Diabetes - Oral Hypoglycaemic Drugs

Question 1

List the following for: Insulin

• Use
• Example drugs
• Drug class
• Mechanism of action
• Adverse effects
• Warnings / contraindications
• Important drug reactions

Answer 1

Diabetes

Aspart – rapid acting
Soluble – short acting
NPH – intermediate acting
Glargine – long acting
Diabetes

Insulin

Injected to help maintain plasma glucose levels within normal range
Acts as a key to unlock cells and allow storage of glucose (plus K)

• Hypoglycaemia
• Lipodystrophy (lipoatrophy or lipohypertrophy)
• Renal impairment
• Systemic steroids (need to increase insulin dose)
• Caution with other hypoglycaemic agents

Question 2

List the following for: Biguanides

• Use
• Example drugs
• Drug class
• Mechanism of action
• Adverse effects
• Warnings / contraindications
• Important drug reactions

Answer 2

Diabetes

Metformin

Biguanides

Reduce glucose production by the liver by inhibiting gluconeogenesis
Supress appetite

• GI upset
• Kidney failure (<30mL/min)
• Alcohol intoxication
• ACEi
• NSAIDS
• Loop diuretics
• Thiazide diuretics

Question 3

List the following for: Sulfonylureas

• Use
• Example drugs
• Drug class
• Mechanism of action
• Adverse effects
• Warnings / contraindications
• Important drug reactions

Answer 3

Diabetes

Gliclazide

Sulfonylureas

Stimulate beta-cells to produce insulin, block ATP-dependant K channels
However, weight gain

• Mild GI upset
• Hypoglycaemia
• Renal disease
• Hepatic disease
• Other hypoglycaemic agents
• Loop diuretics
• Thiazide diuretics

Question 4

List the following for: Thiazolidinediones (glitazones)

• Use
• Example drugs
• Drug class
• Mechanism of action
• Adverse effects
• Warnings / contraindications
• Important drug reactions

Answer 4

Diabetes

Pioglitazone
Rosiglitazone

Thiazolidinediones

Increase sensitivity to muscle and adipose
Hepatic glucose output (activation of PPAR)
However, weight gain

• GI upset
• Fluid retention
• Fracture risk
• Bladder cancer risk
• Heart failure (fluid retention)
• Other hypoglycaemic agents

Question 5

List the following for: SGLT-2 inhibitors (glifloizins)

• Use
• Example drugs
• Drug class
• Mechanism of action
• Adverse effects
• Warnings / contraindications
• Important drug reactions

Answer 5

Diabetes

Dapaglifloizin
Canaglifloizin

SGLT-2 inhibitors

Reduce glucose absorption from PCT (competitive reversible inhibition)
Modest weight loss

• UTIs
• Genital infection
• Thirst
• Polyuria
• Hypovolaemia / hypotension
• Other hypoglycaemic agents
• Anti-hypertensives

Question 6

List the following for: Dipeptidyl peptidase-4 inhibitors (gliptins)

• Use
• Example drugs
• Drug class
• Mechanism of action
• Adverse effects
• Warnings / contraindications
• Important drug reactions

Answer 6

Diabetes

Sitagliptin
Saxagliptin

Dipeptidyl peptidase-4 inhibitors

Prevent incretin degradation (e.g. GLP-1)
Increase plasma incretin
Glucose dependent – needs after meals
Suppress appetite

• GI upset
• Pancreatitis (1%)
• Pregnancy
• History of pancreatitis
• Other hypoglycaemic agents
• Loop diuretics
• Thiazide-like diuretics

Question 7

List the following for: GLP-1 receptor agonists (incretin mimetics)

• Use
• Example drugs
• Drug class
• Mechanism of action
• Adverse effects
• Warnings / contraindications
• Important drug reactions

Answer 7

Diabetes

Exenatide
Liraglutide

GLP-1 receptor agonists

Increase insulin secretion from beta-cells (glucose dependant)
Activate GLP-1 receptor, resistant to degradation by DPP-4
Promote satiety so possible weight loss

• GI upset
• Decreased appetite with weight loss
• Renal impairment
• Other hypoglycaemic agents