Diabetes Mellitus - Medications

Question 1

Mechanism of Action of Metformin.

Answer 1

Biguanide : increases Insulin sensitivity and reduces hepatic production of Glucose.

Question 2

Adverse Effects of Metformin (2).

Answer 2

1. Diarrhoea and Abdominal Pain (Dose-Dependent).

2. Lactic Acidosis.

Question 3

What adverse effects are not typically associated with Metformin? (2)

Answer 3

1. Weight-Loss/Gain (Weight-Neutral).

2. Hypoglycaemia.

Question 4

Mechanism of Action of Pioglitazone.

Answer 4

Thiazolidinedione : increases insulin sensitivity and decreases hepatic production of glucose and activate PPAR-y receptor in adipocytes to promote fatty acid uptake.

Question 5

Adverse Effects of Pioglitazone (5).

Answer 5

1. Weight Gain.
2. Fluid Retention - Oedema.
3. Anaemia.
4. Heart Failure.
5. Extended Use - Increased Risk of Bladder Cancer.

Question 6

Which adverse effects are not typically associated with Pioglitazone?

Answer 6

Hypoglycaemia.

Question 7

Examples of Sulphonylureas (2).

Answer 7

1. Gliclazide.

2. Glimeperide.

Question 8

Mechanism of Action of Gliclazide.

Answer 8

Sulphonylurea : stimulates Insulin release from the pancreas.

Question 9

Adverse Effects of Gliclazide (4).

Answer 9

1. Weight Gain.
2. Hypoglycaemia.
3. Increased Risk of Cardiovascular Disease and MI when Monotherapy.
4. Hyponatraemia.

Question 10

What are Incretins?

Answer 10

Hormones produced by the GI tract to increase insulin secretions, inhibit glucagon production and slow absorption by the GI tract e.g. GLP-1 (Glucagon-Like Peptide 1).

Question 11

What are Incretins inhibited by?

Answer 11

DPP-4 Enzyme : Dipeptidyl Peptidase 4.

Question 12

Examples of DPP-4 Inhibitors (1).

Answer 12

GLIPTINs e.g. Sitagliptin.

Question 13

Mechanism of Action of Sitagliptin.

Answer 13

DPP-4 Inhibitor : increases GLP-1 Activity.

Question 14

Adverse Effects of Sitagliptin (3).

Answer 14

1. GI Tract Upset.
2. URTI Symptoms.
3. Pancreatitis.

Question 15

Examples of GLP-1 Mimetics (2).

Answer 15

TIDES : Exenatide, Liraglutide.

Question 16

Mechanism of Action of Exenatide/Liraglutide.

Answer 16

GLP-1 Mimetic : increase GLP-1 activity.

Question 17

Adverse Effects of Exenatide/Liraglutide (4).

Answer 17

1. GI Tract Upset.
2. Weight Loss.
3. Dizziness.
4. Low Risk of Hypoglycaemia.

Question 18

Examples of SGLT-2 Inhibitors (3).

Answer 18

GLIFLOZINs : Dapagliflozin, Canagliflozin, Empagliflozin.

Question 19

Mechanism of Action of Empagliflozin/Dapagliflozin.

Answer 19

SGLT-2 Inhibitor : protein resorbs glucose from urine at PCT but inhibited so more glucose excreted.

Question 20

Adverse Effects of SGLT-2 Inhibitors (4).

Answer 20

1. Glucosuria & UTIs.
2. Weight Loss.
3. Diabetic Ketoacidosis (With Only Moderately Raised Glucose).
4. Fournier’s Gangrene.