Oral antidiabetics

Question 1

First things first, classes used in diabetes :

Answer 1

inhibiteurs des alpha-glucosidases, inhibiteurs de SGLT-2, sulfamides hypoglycemiants, incrinomimetiques (inhibiteurs de DPP-4 et agonistes GLP-1) , biguanides, glinides, glitazones.

Question 2

Which of the antidiabetic drugs are secretagogue &how do they work, explain mechanism?

Answer 2

*Both sulfonylurea &glinide are secretagogues (only effective in type-2 diabetes) that work by blocking ATP sensitive K channels by binding to their specific receptors on the channels. The decrease in K efflux induces depolarization of the b-cells, both that &the increase in Ca influx stimulate insulin secretion.

Question 3

Difference between glinides &sulfonylureas ?

Answer 3

Glinides have a rapid onset &a short duration of action in comparison to sulfonyureas, they are particularly effective in normalizing glucose levels after a meal, &are taken 1h to 30 mns before meals. Glinides share two common binding sites with sulfonylureas aside to a unique site. Glinides lack sulfur in their structure, which allows their consumption in cases of sulfur/sulfonylurea allergies.

Question 4

When are glinides taken?

Answer 4

30mn to 1h before meals, since glinides have a rapid onset &a short duration of action. you can say ‘immediately before meals’

Question 5

Glitazones; mechanism of action?

Answer 5

*Glitazones work on a molecular level by modulating gene expression. Their specific receptor is the PPAR-gamma present in liver, adipose tissues &skeletal muscles. They regulate lipid &glucose metabolism, adipocytes apoptosis &differentiation, insulin signal transduction, with the ultimate effect of increasing insulin sensitivity &decreasing its resistance. Slow on &offset over weeks to months.

Question 6

When are biguanides taken?

Answer 6

Biguanides : Au milieu ou à la fin des repas Metformine

Question 7

SGLT-2 inhibitors; mechanism of action.

Answer 7

*Sodium-glucose co-transporter inhibitors block SGLT-2 proteins involved in 90% of the glucose reabsorption in the proximal tubules. They are taken once daily, the increase risks of urinary/genitalia infections.

Question 8

incrinomimetiques, what are they?

Answer 8

*Incrinomimetiques : incretins are intestinal hormones that stimulate the secretion of insulin after a meal, they also decrease glucogenesis by the liver.

Question 9

alpha glucosidase inhibitors, best time to be taken?

Answer 9

at the start of the meal, big cup of water.

Question 10

DPP-4 inhibitors, mechanism of action?

Answer 10

DPP-4 inhibitors increase levels of incretins in blood. DPP-4 are enzymes that degrade GLP-1 which is a key enteroendocrine factor responsible for the incretin effect.

Question 11

Incrinomimetiques, two subclasses ?

Answer 11

DPP-4 inhibitors

GLP-1 agonists (inj)

Question 12

DPP-4 inhibitors, mechanism of action?

Answer 12

DPP-4 inhibitors increase levels of incretins in blood. DPP-4 are enzymes that degrade GLP-1 which is a key enteroendocrine factor responsible for the incretin effect.

Question 13

Sulfamides hypoglycemiants, medicaments ?

Answer 13

Sulfamides hypoglycemiants : Carbutamide, Chlorpropamide, Glibenclamide, Glibornuride, Gliclazide, Glimepiride, Glipizide, Gliquidone, Tolbutamide.

Glimepiride AMAREL. Gliclazide DIAMICRON. Glibenclamide DAONIL, EUGLUCAN. Glipizide OZIDIA.

Question 14

Biguanides, medicaments ?

Answer 14

Metformine GLUCOPHAGE, STAGID.

Question 15

Glinides, medicaments?

Answer 15

Repaglinide : NOVONORM, REPAGLINIDE

Question 16

Inhbt de DPP-4, medicaments?

Answer 16

Inhibiteurs de DPP-4 : Vildagliptine GLAVUS 50. Sitagliptine JANUVIA 100, XELEVIA 50 mg. Saxagliptine ONGLYZA 5.

Question 17

Inhbt de l’a-glucosidase, medicaments ?

Answer 17

Inhibiteurs de l’a-glucosidase : En debut de repas, grande verre d’eau.
Acarbose ACARBOSE, GLUCOR. Miglitol DIASTABOL.