Drug management of diabetes

Question 1

Outline the mechanism of action of DPP4 inhibitors?

Answer 1

DPP4 ezyme breaks down incretin hormones. Incretin hormones are responsible for glucose dependent insulin release from pancreas.
Sitagliptin etc

Question 2

Outline a side effect of the DPP4 inhibtors?

Answer 2

rare risk of pancreatitis, so need to be careful if history of pancreatitis.

Question 3

Outline how byetta works?

Answer 3

GLP 1 like analogue- agonist action. glucose dependent insulin production. Reduces gastric emptying. Leads to satiety. Benefit of weight loss, bigger HbA1c reduction compared to DPP4 inhibitors.
Risk of nausea, but tends to improve with ongoing use.

Question 4

Outline the mechanism of action of metformin?

Answer 4

Reduced hepatic glucose production
Improved sensitivity of insulin
Benefit of weight loss or weight neutral.

Question 5

How would you prescribe metformin?

Answer 5

Metformin immediate release start with 500mg daily, then titrate up 500mg BD, then 1g BD, then maximum of 1g TDS. Though the maximum dosage of metformin is 3g, the clinical benefit of of > 2g of immediate release metformin is limited.
Metformin XR - 500mg daily, then 1g daily, 2g daily.

Question 6

How would you renally adjust the dose of metformin?

Answer 6

CrCl 60-90 max 2g
CrCl 30-60 max 1g
CrCl

Question 7

How does forxiga work?

Answer 7

SGL2T inhibitor.
Sodium glucose transporter.
Inhibits glucose reabsorption in the renal tubules of kidney.