Diabetic management and medical pharmacology

Question 1

What is the MOA sulphonylureas? Give 2 examples of drugs which are sulphonylureas.

Answer 1

A class of oral antidiabetic drugs that inhibits ATP-sensitive potassium channels in the pancreatic β-cell membrane, which leads to depolarization and increased insulin release. Adverse effects include weight gain, disulfiram-like effects (particularly in first-generation drugs), hypoglycemia (particularly in second-generation drugs), and nephrotoxicity. Examples include glyburide, glipizide, and glimepiride, glibenclamide, gliclazide, glimepride

Question 2

What are the MOAs of metformin? What class of drug is metformin?

Answer 2

Inhibit hepatic gluconeogenesis, increases peripheral insulin sensitivity and peripheral glucose uptake, decreases glucose absorbance from the GI tract

Question 3

What are the mechanisms of action of alpha glucosidase inhibitors?

Answer 3

Delays digestion of starch and oligosaccharides but has no effect on glucose.

Question 4

What are the mechanisms of action of glitazones?

Answer 4

Activation of peroxisome proliferator-activated receptor. PPAr gamma is a nuclear receptor that alters the transcription of several genes involved in glucose and lipid metabolism and energy balance. Reduces lipid resistance in adipose tissue, muscle and liver.

Question 5

What are the 2 incretin based anti-diabetic medications?

Answer 5

GLP-1 agonists- stimulate glucose-dependent insulin secretion, inhibits glucagon secretion. DPP-4 anatagonists- Prolong the action of native incretins by inhibiting the enzyme which breaks them down

Question 6

What drugs are SGLT-2 inhibitors and what effect do they have?

Answer 6

Gliflozins reversibly inhibit SGLT2 in the renal proximal convoluted tubule and prevent glucose reabsorption by SGLT (sodium glucose co transporters).

Question 7

What are the 6 types of insulin made for use?

Answer 7

Short acting human- relatively low peak Short acting analogue- relatively high peak Intermediate acting human Long acting analogue Pre-mixed human Pre mixed analogue

Question 8

What are two main types of regimens a diabetic can be on?

Answer 8

Basal bolus- requires multiple injections a day but allows for more flexibility Twice daily- Pre-mixed biphasic insulin, less flexibility

Question 9

What is the contraindication to prescribing metformin?

Answer 9

eGFR<30

Question 10

What is the first line medical therapy for T2DM? What is the Hba1c aim?

Answer 10

Standard release metformin 48mmol/mol

Question 11

What is the second line medical therapy for T2DM? What is the Hba1c aim?

Answer 11

Dual therapy of metformin with either: sulphonylurea, pioglitazone, DPP4 inhibitor or SGLT inhibitor 53

Question 12

What is the Hba1c cut off for intensification from first line medication to second line?

Answer 12

58

Question 13

What is the third line medical therapy for T2DM? What is the Hba1c aim?

Answer 13

Triple therapy of metformin with either: DPP4 inhibitor+SU, pioglitazone+SU, SGLT2 inhibitor+pioglitazone/SU Or insulin. 53

Question 14

What is the fourth line medical therapy for T2DM? What are the requirements?

Answer 14

Metformin+SU+GLP-1 BMI>35 or BMI<35 but with significant reasons for not going on to insulin

Question 15

When starting a GLP1 the patients must be checked 6 months later for which two factors before continuing treatment?

Answer 15

A reduction of at least 11 mmol/mol in HbA1c and a weight loss of at least 3% of initial body weight in 6 months

Question 16

Which are the two most common patient education courses in the UK?

Answer 16

X-PERT and DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed)

Question 17

Other than medications directly relating to diabetes, what extra 3 classes of medications might diabetics be on?

Answer 17

ACEIs or CCBs (never BBs) Statins for dyslipidaemia Orlistat for obesity

Question 18

What is the follow up schedule for patients with T1DM?

Answer 18

Review at least annually unless there are worrisome factors

Question 19

What is the follow up schedule for patients with T2DM?

Answer 19

Set HbA1c targets and review every 3-6 months until the patient is stable on unchanging medications. Following that, schedule for 6 monthly for review

Question 20

What is the most widely accessed course for patients looking for flexible insulin usage?

Answer 20

DAFNE- Dose adjustment for normal eating

Question 21

What are the 3 main types of insulin regimens?

Answer 21

1. Once daily basal insulin
2. Biphasic miced dose insulin
3. Basal bolus (QDS)- 1 long term insulin injection followed by 3 bolus injections after each meal

Question 22

What is the ICR in terms of insulin therapy?

Answer 22

The insulin to carb ratio. usually set at 1 unit per

Question 24

What is the MOA of thiazodelinediones?

Answer 24

Increase insulin sensitivity by activating PPARy which stimulates transcription of glucose transporters

Question 25

What is the MOA of alpha-glucosidase inhibitors? Name an example. What are the SEs?

Answer 25

• Inhibit the enzyme alpha-glucosidase, thus preventing the digestion of some carbohydrates.
• Acarbose
• Flatulence and diarrhoea

Question 26

What score should be used to calculate a patients cardiovascular risk in the next 10 years if they have diabetes?

Answer 26

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