Diabetic Drugs

Question 1

Metformin type of drug

Answer 1

Biguanide

Question 2

How does metformin work? (biguanide)

Answer 2

Decrease hepatic glucose production and increase peripheral insulin sensitivity
(do not pose a risk of hypoglycaemia when used as mono therapy)

Question 3

Renal function needed for metformin?

Answer 3

Don’t start if <30

Review dose if <45

Question 4

contraindications to metformin?

Answer 4

eGFR <30 for standard release or <45 for modified release
alcohol addiction
people at risk of lactic acidosis e.g. DKA
People at risk of tissue hypoxia: e.g. cardiac / resp failure

Question 5

e.g.s of sulphonylureas

Answer 5

tolbutamide
gliclazide
glibenclamide

Question 6

How do sulphonylureas work?

Answer 6

Increase insulin secretion

Thus only work if some residual function of pancreatic B cells

Question 7

What groups need cautious prescribing for sulphonyrueas?

Answer 7

elderly: risks of hypoglycaemic events
obese: encourages weight gain

Question 8

e.g. of thiazolidinediones

Answer 8

pioglitazone

Question 9

thiazilodinedione action?

Answer 9

PPAR-Gamma activators - increase peripheral insulin sensitivity

Question 10

side effects of thiazilodinedione

Answer 10

Weight gain: redistribution of ectopically stored lipid
Fluid retention: CONTRAINDICATED in CCF
Liver dysfunction: monitor LFTs
Associated with bladder cancer

Question 11

Gliptin example

Answer 11

sitagliptin

Question 12

How do Gliptins work?

Answer 12

DPP-4 inhibitors, thus increase post-prandial insulin release

Question 13

who should avoid gliptins

Answer 13

cardiac, hepatic or renal dysfunction

Question 14

e.g. GLP 1 mimetic?

Answer 14

enaxatide

Question 15

SGLT-2 inhibitors e.g.?

Answer 15

canagliflozin, dapagliflozin and empagliflozin

Question 16

how do SGLT-2 inhibitors work?

Answer 16

reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.

Question 17

SGLT-2 inhibitors side effects

Answer 17

urinary and genital infection (secondary to glycosuria). Fournier’s gangrene has also been reported
normoglycaemic ketoacidosis
increased risk of lower-limb amputation: feet should be closely monitored