OHAs and Heart Failure

Question 1

Which OHA is contraindicated in heart failure? WHY?

Answer 1

Thiazolidinedione causes fluid retention.
eg: Pioglitazone

Question 2

MOA of thiazolidinedione

Answer 2

agonists to the PPAR-gamma receptor and reduce peripheral insulin resistance.

Question 3

Adverse effects of thiazolidinedione

Answer 3

weight gain

liver impairment: monitor LFTs
fluid retention - therefore contraindicated in heart failure.

The risk of fluid retention is increased if the patient also takes insulin

increased risk of fractures

bladder cancer

Question 4

MOA of (DPP-4) inhibitor ?

Answer 4

Sitagliptin is (DPP-4) inhibitor that works by increasing levels of incretin hormones, enhancing the secretion of insulin, and reducing glucagon release.

NO cardiac side effects or contraindications in heart failure.

Question 5

MOA of sulfonylurea

Answer 5

Gliclazide is a second-generation sulfonylurea . It stimulates the pancreas to secrete more insulin.

NO cardiac side effects or contraindications in heart failure.

Question 6

MOA of glucagon-like peptide-1 (GLP-1) agonist

Answer 6

Exenatide is a glucagon-like peptide-1 (GLP-1) agonist. It enhances glucose-dependent insulin secretion and suppresses inappropriate glucagon secretion, slowing gastric emptying and promoting satiety.

no specific contraindications related to heart failure.

Question 7

MOA of biguanide

Answer 7

Metformin, a biguanide anti-diabetic medication, decreases hepatic glucose production and increasing insulin sensitivity in peripheral tissues.

Contraindications include renal impairment due to the risk of lactic acidosis

No contraindication in heart failure; indeed, recent guidelines suggest its use may be beneficial unless associated with hypo perfusion or hypoxemia.