Diabetes Mellitus

Question 1

What are four oral hypoglycaemic agents?

Answer 1

Thiazolidnediones
Sulfonylureas
Alpha glucosidase inhibitors
Metformin

Question 2

What are Thiazolidinediones?

Answer 2

Drugs that enhance insulin action in peripheral tissues

Drugs that suppress endogenous glucose production

Question 3

What are sulfonylureas?

Answer 3

Drugs that enhance endogenous insulin secretion

Question 4

What are alpha glucosidase inhibitors?

Answer 4

Drugs that delay the absorption of carbohydrate from the GI tract

Question 5

What are Metformin?

Answer 5

Drugs that suppress endogenous glucose production

Drugs that enhance insulin action in peripheral tissues

Question 6

Give a example of a Metformin?

Answer 6

Biguanide

Question 7

What does Metformin do?

Answer 7

↑ Glucose uptake & utilization in skeletal muscle • ↓Hepatic gluconeogenesis • ↓ LDL & VLDL

Question 8

Give one benefit of Metformin?

Answer 8

Food for weight loss and does not stimulate appetite

Question 9

Give a side effect of Metformin?

Answer 9

Causes GI disturbance

Question 10

Give three example of sulphonylureas?

Answer 10

Tolbutamide, Glibenclamide, Glipizide

Question 11

What does sulphonylureas do?

Answer 11

Stimulate insulin secretion from β cell

Question 12

What are side effects of sulphonylureas?

Answer 12

Hypoglycaemia

Appetite stimulation

Drug interactions: NSAID’s, alcohol, MAOI’s & antibiotics & antifungals augment hypoglcaemia

Question 13

What does Thiazolidinediones (Glitazones) do?

Answer 13

Enhance the effectiveness of endogenous insulin

↓ Hepatic glucose output

↑ Glucose uptake into muscle

Question 14

What are physiological effects of Thiazolidinediones (Glitazones)?

Answer 14

↓ Blood glucose

↓ circulating insulin

↓ FFA’s & Triglycerides

Question 15

What is the mechanism of Thiazolidinediones (Glitazones)?

Answer 15

Activate the nuclear receptor Peroxisome Proliferator Activated Receptor γ (PPAR-gamma)

Question 16

What are side effects of Thiazolidinediones (Glitazones)?

Answer 16

Weight gain (1-4 kg)

Monitor for liver tox

Heart failure risk (!)

Question 17

Give a example of a α-Glucosidase Inhibitor?

Answer 17

Acarbose

Question 18

What does α-Glucosidase Inhibitor do?

Answer 18

Delays carbohydrate absorption

↓ Postprandial rise in plasma glucose

Question 19

What are side effects of α-Glucosidase Inhibitors?

Answer 19

GI disturbance: diarrhoea, flatus, pain & bloating

Question 20

What are incretins?

Answer 20

Metabolic hormones (peptides) that increase insulin response before the postprandial rise in glucose signal boosts insulin

Question 21

What do Incretins do?

Answer 21

They also slow the rate of absorption of nutrients into the blood stream by reducing gastric emptying and may directly reduce food intake.

Question 22

Give a example of a incretin

Answer 22

Glucagon-Like peptide 1 agonist

Question 23

What do Dipeptidyl Peptidase 4 Inhibitors do?

Answer 23

Increase incretins (GLP1 & GIP), so inhibit glucagon release • Increase insulin secretion • Decrease gastric emptying • Decrease blood glucose

Question 24

Give a example of a Dipeptidyl Peptidase 4 Inhibitor?

Answer 24

Sitagliptin

Question 25

What is atherosclerosis?

Answer 25

The formation of lipid deposits in the tunica media associated with damage to the endothelial lining

Question 26

Why is HDL good?

Answer 26

HDL accepts cholesterol from cells HDL also accepts cholesterol from lipoproteins that have lost triglycerides Cholesterylesters are returned to liver

Question 27

What are some lipid lowering drugs?

Answer 27

HMG CoA Reductase Inhibitors (statins) Anion Exchange Resins – Colestyramine – Colestipol Nicotinic Acid Fibrates – Gemfibrozil – Bezafibrate Inhibitors of Intestinal Cholesterol Absorption – Ezetimibe

Question 28

What are statins?

Answer 28

3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors

Question 29

What do statins?

Answer 29

Decrease hepatic cholesterol synthesis Induces a compensatory increase in hepatic LDL receptors ↓ Plasma cholesterol

Question 30

Give a example of a statin?

Answer 30

Simvastatin

Question 31

What are the side effects of statins?

Answer 31

Generally low side effect profile Myopathy (muscle weakness) Do not give statins in pregnancy – Cholesterol essential for normal fetal development

Question 32

What does an ion exchange resins do?

Answer 32

Cause ↑ excretion of bile acids More cholesterol converted to bile acids ↓ hepatocyte cholesterol causes compensatory ↑ in HMG CoA reductase activity ↑ LDL receptors

Question 33

What are adverse effects of an ion exchange resins?

Answer 33

GI disturbance Resins not absorbed: Cause bloating, flatulence, discomfort, diarrhoea & constipation

Question 34

What does nicotinic acid do?

Answer 34

Reduces release of VLDL ↓ Plasma triglycerides by 30-50 % ↓ Cholesterol by 10-20 %

Question 35

What do Fibrates do?

Answer 35

↓ in HDL (10%) ↓ in plasma triglycerides (30%) Stimulate lipoprotein lipase activity

Question 36

What are Fibrates?

Answer 36

Ligands for nuclear transcription factor peroxisome proliferator-activated receptor alpha (PPAR- α ).

Question 37

What is the first line drug for patients with high triglyceride levels?

Answer 37

Fibrates

Question 38

What are adverse effects of Fibrates?

Answer 38

Myositis like syndrome (muscle effects) Rhabdomyolysis Higher incidence in patients with renal impairment & with combination therapies

Question 39

What is ezetimibe?

Answer 39

Inhibitor of intestinal cholesterol absorption

Question 40

What does eztimibe do?

Answer 40

Decreases LDL by 18%

Question 41

What has been shown to have cardio-protective effects?

Answer 41

Fish oils