Diabetic

Question 1

Metformin:
- class + mech
- SE
- Contraindications

Answer 1

• Class: biguanide. Decreases hepatic gluconeogenesis + suppresses appetite + increases insulin sensitivity + increases glucose uptake into muscle
• SE: lactic acidosis esp if recent episode of hypoxia, gi upset (diarr, N+V) (hence titrate slowly up or hence can switch to modified release), metallic taste
• Cautions: renal impairment egfr <30/ creatinine >150, iodine containing contrast day of procedure and 48 hours after, suspend when ill with d+v

Question 2

Sitagliptin:
- class + mech
- SE

Answer 2

• class: ddp4 dipeptidyl peptidase inhibitor which decreases incretin degradation
• SE: pancreatitis, headache, gi upset (vomiting), angiooedema

Question 3

Gliclazide:
- class + mech
- SE
- Contraindications

Answer 3

• class: sulfonylurea - blocks atp dep k channels keeping cell depolarisaed so more insulin released
• SE: hypoglycemia, weight gain, hyponatraemia / SIADH, bm suppression, hepatotoxicity, peripheral neuropathy
• Cont: preg, breastfeeding, elderly

Question 4

Dapagliflozin:
- class + mech
- indication
- SE
- Contraindications

Answer 4

• class: SGLT2 reversible inhibitor decreases glucose absorption in PCT and increases excretion
• indication: Should be given with metformin if high risk cvs disease only
• SE: utis, weight loss, fournier’s gangrene, normoglycemic ketoacidosis, inc risk lower limb amputation
• Cont: DKA, t1dm, elderly, hypotension/risk volume depletion, preg, breastfeeding

Question 5

Incretin functions

Answer 5

• inc insulin sensitivity
• inc glucose uptake into muscle
• dec glucose production in liver
• increases satiety
• reduces gastric emptying
• inhibits glucagon production

Question 6

Exenatide:/liraglutide
- class + mech
- SE
- Contraindications

Answer 6

• class: GLP1 rec agonist (incretin mimetic). SC injection 60 mins before food x2 a day w metformin or sulfonylurea if bmi >35 + european or <35 but insulin not an option
• Targets: >11mmol (1%) reduction in hba1c, 3% weight loss after 6 months.
• SE: N+V, weight loss, pancreatitis, DKA
• Cont: DKA, gi disease, elderly, pancreatitis, preg, breast feeding

Question 7

Pioglitazone:
- class + mech
- SE
- Contraindications

Answer 7

• class: thiazolidinediones - activates ppar which inc insulin sensitivity + dec hepatic production
• SE: weight gain, fracture, bladder ca, fluid retention, gi upset
• Cont: liver impairment, HF