Diabetes treatment

Question 1

What is the primary mode of action of Metformin?

Answer 1

Reduces glucose production by the liver

Question 2

What drugs are used in Type 2 diabetes?

Answer 2

1. Metformin
2. Sulfonylureas
   - Glicazide
3. Thiazolodinediones
   - Pioglitazone
4. SGLT2 Inhibitors (Empagliflozin)
5. GLP-1 agonists (Exenatide)
6. DPP-4 inhibitors (Gliptins)

Question 3

What are the main side effects of Metformin?

Answer 3

• GI: Diarrhoea, vomiting, abdo pain
• Renal Toxicity
• Lactic Acidosis
• Liver toxicity
• Interferes with Vitamin B12 absorption

Question 4

What is the mode of action of Sulfonylureas, such as Gliclazide?

Answer 4

Induce Insulin secretion

• close Katp channels
• prevents microvascular complications

Question 5

What are the main side effects of Sulfonylureas (Gliclazide)?

Answer 5

Hypoglycaemia

• elderly patients,
• alcohol excess and
• liver damage (low glycogen)
• Weight gain
• diarrhoea

Question 6

How does Pioglitazone work?

Answer 6

Increases insulin sensitivity

-binds to PPAR-gamma, a nuclear receptor in peripheral tissue and liver

Question 7

What are the side effects of TZD (Pioglitazone)?

Answer 7

Weight gain

Heart Failure

Question 8

TZDs (Pioglitazone) can be safely given to patients of all ages (T/F)

Answer 8

False

-do not give to over 65s

Question 9

What is the incretin effect?

Answer 9

Increased insulin secretion in response to oral glucose as opposed to IV glucose

Question 10

What is the mode of action of GLP-1 Receptor Agonists (e.g. Exenatide)?

Answer 10

Induce Incretin production (mimic Incretins):

1. promote insulin secretion (without hypoglycaemia)
2. suppress glucagon (increased in T2DM)
   - decrease gastric emptying
3. reduces appetite - weight loss

Question 11

What are the downsides of GLP-1 Agonists (Exenatide)?

Answer 11

Nausea

Injectable drug

Question 12

What are the mchanism and the effects of DPP4 inhibitors (Gliptins)?

Answer 12

Inhibit enzymatic break down of incretins

1. Promote Insulin secretion without hypoglycaemia
2. Suppress glucagon

Weight neutral

Question 13

What are the limitations of DPP4 inhibitors (Gliptins)?

Answer 13

Low potency

No weight loss

Question 14

What is the mode of action of SGLT2 inhibitors (Empagliflozin)?

Answer 14

Inhibit glucose reabsorption at the proximal tubule of the nephron

-glucose passed in urine

Question 15

What are the side effects of SGLT2 inhibitors (Empagliflozin) ?

Answer 15

Thrush and UTIs (due high glucose in urine)

Question 16

When are SGLT2 inhibitors counterindicated?

Answer 16

nephropathy - failure to filter glucose

Question 17

Empagliflozin (SGLT2 inhibitor) is cardioprotective and prevents nephropathy (T/F)

Answer 17

True

-indicated in diabetic patients with CVD or renal impairment

Question 18

Liraglutide reduces CV outcomes, death and imporves renal disease. What class of drug is it?

Answer 18

GLP-1 receptor agonist