Diabetes

Question 1

Rapid acting insulin?

Answer 1

Novorapid

Question 2

Short acting insulin?

Answer 2

Humulin S

Question 3

Intermediate acting insulin?

Answer 3

Humulin I

Question 4

Long acting insulin?

Answer 4

Glargine

Question 5

Method of administering insulin?

Answer 5

Subcutaneous injection

Question 6

Metformin class

Answer 6

Biguanides

Question 7

Metformin mechanism of action

Answer 7

Decreases hepatic glucose production by inhibiting gluconeogenesis

Supresses appetite (limits weight gain)

Question 8

Metformin ADRs

Answer 8

GI upset - n,v,d

Question 9

Metformin contraindications and DDIs

Answer 9

Low eGFR, because it is excreted unchanged by kidneys. If kidney function is poor then less excretion.

Do not give with ACEi, diuretics, NSAIDS (may impair renal function).
Loop and thiazide diuretics increase glucose so reduce Metformin action

Question 10

Gliclazide class

Answer 10

Sulfonylureas

Question 11

Gliclazide mechanism

Answer 11

Stimulates pancreatic b cell insulin secretion
Blocks ATP dependant K channels

So needs residual pancreatic function!

Question 12

Gliclazide ADRs

Answer 12

Weight gain (anabolic effects of insulin)
GI upset
Hypoglycaemia

Question 13

Gliclazide DDIs and contraindications

Answer 13

Do not give with other hypoglycaemic agents
Do not give with loop and thiazide diuretics as these increase glucose

Caution: hepatic and renal disease

Question 14

Pioglitazone/rosiglitazone class

Answer 14

Glitazones

Question 15

Pioglitazone mechanism

Answer 15

Insulin sensitisation in muscle and adipose
Decreases hepatic glucose output
Gene transcription

Question 16

Pioglitazone ADRS

Answer 16

Not used frequently:)
Weight gain, there is fat cell differentiation.
GI upset
Fluid retention
Bladder cancer!

Question 17

Pioglitazone contras and DDIs

Answer 17

Do not give in heart failure (ADR is fluid retention)

Do not give with other hypoglycaemic agents. Can only do that with metformin

Question 18

Dapagliflozin/empagliflozin class

Answer 18

SGLT2 inhibitors (gliflozins)

Question 19

Dapagliflozin mechanism

Answer 19

Decreases glucose absorption from tubular filtrate (in PCT)
Increases urinary excretion

Competitive and reversible

Question 20

Dapagliflozin ADRs

Answer 20

UTIS, thirst and polyuria

Hypoglycaemic risk and weight loss risk is low yay

Question 21

Dapagliflozin contras and DDis

Answer 21

Do not give with antihypertensives and other hypoglycaemic agents

Can cause hypovolaemia due to urination

Question 22

What is GLP-1 and it’s actions

Answer 22

Incretin hormone.

Decreases gastric emptying
Increases insulin secretion
Decreases glucose production

Question 23

What class is sitagliptin/saxagliptin

Answer 23

DPP4 inhibitors (dipeptidyl peptidase 4)

Question 24

Gliptin (DPP4 inhibitors) mechanism

Answer 24

Prevents incretin degradation
Postprandial action
Doesn’t stimulate insulin so lower hypoglycaemic risk

Question 25

Sitagliptin ADRS

Answer 25

GI upset Pancreatitis risk

Question 26

Sitagliptin contras and DDIs

Answer 26

Avoid in pregnancy and history of pancreatitis Do not give with other hypoglycaemic agents Or with thiazide/loop diuretics as they increase glucose

Question 27

GLP 1 (glucagon like peptide) receptor agonist examples

Answer 27

Semaglutide Exenatide

Question 28

Semaglutide (GLP1 receptor agonist) mechanism

Answer 28

Increases glucose dependant insulin secretion from, b pancreatic cells Activates GLP1 receptors Slows gastric emptying so decreases appetite

Question 29

Semaglutide administration?

Answer 29

Subcutaneous injection Peptide hormone, would be degraded in stomach

Question 30

Semaglutide ADRs

Answer 30

GI upset Weight loss due to decreased appetite

Question 31

Semaglutide contras and DDIs

Answer 31

Do not give if eGFR less than 30 (renal impairment, will not be excreted unchanged by kidneys) Do not give with other hypoglycaemic agents