Diabetes

Question 0

Metformin mechanism

Answer 0

Increased insulin receptor sensitivity-more uptake from fat and muscle 
Inhibits hepatic gluconeogenesis
Decreased glucose uptake from gut
No action on beta cells 
Reduces HbA1c by 2%

Question 1

Metformin

Answer 1

Biguanide

Question 2

Metformin pharmacokinetics

Answer 2

Half life 4 hours
2 or 3 times daily dosing
Not metabolised
Total renal elimination

Question 3

Metformin ADRs

Answer 3

GI symptoms
Potential for lactic acidosis
Not in renal, hepatic or respiratory failure
B12 deficiency

Question 4

Gliclazide

Answer 4

Sulphonylurea

Half life 10-12 hours

Question 5

Glimepiride

Answer 5

Sulphonylurea

Half life 18-24 hours

Question 6

Glipizide

Answer 6

Sulphonylurea

Question 7

Sulphonylureas mechanism

Answer 7

Stimulation of beta cells - closes potassium channel, causing depolarisation, calcium influx and insulin granule secretion.
Reduce HbA1c 1-2%

Question 8

Sulphonylureas ADRs

Answer 8

Hypoglycaemia
Weight gain (more insulin)

Question 9

Repaglinide

Answer 9

Meglitinide

Question 10

Nateglinide

Answer 10

Meglitinides

Question 11

Meglitinides mechanism

Answer 11

Similar to Sulphonylureas but distinct binding site on potassium channel
Shorter half life so given before meals

Question 12

Pioglitazone

Answer 12

Thiazolidinediones

Question 13

Thiazolidinediones mechanism

Answer 13

Insulin sensitisers
Via nuclear peroxisome stimulation
Suppresses gluconeogenesis in liver
Reduce HbA1c 1-1.5%

Question 14

Thiazolidinediones ADRs

Answer 14

Weight gain and oedema 
Fractures in post menopausal women 
Bladder cancers
Increase LDLs and HDLs
Use contraindicated in heart failure

Question 15

GLP 1 mechanism

Answer 15

More insulin secretion from beta cells
Promotes satiety in brain.
Reduced hepatic glucose output
Slowed gastric emptying

Question 16

Acarbose

Answer 16

Alpha glucosidase inhibitor.

Question 17

Acarbose mechanism

Answer 17

Delayed glucose load into blood (overall absorption not affected)
Drug is excreted unchanged

Question 18

Acarbose ADRs

Answer 18

Flatulence and diarrhoea

Increased AST at high doses

Question 19

SGLT2 inhibitor mechanism

Answer 19

Glucose not re absorbed, excreted in urine.

Question 20

SGLT2 inhibitor ADRs

Answer 20

Thrush

UTI

Question 21

Dapagliflozin

Answer 21

SGLT2 inhibitor

Question 22

Canaglifozin

Answer 22

SGLT2 inhibitor

Question 23

Thiazolidinediones metabolism

Answer 23

Via liver
T1/2 around 7 hrs
99% protein bound

Question 24

Tolbutamide

Answer 24

Sulphonylurea

Question 25

DPP4 inhibitors

Answer 25

GLP1 is broken down by DPP4, so this increases the half life