FN: Diabetes Oral Hypoglycaemics

Question 1

Metformin MOA

Answer 1

Biguanide
Insulin sensitizer
- reduced gluconeogenesis
- Increased peripheral glucose use
- reduced LDL and VLDL

Question 2

Metformin Indications

Answer 2

Lactic acidosis

GI upset - anorexia - wt. loss

Question 3

Metformin Contraindications

Answer 3

Caution in renal or hepatic impairment

Contrast media
General anesthesia
Recent MI

Question 4

Metformin other

Answer 4

Renal excreted - reduced dose or avoid if reduced eGFR

Cannot cause hypos

Question 5

Ploglitazone MOA

Answer 5

Thiazolidinedione
Peripheral insulin sensitizer
PPAR gamma ligand (nuclear receptor involved in glucose and lipid homeostasis)

Question 6

Ploglitazone SE

Answer 6

Wt. gain
Fluid retention
Hepatoxicity
May exacerbate HF

Question 7

Ploglitazone Contraindications

Answer 7

H/L
Insulin use
ACS

Question 8

Ploglitazone other

Answer 8

Dont use with insulin
V. protein bound
Hepatic metabolism
Monitor LFTs

Question 9

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide)

Answer 9

Sulfonylureas
Insulin secretagogues
Block hyperpolarising potassium channels on beta cells - depolarisation and insulin release

Question 10

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide) interactions

Answer 10

effects increased by:
-sulphonamids
-trimethoprim
-NSAIDS
0 warfarin
- fibrates

Question 11

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide) SE

Answer 11

Hypoglycaemia - can be prolonged
Wt. gain (increased appetite)
GI upset
Headache

Question 12

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide) Contraindications

Answer 12

Severe L/R

Acute porphyria

Question 13

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide) Other

Answer 13

Renally excreted
V. albumin bound
Caution in elderly with reduced renal function
Avoid long-acting (glibenclamide) in elderly - use gliclazide or tolbutamide

Question 14

Nateglinide

Repaglinide MOA

Answer 14

Meglitinides
Insulin secretagogues
Block hyperpolarising potassium channel

Question 15

Nateglinide

Repaglinide SE

Answer 15

Hypoglycaemia

Question 16

Nateglinide

Repaglinide Other

Answer 16

V. short acting - reduced risk of hypo

Give before meal

Question 17

Sitagliptin

Vildagliptin MOA

Answer 17

Insulin secretagogues
Dipeptidylpeptidase - 4 inhibitor
DPP - 4 breaks down endogenous GLP-1

Question 18

Sitagliptin

Vildagliptin SE

Answer 18

Hypoglycaemia

GI upset

Question 19

Exenatide

Liraglutide MOA

Answer 19

Insulin secretagogues
GLP-1 analogue
Increases insulin secretion and sensitisation

Question 20

Exenatide

Liraglutide SE

Answer 20

hypoglycaemia

GI upset

Question 21

Exenatide

Liraglutide other

Answer 21

Admin by SC injection

Question 22

Acarbose MOA

Answer 22

Intestinal alpha-glucosidase inhibitor
Delays carb absorption - reduced post-prandial blood glucose
Little effect on fasting glucose

Question 23

Acarbose SE

Answer 23

Flatulence
Looe stools/diarrhoea
Abdo pain/bloating
Hepatoxicity (rare)

Question 24

Acarbose contraindications

Answer 24

IBD

L

Question 25

Acarbose Other

Answer 25

Monitor LFTs