high risk drugs

Question 1

what are the symptoms (the 4 T’s) of type 1 diabetes

Answer 1

• Toilet (frequent urination)
• Thirsty
• Tired
• Thinner (unexplained weight loss )

Question 2

what are the symptoms of type 2 diabetes

Answer 2

• like type 1 (Toilet (frequent urination), thirsty, tired, thinner) but slower onset and less extreme
• repeat episodes of genital thrush
• slow wound healing

Question 3

name some differences between type 1 and type 2 diabetes

Answer 3

• type 1: no insulin
  produced, type 2: insulin is usually produced
• type 1 treatment is to replace insulin, type 2 treatment most of the treatment is diet and exercise and insulin is the last option
• type 1 has no risk factors (slight genetic link), type 2 has a lot: ethnicity, age, obesity, smoking, PCOS, genetics

Question 4

what is the first- line treatment for type 2 diabetes if hbA1c rises to 48 mmol/mol

Answer 4

metformin

Question 5

describe how drug treatment for type 2 diabetes is escalated

Answer 5

• HbA1c of 48 mmol/mol: metformin
• HbA1c of 58 mmol/mol:
  metformin + DPP-4i / pioglitazone/ SU/ SGLT-2i.
  Target hbA1c is 53 mmol/mol
• if that doesn’t work, try triple therapy with drugs above. Target hbA1c is still 53 mmol/mol

Question 6

what is the first line treatment for type 1 diabetics

Answer 6

Basal Bolus Regime: one or two long acting insulin (morning and night) and 3 doses of short-acting/ rapid insulin during the day before meals

Question 7

what is the best benefit of long acting insulin

Answer 7

it reduces the incidence of nocturnal hypoglycaemia

Question 8

when would you use ULTRA long acting insulin

Answer 8

• in patients with troublesome nocturnal hypoglycaemia

- non-adherence: patients who forget to take their insulin

Question 9

what is a biphasic insulin regimen

Answer 9

the patient takes two biphasic insulin dose, one in the morning (usually breakfast) and one at dinner. Dose depends on when the biggest meal is eaten

Question 10

what food do statins interact with

Answer 10

grapefruit juice

Question 11

what should patients on statins do if they experience muscle pain/ tenderness / weakness

Answer 11

seek medical advice to get creatinine kinase levels measured

Question 12

how should you use NSAIDS

Answer 12

use the lowest dose for the shortest period of time to control symptoms