion and constipation

Question 18

___ Provides subcutaneous delivery upto 1 year

Answer 18

Soliqua 100/33 ( 100 insulin, 33 Lixisenatide

Question 19

GLP-1 RA “ideal patient”

Answer 19

• Second/ third line after metformin
• CV BENEFITS
• REDUCES WEIGHT AND LOW RISK OF HYPOGKYCMEIA

Question 20

DDP4 Warning?

Answer 20

Join Pain- Sitagliptin

Question 21

Benefits of SGLT-2?

Answer 21

WEIGHT BENEFITS
Empagliflozin & Dapaglifolzin have CV benefits
Canagliflozin: Has potential CV benefits

Question 22

Combo drugs under SGLT class?

Answer 22

• SYnjardy: Emoaglifolzin & Metformin
• Trijardy: Metfomin, Empaglifolzin, Linagliptin
• Glyxambi: Empagliflozin & Linagliptin

Question 23

Dual SGLT

Answer 23

Sotagliflozin

Question 24

Boxed warning for Canaglifolzin ( SGLT?)

Answer 24

Increased risk of amputation

Question 25

SGLT iDEAL PATIENTS

Answer 25

Used as second/third-line agent after metformin Overweight/obese patients Patients with heart failure/CV Patients with risk of hypoglycemia

Question 26

SGLT risks?

Answer 26

Cost, Genital Mycotic infection, potential orthostatic hypotension,

Question 27

SGLT Pros?

Answer 27

doesn't require endogenous insulin secretion so can be used at any stage of disease

Question 28

why is SGLT discontinued before surgery?

Answer 28

An FDA safety communication recommends stopping canagliflozin, dapagliflozin, and empagliflozin at least 3 days prior to scheduled therapy. Ertugliflozin should be stopped at least 4 days before surgery. All 4 agents can be restarted after surgery ( to lessen the risk for ketoacidosis)

Question 29

drug example of each class

Answer 29

``` Biguanides: Metformin Sulfonylurea Meglinides: Repaglinides & Nateglindies GLP: Lixentide & Semgalutide DPP: SGLT: Sotagliflozin Trijardy Synjardy XR Glyxambi Thizolidinediones: Pioglitazone & Rosiglitazone ```