Diabetics

Question 1

What is wagners classification of Diabetic foot 🦶 ulcer grading what is foot at risk

Answer 1

Grade 0: Foot 🦶 at risk -which means foot with previous ulcer,deformity e.g clawed toes,clubbed foot,skin changes,chronic Dm callus formation, poor perfusion, loss of pain or sensation

Question 2

Mention the grading of Diabetic foot 🦶 ulcer

Answer 2

Grade 0- foot 🦶 at risk
Grade 1- superficial ulcers
Grade 2- Deep ulcers as far as joint capsules,tendons and bones 🦴
Grade 3: Deep ulcers with abscess formation,osteomyelitis and infection of joint capsules
Grade 4:limited Necrosis of the whole foot 🦶
Grade 5: Necrosis of the whole foot 🦶

Question 3

List important classes of diabetic drug

Answer 3

-insulin preparations
-Insulin secretagogues
-Biguanides
-Alpha glucosidase inhibitors
-Thiazolidinediones
-Incretin based drugs
-Amylin Analogs

Question 4

Types of insulin preparations ,mechanism of action and route of administration

Answer 4

1.Rapid acting
-Lispro and Aspart

2 : short acting 🎭
-Regular insulin or neutral insulin

3: intermediate
-protamine
-Hegedorn(NPH) or isophane

4:Long acting
- Detemir and glargine

Mechanism of action
- Activate insulin receptors

Route of administration and toxicity
-parenteral ( subcutaneous, IV)
Toxicity: hypoglycemia, weight gain and lipodystrophy

Question 5

Insulin secretagogue examples generations, mechanism of action, pharmacokinetics and toxicity and route of administration

Answer 5

1. Sulfonylureas 2nd generation
   - Glipizide,Glyburide
   -Glimepride

2.sulfonylureas 1st generation
-Tolbutamine
-chlorpropamide

Mechanism of action
-close K channel in Beta cells
-increase insulin release

Route of administration
-oral :fast onset of action
Toxicity: hypoglycemia, weight gain

Question 6

Mention 2 drugs under glitinides , mechanism of action and route of administration and toxicity

Answer 6

Glitinides
-Repaglinide
-Nateglinide

Mechanism of action
-close k channel In beta cells
-increase insulin release

Route of administration
-oral fast onset of action
-Toxicity: hypoglycemia

Question 7

Biguanides , mechanism of action,route of administration, toxicity and contraindications

Answer 7

Drug
-Metformin

Mechanism of action
-Reduces Hepatic and renal gluconeogenesis

Route of administration
- oral

Toxicity: GI symptoms and lactic acidosis

Contraindications
- impaired renal or hepatic function
-chronic heart failure
-Hypoxic/acidotic states, Alcoholism

Question 8

Alpha glucosidase mention the drugs , mechanism of action,toxicity, contraindications

Answer 8

• Acarbose
  -Miglitol

Mechanism of action
-inhibits intestinal alpha glucosidase

Route of administration
-oral
Toxicity: Gi symptoms

Contraindications
-Renal and hepatic dysfunction
- Intestinal disorders

Question 9

Thiazolidinediones drug examples, mechanism of action, route of administration,toxicity and contraindications

Answer 9

1.Drugs
-Rosiglitazone
-pioglitazone

Mechanism of action
-Regulates gene expression by binding to PPAR gamma and alpha

Route administration
-oral (long acting >24 hours )

Toxicity: fluid retention.oedema, anaemia, weight gain,bone fractures in women

Contraindications
- chronic heart failure
-Hepatic disease

Question 10

Incretin Based Drugs , mechanism of action, route of administration,toxicity

Answer 10

Drugs
-Exenatide
-sitagliptin

Mechanism of action
- Analog of GLP1, binds of GLP receptor
-Glp: Glucagon like polypeptide

Route of administration
-subcutaneous

Toxicity: nausea ,vomiting ,anorexia, weight loss , pancreatitis ( Exenatide)

Question 11

Amylin Analog drugs ,mechanism of action route of administration and toxicity

Answer 11

Drug
-Pramlintide

Mechanism of action
-Binds to amylin receptors

Route of administration
-Parenteral (subcut)

Toxicity
-nausea ,vomiting ,anorexia, weight loss , pancreatitis, hypoglycemia