DIABETES DRUGS

Question 1

What type of drugs is alogliptin, sitagliptin and linagliptin?

Answer 1

DPP4 inhibitors

Question 2

What type of drug is metformin?

Answer 2

Biguanide

Question 3

What type of drug is pioglitazone?

Answer 3

A thiazolidinedione

Question 4

What type of drugs are canagliflozin, dapagliflozin, ertugliflozin?

Answer 4

SGLT2 inhibitors

Question 5

What type of drugs are gliclazide, glimeperide, tolbutamide?

Answer 5

Sulfonylureas

Question 6

What type of drugs are dulaglutide, exenatide, Liraglutide?

Answer 6

GLP-1 agonists

Question 7

Whats the suffix for DPP4 inhibitors?

Answer 7

-gliptin

Question 8

Whats the suffix for thiazolidinediones?

Answer 8

-glitazone

Question 9

Whats the suffix for SGLT2 inhibitors?

Answer 9

-flozin

Question 10

Whats the suffix for sulfonylureas?

Answer 10

-ide

Question 11

Whats the suffix for GLP1 agonists?

Answer 11

-tide

Question 12

Whats the MOA of DPP4 inhibitors?

Answer 12

Inhibits DPP4 which prevents inactivation of glucagon-like peptide which is an incretin

Question 13

Whats the MOA of GLP1 agonists?

Answer 13

mimic the action of endogenous GLP-1 (incretin) to enhance insulin secretion and inhibit glucagon secretion from pancreatic islet cells.

Question 14

Whats the MOA of metformin?

Answer 14

Decreases gluconeogenesis, intestinal absorption of glucose and increases insulin sensitivity by increasing peripheral glucose uptake and reabsorption.

Question 15

Whats the MOA of thiazolidinediones?

Answer 15

Activate PPARs which are a group of nuclear receptors that when activated, increase insulin sensitivity by acting on adipose, muscle, and, to a lesser extent, liver to increase glucose utilization and decrease glucose production.

Question 16

Whats the MOA of SGLT2 inhibitors?

Answer 16

Inhibit SGLT2 in the PCT to prevent reabsorption of glucose and facilitate its excretion in urine

Question 17

Whats the MOA of sulfonylureas?

Answer 17

close ATP-sensitive K-channels in the beta-cell plasma membrane, and so initiate a chain of events which results in insulin release.

Question 18

What are the contraindications of thiazolidinediones?

Answer 18

HF
Previous or active bladder cancer or uninvestigated macroscopic haematuria

Question 19

Whats the first line drug of choice in type 2 diabetes?

Answer 19

Metformin

Question 20

When should SGLT2 inhibitors be given in addition to metformin?

Answer 20

If the patient has a high risk of developing CVD, has CVD or has chronic HF

Question 21

If metformin is contraindicated, what drug is first choice for type 2 diabetes?

Answer 21

SGLT2 mono therapy if the patient has risk of, has CVD or chronic HF
DPP4 inhibitor or sulfonylureas or pioglitazone if patient doesnt have above

Question 22

When should GLP1 mimetic treatment be considered?

Answer 22

If triple therapy with metformin and 2 other oral drugs is not effective, not tolerated or contraindicated then consider triple therapy by switching 1 drug for GLP1 mimetic

NICE like patients to have achieved a > 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months to justify the ongoing prescription of GLP-1 mimetics.

Question 23

When should you consider insulin therapy for type 2 diabetes?

Answer 23

When dual therapy has not continued to control HbA1c to below the person’s individually agreed threshold

Question 24

Which antidiabetic drugs cause weight gain?

Answer 24

Pioglitazone
Sulfonylureas
Insulin

Question 25

Which antidiabetic drugs cause weight loss?

Answer 25

SGLT2 inhibitors GLP1 mimetics

Question 26

Which antidiabetic drugs are weight neutral?

Answer 26

DPP4 inhibitors Metformin

Question 27

Which antidiabetic drugs carry risk of hypoglycaemia?

Answer 27

Insulin Sulfonylureas - moderate risk

Question 28

Which diabetics should statin be offered in?

Answer 28

Only pt with 10 year cardiovascular risk >10%

Question 29

What is the incretin effect?

Answer 29

In normal physiology an oral glucose load results in a greater release of insulin than if the same load is given intravenously This is because L cells of the ileum release GLP1

Question 30

What are incretins?

Answer 30

hormones that are secreted from the gastrointestinal tract into the circulation in response to nutrient ingestion that enhance glucose-stimulated insulin secretion

Question 31

What are common side effects of metformin?

Answer 31

GI side effects Lactic acidosis

Question 32

What are common side effects of sulfonylureas?

Answer 32

Hypoglycaemic episodes Increased appetite and weight gain SIADH - hyponatraemia Hepatotoxicity Bone marrow suppression Peripheral neuropathy Dont give in breast feeding or pregnancy!

Question 33

What are common side effects of pioglitazone?

Answer 33

Weight gain Fluid retention Liver impairment Fracture risk Increased risk of bladder cancer

Question 34

What are common side effects of DPP4 inhibitors?

Answer 34

Pancreatitis

Question 35

What are metformin contraindications?

Answer 35

Renal dysfunction Impaired hepatic dysfunction Congestive HF Metabolic acidosis

Question 36

When should you add another drug when a pt is on metformin?

Answer 36

If HbA1c rises to 58 mmol/mol (7.5%) Before this you can titrate metformin up and make lifestyle changes

Question 37

If a pt is not tolerating metformin due to GI side effects, what should you do next?

Answer 37

Start metformin modified release - this has a better GI SE profile. This is also only given once daily

Question 38

Whats the most effective oral antidiabetic agent? Whats the biggest risk with this?

Answer 38

Sulfonylureas -gliclazide Greatest risk of hypoglycaemia

Question 39

Why should you stop metformin when you are sick?

Answer 39

Dehydration makes it more likely to develop lactic acidosis

Question 40

Why should you stop sulfonylureas when you are sick?

Answer 40

If you are unable to eat and drink then you are more likely to develop hypos

Question 41

Why should you stop SGLT2 when you are sick?

Answer 41

Dehydration can make it more likely to develop ketoacidosis

Question 42

What are the major adverse efefcts of GLP-1 mimetics?

Answer 42

Nausea and vomiting Exanatide - pancreatitis

Question 43

What are the adverse side effects of SGLT2 inhibitors?

Answer 43

Urinary and genital infections Normoglycaemic ketoacidosis Increased risk of lower-limb amputation Weight loss

Question 44

How are GLP-1 mimetics administered?

Answer 44

Subcutaneous injections!