L10: Diabetes (drug content)

Question 1

What are the pharm classes used to lower glucose levels

Answer 1

1. Biguanides
2. Sulphonylureas
3. Dipeptidyl peptidase 4 (DPP-4) inhibitors
4. Sodium-glucose co-transporter 2 (SGLT2) inbitor
5. Glucago-like-peptide-1 (GLP-1) antagonists

Question 2

only 1

What is the drug in Biguanides?

*need to know counselling points and practice points

biguanide - pharm class

Answer 2

Metformin

Counselling points:
1. Take with or without food to reduce sotmach upset
2. swallow controlled release tablets whole: do not chew or crush them
3. you may feel less hungry and find that food tates different. This should wear off after a few days
4. Limit alcohol intake
5. Stop taking the medication & tell doctor immediately if you have loss of appetite, weakness, malaise, diarrhoea, abdominal stress

Practice points: important
1. First line / preferred choice for lowering blood glucose
2. Does not cause weight gain
3. Hypoglycaemia is uncommon

Question 3

3 Gli + 1 Tol

What are the drugs in Sulphonylureas?

*need to know contraindi, side effect, counselling & practice points

Answer 3

Glipizide
Gliclazide
Glibenclaminde
Tolbutamide

Contraindication:
1. Sulphonamide allergy

Side effects:
1. weight gain & hypoglycaemia (hypo due to excessive dose or patient did not consume food as per normal)

Practice points:
1. Hypoglycaemia is more common in elderly
2. Risk of hypoglycaemia increases in glibenclamide & gliclazide due to longer duration of action compared to other sulphonylureas. Avoid use of glibenclamide and glicalzide in elderly due to potential severe hypoglycaemia. Use tolbutamide or glipizde in elderly instead
3. Not suitable for obese patients due to weight gain

Question 4

only 1

What is the drug in SGLT-2 inhibitors

*need to know side effects, practice points & counselling points

Answer 4

Dapagliflozin

Side effects:
1. Genital infections, polyuria

Practice points:
1. Significantly reduce risk of cardiorenal risks and hospitalization due to heart failure (cardiorenal - heartattack, stroke, obesity, hypertension)
2. Weight loss –> beneficial for overweight/obese
3. *Hypoglycaemia is rare, can be used in patients with risk of hypo

*practice points is same as liraglutide (GLP-1 RA)

Counselling points:
1. Drink enough water –> avoid dehydration
2. avoid taking at evening/bedtime –> avoid nightmare urination (nocturia)
3. need consult doc immediately when blood in urine, burning/pain when passing urine, need to pass urine often / fever
4. Women may get vaginal yeast infections –> need maintain good hygiene. Symptoms: vaginal odour, white or yellowish vaginal discharge
5. Men may get yeast infection of the skin around penis –> need maintain good hygiene. Symptoms: redness, itching or swelling of penis
6. Seek urgent medication attention if got symptoms of diabetic ketoacidosis (eg, deep, rapid breathing, fruit smelling breadth, flushed face) and pain in their lower limbs

Question 5

gliptins –> got 2

What is the drug in DPP-4 inhibitors?

Answer 5

Sitagliptin
Linagliptin
Side effects:
1. Nasopharyngitis

Counselling points:
1. Discontinue and see doctor immediately if symptoms of acute pancreatitis occurs (persistent, severe upper stomach pain spreading to your back)

Practice points:
1. Does not casue weight gain
2. Low risk for hypoglycaemia
3. Can be used in patients with renal impairment

Question 6

got 1

What is the drug in GLP-1 agonists?

Answer 6

Liraglutide (long acting)

• Use for Type 2 DM patients who have not achieved adequate glycaemic control and has cardiorenal risk

Practice points:
1. Significantly reduce risk of cardiorenal risks and hospitalization due to heart failure (cardiorenal - heartattack, stroke, obesity, hypertension)
2. Weight loss –> beneficial for overweight/obese
3. *Hypoglycaemia is rare, can be used in patients with risk of hypo

*practice points is same as Dapagliflozin (SGLT-2 inhibitor)