Diabetes Type II Pharmacology

Question 0

What group of drugs does Metformin fall within?

Answer 0

Biguanides

Question 1

What is currently the first line pharmacological treatment for diagnosed diabetes mellitus type 2?

Answer 1

Metformin

Question 2

When should you tell a patient to take their Metformin prescription?

Answer 2

With food

Question 3

What is the maximum daily dose of Metformin you can prescribe to a patient?

Answer 3

1g TDS

Question 4

What is the major side-effect of Metformin (Biguanides in general)?

Answer 4

GI disturbance (nausea, vomiting, diarrhoea - very rarely fatal lactic acidosis)

Question 5

How does Metformin act?

Answer 5

It REDUCES hepatic glucose release and INCREASES peripheral glucose uptake
(DOES NOT increase insulin release)

Question 6

What is the best treatment for those with impaired glucose intolerance? (Pre-diabetes)

Answer 6

Lifestyle changes - exercise, reduced carbohydrate dietary intake and smoking cessation

Question 7

What are usually considered to be second-line DM type 2 treatments?

Answer 7

Sulphonylureas (SUs) (1st line in some cases)
Thiazolidinediones (TZDs)
DDP-4 inhibitors

Question 8

Why might sulphonylureas not be first-line for many type 2 diabetics?

Answer 8

Must have partially functioning Beta cells for them to work as they increase insulin release from them

Question 9

Give examples of SUs with short half-lives

Answer 9

Gliclazide and Glipizide

Question 10

Why might you choose to give Glibenclamide instead of Gliclazide?

Answer 10

Has a longer half-life so can prescribe od

Question 11

What are the two significant side-effects of sulphonylureas?

Answer 11

Hypoglycaemia (as increase insulin release)

Weight gain

Question 12

Which group of patients would you usually avoid prescribing SUs to?

Answer 12

The elderly - greater risk of hypo

Question 13

When would you advise a patient to take their prescription of SU (Gliclazide or Glimepiride)?

Answer 13

With food

Question 14

Name another type of DMII treatment which acts in a very similar way to SUs?

Answer 14

Metiglanides (Repaglimide or Nateglimide)

Question 15

What are the major side effects of Repaglinide and Nateglinide

Answer 15

Mild hypoglycaemia

GI disturbance

Question 16

What type of DM II treatment is Acarbose?

Answer 16

An alpha-glucosidase inhibitor

Question 17

How does Acarbose act in the treatment of DMII?

Answer 17

Inhibits intestinal alpha-glycosidases > delaying glucose absorption / digestion of starch and sucrose

Question 18

What is commonly complained of by those prescribed Acarbose?

Answer 18

Flatulance

Question 19

Thiazolidinediones (TZDs) (AKA Glitazones) are common second-line DM II treatments. Which one is solely used in the UK currently?

Answer 19

Pioglitazone

Question 20

How do TZDs / Glitazones act?

Answer 20

They increase peripheral sensitivity to insulin (so no effect if no circulating insulin!)
They increase transcription of certain insulin-sensitive genes.

Question 21

What are the side-effects of TZDs /Glitazones?

Answer 21

Peripheral oedema
Anaemia
Pathological fractures

Question 22

when should TZDs definitely be avoided?

Answer 22

In congestive cardiac failure

Question 23

What are Sitagliptin, Vildagliptin and Linaglyptin examples of?

Answer 23

DPP-4 inhibitors

Question 24

What do DPP-4 inhibitors do pharmacologically?

Answer 24

Protect GLP-1 from inactivation by DPP-4

Question 25

What is GLP-1?

Answer 25

An incretin (released by the L-cells of the intestine upon detection of glucose to stimulate insulin release from the beta cells of the pancreas)

Question 26

What are Liraglutide and Exenatide examples of?

Answer 26

A GLP-1 receptor agonist (GLP-1 mimic)

Question 27

Sitagliptin (DPP-4 inhibitor) combined with Metformin has been proven to be as effective as Metformin combined with what other anti diabetic drug?

Answer 27

Sulphonylureas

Question 28

What advantage does the combination of Metformin and Sitagliptin have over that of SUs with Metformin?

Answer 28

Much lower incidence of hypoglycaemia and illustrated weight reduction

Question 29

Liraglutide has been shown to have what two effects on 67% of DM II sufferers?

Answer 29

HbA1c decrease and weight loss (21% showed weight gain but still with reduced HbA1c)

Question 30

GLP-1 receptors agonists and Acarbose are generally considered what line of treatment in DM II?

Answer 30

3rd line. (Officially DPP-4 inhibitors and TZDs are also but are considered alternatives to SUs in 2nd-line Tx)

Question 31

What do SGLT2 inhibitors do?

Answer 31

They reduce glucose reabsorption by the kidneys (proximal tubules) > increase urinary excretion of glucose > reducing blood glucose

Question 32

Name 3 licensed SGLT2 inhibitors

Answer 32

Canagliflozin Dapagliflozin Empagliflozin

Question 33

Dual therapy Met + Cana combined therapy are thought to have what effect?

Answer 33

Weight reduction

Question 34

Canagliflozin reduces what?

Answer 34

HbA1c