Diabetes

Question 1

SE Metformin

Answer 1

GI&raquo_space; swap to MR if not tolerated well

Lactic acidosis

Question 2

SE Sulfonylureas

Gliclazide

Answer 2

Hypos
Increased appetite ,weight gain &laquo_space;not preferred
SIADH secretion
Liver dysfunction (cholestatic)

Question 3

Example of Sulfonylureas

Answer 3

Gliclazide

Question 4

SE Glitazones

Answer 4

Weight gain
Fluid retention
Liver dysfunction
Fractures
CI: bladder cancer

Question 5

SE Gliptins (DPP4I)

Answer 5

Pancreatitis

Question 6

Exanatide

Answer 6

GLP1 agonist
Good for weight loss so patients >35 BMI – now used more often
SC injection

Question 7

Who do you offer atorvastatin 20mg to?

Answer 7

T1DM +
> 40 years of age
> 10 years
Established nephropathy
Other CVD risk factors (such as obesity and hypertension)

T2DM >10% risk

Question 8

Insulin sensitizer

Answer 8

Pioglitazone only one left

Question 9

Acarbose

Answer 9

Glucosidase inhibitor, not really used now

Question 10

Sulphonylurea MOA

Answer 10

Gliclazide
Inhibit potassium transporter in B cells> depolarisation &raquo_space; insulin release
Hypo risk

Question 11

When are sulphonylureas used?

Answer 11

Rapid reduction in Hba1c eg if > 100
Risk hypos so needs monitoring
Then later swap med

Question 12

Biguanides

MOA

Answer 12

metformin
increase insulin sensitivity and glucose uptake
weight loss
reduces the risk of bowel/ breast/ brain/ prostate ca

Question 13

Example of DPP4 I

Answer 13

liptins

linagliptin is renal ok, least interactions

Question 14

DPP4 I MOA

Answer 14

Inhibits DPP4 from breaking down the incretins (GLP1 GIP) > increased incretins > stimulate insulin

Question 15

Second line treatment

Answer 15

Metformin +
DPP4 I
SU
SGLT 2
Pioglitazone

Question 16

SGLT2 inhibitors

Answer 16

Newest

Glifozins

Question 17

SGLT2 inhibitors MOA

Answer 17

inhibit reabsorption of glucose in the PCT > glycosuria> lower blood sugars

Question 18

SGLT2 inhibitors SE

Answer 18

weight loss
DKA
UTIs/ thrush

Question 19

Dapaglifozin

Answer 19

SGLT2 inhibitor , used in HF

Question 20

GLP 1 agonist

Answer 20

can cause weight loss - px at weight loss clinics
4th line NHS guidelines, BMI >35
Cardioprotective
SC injections
Semuglutide any renal function