Diabetes Meds

Question 1

What should be the first line anti-hypertensive in patients with T2DM?

Answer 1

ACE-I

Except if may become pregnant or afro-caribbean origin

Question 2

What is the initial drug treatment for patients with T2DM?

Answer 2

Standard release metformin

Question 3

What are adverse effects of metformin?

Answer 3

GI upset
Lactic acidosis
Altered LFTs/Hepatitis
Reduced B12 absorption

Question 4

What investigations should you do before and during metformin treatment?

Answer 4

Renal function before and at least annually.
Caution if eGFR <45
Stop if eGFR <30

Question 5

Give examples of sulphonylureas.

Answer 5

Gliclazide
Tolbutamide
Glipizide
Glimepiride

Question 6

What is the MOA of sulphonylureas?

Answer 6

Stimulate insulin release by binding to and closing ATP-sensitive K+ channels on beta cells, causing depolarised and opening of voltage dependent calcium channels.

Question 7

Which patient group might you be cautious to prescribe sulphonylureas for?

Answer 7

Elderly - risk of hypoglycaemia, especially if levels accumulate in renal impairment.

Obesity - patient can put weight on due to increased insulin release.
Metformin is weight-neutral.

Question 8

Give an example of a thiazolidinedione.

Answer 8

Pioglitazone

Question 9

Which patients would you not offer pioglitazone to?

Answer 9

HF
Hepatic Impairment
Bladder cancer - current or history of

Question 10

What adverse effects are associated with Pioglitazone?

Answer 10

Water retention
Weight gain
Eye problems

Long term use associated with: HF, macular oedema, bone fractures, bladder cancer.

Question 11

What is the MOA of DPP4 inhibitors?

Answer 11

Inhibit enzyme DPP4 which breaks down incretin (GLP-1). Higher levels of GLP-1 delays gastric emptying, inhibits glucagon release and increases insulin secretion.

Question 12

Give examples of DPP4 inhibitors.

Answer 12

Sitagliptin
Saxagliptin
Linagliptin
Alogliptin

Question 13

What adverse effects are associated with DPP4 inhibitors?

Answer 13

Acute pancreatitis - avoid if history of alcohol abuse or pancreatitis.

Question 14

Give examples of SGLT2 inhibitors.

Answer 14

Dapagliflozin
Canagliflozin
Empagliflozin

Question 15

What is the MOA of SGLT2 inhibitors?

Answer 15

Inhibit reabsorption of glucose in the PCT of kidneys, increasing urine excretion of glucose.

Question 16

What must renal function be in order for SGLT2 to be prescribed?

Answer 16

eGFR 60 or more

Question 17

What are adverse effects associated with SGLT2 inhibitors?

Answer 17

Kidney injury
Infections - genital and UTI
Amputations
Lactic acidosis
Bone fractures

Question 18

Give examples of GLP-1 analogues.

Answer 18

Exenatide

Liraglutide

Question 19

What is the MOA of GLP-1 analogues?

Answer 19

Slows gastric emptying
Inhibits glucagon release
Stimulates insulin release

Question 20

Which patient group may benefit from GLP-1 analogue?

Answer 20

Obese - promotes weight loss.

Must loose 3% weight in 6 months.

Question 21

How are GLP-1 analogues delivered?

Answer 21

Injection

Question 22

Why might sulphonylureas be less effective in more advanced diabetes?

Answer 22

Require functioning beta cells to work

Question 23

What are adverse effects of insulin?

Answer 23

Hypoglycaemia
Hyperglycaemia
Lipodystrophy
Painful injections
Insulin allergies
Weight gain

Question 24

What are potential dangers of missing out insulin?

Answer 24

Hyperglycaemia

HHS

Question 25

When is metformin CI?

Answer 25

Risk factors for lactic acidosis - compromised renal function, with other nephrotoxic drugs.

Question 26

At what stage would you begin drug therapy for patients with T2DM?

Answer 26

If Hba1c is 6.5% (48) on lifestyle modifications.

Question 27

At what stage do you intensify drug treatment regime?

Answer 27

If Hba1c is 7% (58) on lifestyle modifications.