Diabetic drugs

Question 1

biguanide e.g =

Answer 1

metformin

Question 2

metformin Moa

Answer 2

• cAMP mediated action in regulating cellular metabolism

- reduces gluconeogenesis and glycogenolysis and peripheral insulin resistance

Question 3

clinical effects of metformin (4)

Answer 3

• doesn’t induce hypoglycaemia or cause sig weight gain
• improves CV mortality
• Safe in pregnancy
• improves HbA1c

Question 4

side effects of metformin

Answer 4

• GI disturbance

- lactic acidosis in patients with severe hepatic or renal disease

Question 5

when is metformin contraindicated

Answer 5

eGFR <30

MI

Question 6

sulonylureas with hepatic metabolism examples

Answer 6

tobutamide

gliclazide

Question 7

sulfonureas with renal excretion (avoid in renal failure)

Answer 7

gliplizide

glimperide

Question 8

moa of sulpnylureas

Answer 8

insulin secretagons -act on beta cells increasing insulin secretion

Question 9

clinical effect of sulonylureas

Answer 9

effective in reducing HbA1c

Question 10

side effects of sulonylureas

Answer 10

weight gain
hypoglycaemia 
hepatotoxicity 
SIADH 
cholestatic liver dysfunction

Question 11

glitazone e.g

Answer 11

pioglitazone

Question 12

moa of glitazone

Answer 12

reduce insulin resistance by interaction with PPAR-gamma nuclear receptor. regulating genes to enhance insulin sensitivity and reducing hepatic gluconeogenesis

Question 13

side effects of glitazone

Answer 13

weight gain
fluid retention/ oedema
bone fracture
bladder cancer

Question 14

glitazone contraindicated in

Answer 14

previous bladder cancer

HF

Question 15

dipeptidyl peptidase 4 inhibitors (DPP4 inhibitor) examples

Answer 15

linagliptin
saxagliptin
sitagliptin

Question 16

moa of DPP4 inhibitors (3)

Answer 16

• enhance incretin effect- GLP-1
• acts on brain to promote satiety
• enhances beta-cell proliferation and decreases apoptosis

Question 17

where is GLP-1 released from and why

Answer 17

intestinal L cells and K cells in response to feeding

Question 18

clinical effect of DPP4 inhibitors

Answer 18

moderate plasma glucose reducing effect (mainly in early stage when beta cell preserved)

Question 19

effect of DPP4 on weight

Answer 19

neutral

Question 20

GLP-1 agonist examples

Answer 20

liraglutide

exenatide

Question 21

moa of GLP-1 agonists

Answer 21

injectable long acting analogues of GLP-1 promoting incretin effect

Question 22

clinical effects of GLP-1 agonists

Answer 22

may promote weight loss
improve CV mortality
good glucose control

Question 23

when are GLP-1 agonists used

Answer 23

alternative to insulin in obese

Question 24

SGLT-2 inhibitors example

Answer 24

canaglifozin

dapagliflozin

Question 25

Moa of SGLT-2 inhibitors

Answer 25

reduces renal threshold and increases excretion of glucose from kidneys (proximal renal tubules)

Question 26

clinical effects of SGLT-2

Answer 26

weight loss

CV protective

Question 27

SE of SGLT-2 inhibitors

Answer 27

UTI

candidiasis