Diabetic drugs

Question 1

MoA for metformin

Answer 1

Reduces insulin resistance

Inhibits hepatic gluconeogenesis

Question 2

Advantages of metformin

Answer 2

Can use in conjunction with all oral diabetes medication
Low risk of lactic acidosis
Limits weight gain
Lowers risk of CVS events

Question 3

Disadvantages of metformin

Answer 3

GI side effects common
Can’t use if GFR below 30
Can’t use if resp, hepatic or cardiac failure
Decreases vitamin B12 absorption (rare)

Question 4

Examples of sulphonylureas

Answer 4

Gliclazide

Glimepiride

Question 5

Benefit of gliclazide to treat diabetes

Answer 5

Safe in renal impairment

Question 6

MoA of sulphonylureas

Answer 6

Stimulate insulin production by beta islet cells of pancreas

Question 7

Advantages of sulphonylureas

Answer 7

Cheap

Decreases microvascular damage

Question 8

Disadvantages of sulphonylureas

Answer 8

GI side effects
Weight gain
Higher risk of hypoglycaemia

Question 9

What is acarbose

Answer 9

Alpha glycosidase inhibitor

Question 10

Why is acarbose rarely used

Answer 10

Very small decrease in HbA1c

GI side effects very common

Question 11

MoA of glitizones

Answer 11

Increases muscle and adipose tissue’s sensitivity to insulin
Decreases hepatic glucose output

(Via peroxisome proliferator activated receptors)

Question 12

Advantages of glitizones

Answer 12

Can be used in conjunction with all oral diabetes medication

Question 13

Disadvantages of glitizones

Answer 13

Weight gain
Fluid retention (CI in HF)
Effects bone metabolism (CI in post menopausal women)
Increased risk of bladder cancer

Question 14

MoA of all glucagon like peptide 1 therapies

Answer 14

Increase insulin
Decrease glucagon
Slows bowel motility
Decreases appetite

Question 15

MoA of gliptins

Answer 15

Inhibit DDP4 to protect native GLP1

Question 16

MoA of exenatide

Answer 16

GLP1 receptor agonist so mimics action of GLP1

Question 17

Advantages of gliptins

Answer 17

Weight neutral/loss

Low risk of hypoglycaemia

Question 18

Disadvantages of gliptins

Answer 18

Small drop in HbA1c
GI side effects
Expensive

Question 19

Advantages of exenatide

Answer 19

Low risk of hypoglycaemia

Question 20

Disadvantages of exenatide

Answer 20

Can’t have if GFR <30
Need to inject
GI side effects including reflux

Question 21

MoA of SGLUT2 inhibitors

Answer 21

Reduce glucose reabsorption in PCT of kidney which increases glucose excretion in urine

Question 22

Examples of SGLUT2 inhibitors

Answer 22

Dapagliflozin

Canagliflozin

Question 23

Advantages of SGLUT2 inhibitors

Answer 23

Can be used as add on therapy
Weight loss
Low risk of hypoglycaemia

Question 24

Disadvantages of SGLUT2 inhibitors

Answer 24

Polyuria
Thrush
UTIs
Dehydration

Question 25

Categories of insulin and an example

Answer 25

Ultrafast - FiAsp
Rapid - humalog
Short - humulin S
Intermediate - humulin I
Long - ultralente
Very long - glargine

Question 26

When does the level of each category of insulin peak in blood

Answer 26

Ultrafast - <1 hour
Rapid - 1 hour
Short - 2-3 hours 
Intermediate - 4-8 hours
Long - none
Very long - none

Question 27

Modes of insulin delivery

Answer 27

Vials
Pen cartridges
Disposable pens
Pump therapy (type 1 only)

Question 28

Usual insulin regime

Answer 28

Short acting 15-30 mins before a meal

Intermediate acting overnight

Question 29

Adverse effects of insulin therapy

Answer 29

Hypoglycaemia
Hyperglycaemia
Lipohypertrophy at injection site
Allergies