Drugs

Question 1

Effect of metformin

Answer 1

Decrease gluconeogenesis in liver
Decrease glucotoxicity which:
increases absorption in skeletal muscles
Increases sensitivity to insulin

Question 2

Side effects of metformin

Answer 2

Weight loss
GI SE (bloating, constipation etc.)

Question 3

Cautions for metformin

Answer 3

If patient has renal impairment
Or
Hepatic impairement
Increased risk of lactate acidosis

Question 4

Contra-Indication for metformin

Answer 4

Ketoacidosis

General anaesthesia

Question 5

Dosage of Metformin

Answer 5

500mg with breakfast for at least 1 week
Gradually increase for 10-15 days up to max 2g
Can be split BD if BM not controlled by OD.

Question 6

Mode of action of sulfonylureas

Answer 6

Attached to ATP sensitive K+ channel
Upon binding of SU to the receptor there is an influx of K through the K channel and depolarisation
Results in influx of Ca
Stimulates release of insulin in vesicles

Question 7

Examples of sulfonylureas

Answer 7

Glyburide (DiaBeta, Glynase)
Glipizide (Glucotrol)
Glimepiride (Amaryl)

Question 8

Side effects of SUs

Answer 8

Hypoglycaemia

Weight gain

Question 9

Contra-indication of SU

Answer 9

Ketoacidosis
Avoid in:
Overweight patients
Pregnancy or breast feeding (neonatal/ infant hypoglycaemia)

Question 10

Mode of action of meglitinides

Answer 10

Bind to SUR1 similar to SU but with a much weaker affinity. Mechanism same as SU. Faster acting and side effects similar to SU

Question 11

Example of meglitinide

Answer 11

Nateglinide

Question 12

Dosage of meglitinide

Answer 12

Always use in conjunct with metformin

Nateglinide: Initially 60mg TD (max 180mg). Increase according to response. Taken 30 minutes before meals

Repaglinide. 500ug (max 4mg) Taken 30 minutes before main meals. Max 16mg a day.

Question 13

Mode of action of DDP-4i

Answer 13

Inhibits dipeptidyl peptidase-4 from breaking down incretin (GLP-1, GIP)