Pharm Flashcards
List two classes of oral anti-diabetic medication that could be prescribed & briefly describe the mechanism of action (3)
Biguanides (e.g. metformin) – Euglycaemic agents, acts to increase glucose sensitivity (glycolysis) in tissues and reduces hepatic gluconeogenesis
Sulphonylureas (e.g. glibenclamide) – Increases insulin release from pancreas
List the adverse effects for both classes of medication above (2)
Metformin: GIT side effects, anorexia, strange (weird and wonderful with exotic fruits) taste, lactic acidosis (rare)
Glibenclamide: Hypoglycaemia, rash, headache and dizziness, GIT side effects
Name the drug you would prescribe for an overweight, type 2 diabetic and explain your choice (1½)
Metformin is the drug of choice as the patient has a raised BMI and metformin helps improve glucose utilization which is the primary problem with type 2 diabetes; it may also aid in weight loss.
Describe metabolic syndrome, with particular reference to glucose control. Briefly mention the non-drug measures that can be used to treat the metabolic syndrome (5)
- Metabolic syndrome = Dyslipidaemia, hypergylcaemia, hypertension, obesity.
- Glucose control is hampered because of glucose intolerance and hyperinsulinaemia resulting in difficulty with weight loss, increased triglycerides, endothelial dysfunction.
- Non-drug measures i.e. lifestyle changes - exercise, diet. SAWED
List three management options (other than insulin) for type 2 diabetic’s blood glucose (1½) (CPATH)
Weight reduction, exercise, diet, oral agents (sulphonylureas, metformin)
Describe the dietary advice that you would offer an overweight, type 2 diabetic (3)
Diet (low salt, low fat, complex carbs, increased omega-3 fatty acid consumption, increasing fruit and veg consumption).
List the effects of insulin (5)
Promotes the transport of glucose into cells and it utilisation there, Increases hepatic glycogen formation, Inhibits gluconeogenesis, Inhibits lipolysis, Increases protein synthesis
A diagnosis of DKA was made. Briefly discuss the further management of this patient after the DKA has resolved (5)
Briefly discuss: Counselling, Dietary advice, Education home glucose monitoring, Insulin regimen, risk of hypo and its management
29-year-old Type 1 diabetic, is visiting her obstetrician for her 6 weeks follow-up after the birth of her healthy son, who weighed 4.7 kg at birth. She said that she has been feeling very tired, although the baby is now sleeping through from midnight to 05h30. She also needs to get up at night to urinate, and urination has recently become very painful. O/E Her thyroid felt normal, her fasting blood glucose was raised, and there were leucocytes and nitrites present in her urine. Urine sent to the microbiology lab for culture.
Discuss the two commonly used insulin regimens, explaining the rationale for the use of each one in this patient [4]
Basal/ bolus regimen – consists of pre-meal rapid acting insulin and bedtime intermediate acting insulin. Adjusted on an individual basis twice daily pre-mixed insulin.
Give one positive and one negative feature for the use of each regimen [2]
Pro – Effective/ individualized insulin control. Con – More time-consuming
Pro – More convenient. Con – Less effective diabetic control
Outline the advice that you would give a 14-year-old diabetic and his parents on discharge with regard to the future management of his diabetes. Include the use of insulin, monitoring and diet (10)
Adherence to insulin critical
Essential to eat after each dose
Report lipoatrophy and liphypertrophy and
Rotate sites of injection to prevent lipodystrophy
Avoid alcohol
Monitor blood glucose and change insulin as required
Exercise regularly
Adjust meals and insulin requirements for exercise
If sick, increased insulin requirements
Eat frequent small meals and snacks
Get a medic alert bracelet
Carry sweets with you for hypoglycaemic episodes
Tell close family and friends about your condition
Watch feet for infections
