Diabetes

Question 1

Antiobesity drug of choice?

Answer 1

Orlistat

Question 2

Orlistat moa?

Answer 2

Pancreatic lipase inhibitor. Reduce breakdown and subsequent absorption of fat from gut.

Question 3

Name 2 insulin sensitising agents with examples

Answer 3

• Biguanides: metformin

* thiazolidinediones: pioglitazone

Question 4

Metformin moa? (3)

Answer 4

• Increase peripheral use glucose by increasing uptake and decreasing gluconeogenesis, increase glycogenolysis
• decrease hepatic glucose production by inhibiting mitochondrial respiratory chain complex. Decrease GNG, glycogenolysis, fa oxidation
• reduce carb absorption from intestine
• activate insulin receptors and glut 4

Question 5

Name 5 advantages metformin

Answer 5

• Weight loss
• No hypoglycaemia
• decrease thrombotic risk: decrease platelet aggregation and pai-1 levels
• beneficial effect lipid profile: decreased LDL, triglycerides, increased HDL
• safe pregnancy

Question 6

Contraindications metformin?

Answer 6

Egfr <30 and hepatic impairment (risk lactic acidosis)

Question 7

Pioglitazane moa? (3)

Answer 7

• PPARgamma nuclear receptor agonist: increase transcription proteins that augment post receptor action of insulin
. Increase lipogenesis, uptake fatty acids and glucose
• reduce peripheral insulin resistance therefore increase sensitivity.

Question 8

Indication pioglitazone?

Answer 8

Combination with metformin or sulfonylurea DM 2.

Question 9

Name 4 advantages pioglitazone

Answer 9

• Reduce cv risk
• increase HDL, decrease LDL and triglycerides
• Improve Nash (nonalcoholic steatohepatitis)
• improve ovulation PCOS
• no hypoglycemic

Question 10

Name 5 adverse effects pioglitazone

Answer 10

• Weight gain
. Fluid retention
• increased risk fractures long term use
• increased risk heart failure congestive
• increased risk bladder cancer

Question 11

Moa sulfonylureas? (2)

Answer 11

• Block ATP dependent potassium channels in membrane of pancreatic B cells
• cause depolarisation, calcium influx and insulin release.

Question 12

Name 3 sulfonylureas.

Answer 12

• Glimepiride
• tolbutamide
• glibenclamide

Question 13

Name 3 adverse effects sulfonylureas

Answer 13

• Hypoglycaemia
• weight gain
• increased risk CV mortality

Question 14

Name 2 types incretins and example each.

Answer 14

• GLP-1 agonist: exenatide, liraglutide, dulaglutide, semaglutide
• Gliptins/DPP-4 inhibitors: sitagliptin, saxagliptin, vildagliptin, linagliptin

Question 15

GLP 1 agonist moa?

Answer 15

Eg exenatide.
• increase insulin secretion
• suppress glucagon secretion
. Slow gastric emptying

Question 16

Indication glp-1 agonists?

Answer 16

Obese patients with DM 2 after dual therapy fail.

Question 17

name 2 adverse effects glp-1 agonist

Answer 17

Eg dulaglutide.
• git disturbance
• pancreatitis

Question 18

Name 2 adverse effects dpp-4 inhibitors

Answer 18

• Heart failure, especially saxagliptin

* pancreatitis

Question 19

Sglt2 inhibitors moa?

Answer 19

Increased glucose excretion by kidney.

Question 20

Indication sglt2 inhibitors?

Answer 20

Dual therapy with metformin in patients that can’t tolerate sulphonylareas.
Cause weight loss, CV protection, slow progression DKD

Question 21

Name 3 SGLT2 inhibitors

Answer 21

• Dapagliflozin
. Canagliflozin
• empagliflozin

Question 22

Name 3 adverse effects sglt2 inhibitors.

Answer 22

• DKA risk
• genitourinary infections and thrush,polyuria, risk Fournier gangrene
• volume depletion, hypotension

Question 23

Name 3 principles treatment DKA

Answer 23

• Fluid: resuscitate, ns initially then 5% dextrose when glucose <14
• iv insulin
• K supplement iv