Diabetic Drugs

Question 1

Metformin

• Class
• MoA
• Indications
• Side effects
• Contraindications
• Monitoring
• Rules for surgery
• Extra info

Answer 1

Class:
Biguanide

MoA:
Activates AMPK - inhibits hepatic gluconeogenesis and increases insulin sensitivity

Indications:
First line for type 2 diabetes mellitus, PCOS, NAFLD

Side effects:
GI effects (20% find intolerable), lactic acidosis, B12 deficiency(?)

Contraindications:
Avoid in tissue hypoxia, e.g. recent MI, as may precipitate lactic acidosis
Review dosage in active kidney disease

Monitoring:
Renal function before initiation and annually thereafter, stop if eGFR<30

Rules for surgery:
If taken 3 times a day then omit lunchtime dose

Extra info:
Most effective in presence of insulin
Titrate slowly and consider modified release for GI effects
If fasting then take 1/3 of dose in morning and 2/3 in evening

Question 2

-gliptin

• Class
• MoA
• Side effects
• Rules for surgery

Answer 2

Class:
DPP-4 inhibitors

MoA:
Inhibits DPP-4 which degrades incretins e.g. GLP-1

Side effects:
Respiratory tract infections, pancreatitis, headache

Rules for surgery:
Take as normal

Question 3

Gliclazide

• Class
• MoA
• Side effects
• Rules for surgery
• Pregnancy
• Extra info

Answer 3

Class:
Sulphonylurea

MoA:
Inhibits K+ channel on pancreatic beta cells, leading to depolarisation, Ca2+ influx and insulin exocytosis

Side effects:
Weight gain, hypoglycaemia, photosensitivity, cholestasis, hyponatremia

Rules for surgery:
Omit morning dose - if taken twice daily and evening surgery then skip evening dose as well

Rules for pregnancy:
Not safe for pregnancy or breastfeeding

Extra info:
During fasting majority of dose should be taken in evening
CYP450 inducer

Question 4

-gliflozin

• Class
• MoA
• Indications
• Side effects
• Rules for surgery
• Extra info

Answer 4

Class:
SGLT-2 inhibitors

MoA:
Reduces glucose reabsorption in the proximal convoluted tubule

Indications:
Type 2 diabetes mellitus, heart failure

Side effects:
Uro-genital infections, Fourniers gangrene, euglycaemic diabetic ketoacidosis

Rules for surgery:
Omit on day of surgery

Extra info:
Weight loss and reduced blood pressure. Increased risk of lower limb amputation.

Question 5

**Pioglitazone **

• Class
• MoA
• Side effects
• Contraindications
• Monitoring

Answer 5

Class:
Thiazolidinediones

MoA:
Promote adipogenesis and fatty acid uptake, increase peripheral insulin sensitivity

Side effects:
Fluid retention, weight gain, increased risk of fractures,** bladder cancer**

Contraindications:
Bladder cancer, hepatic impairment , heart failure

Monitoring:
LFTs

Question 6

-atide drugs

• Class
• MoA
• Indications
• Side effects
• Rules for surgery
• Extra info

Answer 6

Class: GLP-1 agonists

MoA:
Stimulate insulin and reduce glucagon secretion

Indications:
BMI greater than 35 and triple therapy failed

Side effects:
GI effects, hypoglycaemia and pancreatitis

Rules for surgery:
Take as normal

Extra info:
Should lose more than 3% of body weight in 6 months