Diabetic Drugs

Question 1

Biguanides

Answer 1

Decrease hepatic glucose production by inhibiting gluconeogenesis
Some gluconegenic activity remains so hypoglycaemic risk reduced
Limits weight gein
First drug offered
can be taken concomitantly with other hypoglycaemic agents

Question 2

Biguanides contraindications

Answer 2

Question 3

Sulfonylureas (SU)

Answer 3

Stimulate B-cell pancreatic insulin secretion blocking ATP-dependant K+ channels

• Need residual pancreatic function to work

Question 4

Sulfonylureas (SU) contraindications

Answer 4

Question 5

Thiazolidinediones (glitazones)

Answer 5

Insulin sensitization in muscle and adipose
Decrease hepatic glucose output by activation of PPAR-y -> gene transcription

Question 6

Thiazolidinediones (glitazones) contraindications

Answer 6

Question 7

Sodium-glucose co-transporter (SGLT-2) inhibitors (gliflozins)

Answer 7

Large decrease of glucose absorption from tubular filtrate
Increase urinary glucose excretion competitive reversible inhibition of SGLT-2 in PCT

TIIDM as add on therapy
HFrEF

Question 8

Sodium-glucose co-transporter (SGLT-2) inhibitors (gliflozins) contraindications

Answer 8

Question 9

Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins)

Answer 9

Prevent incretin degradation
Increase plasma incretin levels
Glucose dependant so postprandial action do not stimulate insulin secretion at normal blood glucose

Question 10

Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) contraindications

Answer 10

Question 11

Glucagon-like peptide-1 (GLP-1) receptor agonist (incretin mimetics)

Answer 11

Increase glucose dependant synthesis of insulin secretion from B-cells activate GLP-1 receptor - resistant to degradation by DPP-4
Subcutaneous injection
NICE suggest swap-in if triple therapy ineffective

Question 12

Glucagon-like peptide-1 (GLP-1) receptor agonist (incretin mimetics) contraindications

Answer 12