diabetic drugs and statins

Question 1

which diabetic drugs cause weight gain, weight loss and neutral weight

Answer 1

weight gain - sulphynlureas and glitazones

weight loss - metformin, sglt2 inhibitors, incretin mimics

weight neutral - dpp4 inhibitors

Question 2

which diabetic drug can be used in low renal function

Answer 2

dpp4 inhibitors

Question 3

which diabetic drug has hypoglycaemia risk

Answer 3

sulphonylurea

Question 4

which diabetic drug has side effect of water retention

Answer 4

glitazones

Question 5

examples of incretin mimics

Answer 5

exanatide

Question 6

example of sglt2 inhibitors

Answer 6

dapagliflozin

Question 7

what are -gliptins

Answer 7

dpp4 inhibitors

Question 8

what is tuolbutamide

Answer 8

sulphonylurea

Question 9

which diabetic works thru transcriptional factor chances

Answer 9

glitazones

Question 10

mechanism of action of glitazones

Answer 10

transcriptional factor change causing

increased lipogenesis
decreased lipolysis
decreased plasma FFA

Question 11

mechanism of action of metformin

Answer 11

decreased hepatic gluconeogenesis
increased fatty acid oxidation
decreased LDL and VLDL
increased peripheral muscle glucose uptake

Question 12

what do sulphonylureas do?

Answer 12

increase insulin secretion

Question 13

how do -flozins work?

Answer 13

sglt2 inhibitor in kidney, reduce glucose reabsorption

Question 14

side effect of -flozins

Answer 14

UTI

Question 15

how do statins work?

Answer 15

inhibit cholesterol synthesis by inhibiting HMG-CoA reductase

Question 16

side effects of statins

Answer 16

deranged LFTS
mylagia
myositis - increased CK

Question 17

what are some drug interactions of statins

Answer 17

do not use with cyp3a4 inhibitors e.g. macrolide antibiotics, amlodipine, verapamil

Question 18

causes of high anion gap metabolic ketoacidosis

Answer 18

MUD PILES

methanol/metformin
uraemia
DKA
paracetamol
iron/isoniazid
lactic acidosis
ethanol/ethylene glycol
salicyclic acid

Question 19

why does dehydration occur in DKA?

Answer 19

due to high osmolality of blood from increased glucose and ketones, kidneys increase diuresis

Question 20

3 criteria needed for diagnosis of DKA

Answer 20

BM >11 mmol/l
ketones >3 mmol/L
pH <7.3 OR bicarb <15

Question 21

management steps for patient in DKA

Answer 21

1) fluid bolus 0.9% nacl
2) insulin infusion 0.1 u/kg/hour
3) potassium chloride + IVT
4) glucose + IVT
5) further investigations
6) extra monitoring

Question 22

how is insulin regime recommenced after DKA is over?

Answer 22

if not previously on insulin, give fast acting insulin with meal, remove insulin infusion 30 mins later

Question 23

why is continuous cardiac monitoring important in DKA ?

Answer 23

risk of hypo or hyper kalaemia

Question 24

how is insulin infusion prepared in DKA?

Answer 24

infuse 50 units of insulin with 50 mls of saline, give at rate of 0.1 units/kg/hour

Question 25

what kind of insulin to use in DKA?

Answer 25

fast acting e.g. actrapid or novorapid