DM drugs

Question 1

x

Answer 1

x

Question 2

x

Answer 2

x

Question 3

x

Answer 3

x

Answer 4

x

Question 5

adverse effects of metformin ?

Answer 5

gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20%

reduced vitamin B12 absorption - rarely a clinical problem

lactic acidosis with severe liver disease or renal failure

Question 6

indication to start someone on metformin ?

Answer 6

DM diagnosis

whose blood glucose measure (fasting plasma glucose or HbA1c) shows they are still progressing towards type 2 diabetes, despite their participation in an intensive lifestyle-change programme’

Question 7

HB1AC targets for DM

Answer 7

HbA1c target

Lifestyle = 48 mmol/mol (6.5%)

Lifestyle + metformin (500mg OD) 48 mmol/mol (6.5%)

Question 8

at what HB1AC level should we add a second drug ?

Answer 8

should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)

Question 9

due to contrast nephropathy; metformin should be discontinued when?

Answer 9

on the day of the procedure and for 48 hours thereafter

Question 10

o reduce the incidence of gastrointestinal side-effects of metformin what do clinicians do ?

Answer 10

metformin titrated up slowly

Question 11

in what condition are lactic acidosis in metformin exacerbated ?

Answer 11

taken during a period where there is tissue hypoxia:
recent myocardial infarction,
sepsis,
acute kidney injury
and severe dehydration

Question 12

DM medications causing weight gain.

Answer 12

Sulfonylureas - Gliclazide

Question 13

side effects of agliflozins , sodium-glucose co-transporter-2 (SGLT2)- inhibitor group

Answer 13

weight loss = via the excretion of glucose by the kidneys.
fournier’s gangrene

Can increase the risk for necrotising fasciitis

SGLT-2 inhibitors reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule = can cause normoglycemic ketoacidosis
= unexplained raised anion gap acidosis and normal blood sugar level who is on one of these medications

Question 14

Glucagon-like peptide-1 (GLP1)-agonist group are administered ?

Answer 14

subcutaneously

Question 15

advantage of Glucagon-like peptide-1 (GLP1)-agonist such as Exenatide and liraglutide

Answer 15

help with weight loss.

Liraglutide has the added benefit of being given only once a day.

Question 16

benefit of Dipeptidyl-peptidase 4 (DPP4 inhibitors) , gliptin?

Answer 16

do not cause weight gain.
no increased incidence of hypoglycaemia

Question 17

route for DPP-4

Answer 17

oral

Question 18

function of gliptin (DPP-4 inhibitor) ?

Answer 18

increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown

incretin
stimulate insulin release
and inhibit glucagon release

Question 19

function of metformin ?

Answer 19

activation of the AMP-activated protein kinase (AMPK)

increases peripheral insulin sensitivity

and decreased hepatic gluconeogenesis

Question 20

function of sulfonyureas - gliclazide ?

Answer 20

augment pancreatic insulin secretion.

bind to an ATP-dependent K+(KATP) channel

Increased insulin secretion can lead to hypoglycaemia.

Question 21

function of GLP mimetic ?

Answer 21

exeatide - increase pancreatic inulin release
slow gastric emptying
promote satiety
suppress glucagon

Question 22

when should GLP-1 be administered

Answer 22

Exenatide must be given by subcutaneous injection within 60 minutes before the morning and evening meals. It should not be given after a meal.

Liraglutide is the other GLP-1 mimetic currently available. One the main advantages of liraglutide over exenatide is that it only needs to be given once a day.

Question 23

Glucagon-like peptide-1 (GLP-1) mimetics combination together

Answer 23

sulfonylureyas - gliclazide
metformin

Question 24

To continue GLP-1 mimetic NICE guidelines would like to achieve what parameters ?

Answer 24

> 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months

3% weight loss after 6 months to justify the ongoing prescription of GLP-1 mimetics.

Question 25

side effects of GLP-1 ?

Answer 25

nausea and vomiting

severe pancreatitis in some patients.

Question 26

indications for GLP1 ?

Answer 26

Consider adding exenatide to metformin and a sulfonylurea if:
BMI >= 35 kg/m² in people of European descent and there are problems associated with high weight,

or
BMI < 35 kg/m² and insulin is unacceptable because of occupational implications or weight loss would benefit other comorbidities.

Question 27

contradiction for metformin ?

Answer 27

CKD
SHOULD BE stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min)

relative contra : alcohol abuse

eGFR <30

Question 28

benefit of GLP -1

Answer 28

= RESULT IN WEIGHT LOSS

Question 29

sie effects of sulfonylureas ?

Answer 29

hypoglycemia
weight gai
hyponatremia secobdary SADH
hepatotoxicity

Question 30

which DM drugs should be avoided in pregnancy and breast feeding ?

Answer 30

sulfonylurea

Question 31

increased risk of severe pancreatitis and renal impairment

Answer 31

eventide