Diabetes Drugs

Question 1

How does metformin work? (4)

Answer 1

1) INCREASES SENSITIVITY TO INSULIN
2) Decreases gycogenolysis
3) Decreases gluconeogenesis
4) Increase uptake and utilisation of glucose

Question 2

What type of drug is metformin?

Answer 2

Biguanide

Question 3

What are the main benefits of Metformin as a drug? (2)

Answer 3

1) Helps with weight loss

2) No risk of hypos

Question 4

What is the most common side effect of Metformin?

Answer 4

GI disturbance

Question 5

What are the contraindications of Metformin?

Answer 5

Renal failure (stop if GFR <30 and review if GFR <45)

Caution in hepatic failure

Question 6

What are the interactions of Metformin?

Answer 6

Any other nephrotixic drugs

Drugs which increase glucose levels - e.g. corticosteroids

Question 7

Give an example of a Sulphonylurea

Answer 7

Gliclazide

Question 8

How do sulphonylreas work? (1)

Answer 8

Increase pancreatic insulin production

Question 9

What are the side effects of sulphonylureas? (3)

Answer 9

1) Weight gain
2) HYPOS
3) GI upset

Question 10

What are the contraidications of using sulphonylureas?

Answer 10

Hepatic/renal faikure

Question 11

Give an example of a Thiazalidinone?

Answer 11

Pioglitazone

Question 12

How do Thiazalidinones (Pioglitazone) work?

Answer 12

Increase fatty acids in adipocytes, thus less circulating fatty acids thus more cells dependent on glucose

Question 13

What are the side effects of Thiazalidinones? (2)

Answer 13

1) Weight gain

2) Oedema/water retention

Question 14

What are the contraindications to using Thiazalidinones? (3)

Answer 14

1) Heart failure
2) Bladder cancer
3) Uninvestigated macroscopic haematuria

Question 15

Give an example of a DPP4 inhibitor?

Answer 15

Sitagliptin

Question 16

How do DPP4 inhibitors work?

Answer 16

Increase incretin

Decrease glucagon and blood glucose level

Question 17

What are the side effects (2) and advantages (2) of DPP4 inhibitors?

Answer 17

1) Allergy
2) GI disturbance

1) Weight neutral
2) Low risk of hypos

Question 18

Give an example of an SGLT2 inhibitor?

Answer 18

Dapigliflozin (FLOZINS)

Question 19

How do SGLT2 inhibitors work?

Answer 19

Prevent reuptake of glucose in the proximal tubule leading to glucose being excreted in the urine

Question 20

What are the advatanges of SGLT2 inhibitors?

Answer 20

1) Weight loss

Question 21

What are the disavanatages of SGLT2 inhibitors? (4)

Answer 21

1) UTIs
2) Need close drug monitoring
3) Expensive
4) Efficacy depends on renal function

Question 22

How do GLP-1 mimics work?

Answer 22

1) increase insulin
2) decrease glucagon
3) delays gastric empyting - thus leads to decrease in food intake and body weight
4) increases B cell mass

Question 23

What are the adverse effects of GLP-1 mimics? (2 + 2 bonus)

Answer 23

1) nausea
2) pancreatitis

To NHS - v expensive
SC injection

Question 24

What effect does illness have on insulin requirement?

Answer 24

Illness makes resistance to insulin worse so may need more insulin

Also illness increases metabolic requirements of the body so need more energy and thus more glucose

Question 25

What are the symptoms of hypo-ing?

Answer 25

1) Dizziness
2) Nausea
3) Sweating
4) Confusion

Question 26

What is the management of hypos?

Answer 26

At home - something sugary and then something starchy

In hospital - there is a hypo box