Pharmacology - Treatment of Diabetes 2 Flashcards
what are the 3 causes of hyperglycaemia in type 2 diabetes
impaired insulin secretion
insulin resistance
increased hepatic glucose production
which type of diabetes has poor glucose control with oral agents
a.type 1
b.type 2
c. maturity onset diabetes of the young
d.latent autoimmune diabetes in adulthood
d.latent autoimmune diabetes in adulthood
subgroup of type 2 diabetes
what is the diagnostic criteria for diabetes type 1
a.hypoglycaemia
b.hyperglycaemia
c. HbA1c
d.high fasting plasma glucose
b.hyperglycaemia
with DKA, rapid weight loss, BMI <25, family history of autoimmune disease
what is the diagnostic criteria for diabetes type 2
a.hypoglycaemia
b.hyperglycaemia
c. HbA1c
c. HbA1c > 48 mmol on 2 occasions more than 3 months apart
fasting plasma glucose >7mmol/l
random plasma glucose >11.1 mol/l
hba1c less than this does not exclude type 2 diabetes , less sensitive than fasting glucose measurements
which tests cannot be done in cases of increased red cell turnover and acute blood sugar rise
a.hbAc1
b.fasting glucose
c.random glucose
a.hbAc1
increased red cell turnover - pregnancy, anaemia , haemoglobinopathies
acute blood sugar level rise: type 1diabetes, acute illness, drug- oral steroids and antipsychotics
if HbAc1 is above 48 mmol what action should be taken
a.highly intensive management to meet that level
b. individual target hbAc1 with medication lifestyle advice
c.medication and lifestyle advice to reduce it to under 48
b. individual target hbAc1 with medication lifestyle advice
what is the first line drug for type 2 diabetes treatment the majority of the time
a.metformin
b,SGLT2 inhibitor
c.glicazide
d.glucagon like peptide
a.metformin
what should be offered to patients with chronic heart failure / established atherosclerotic CVD after metformin as soon as tolerability is confirmed
a.metformin
b,SGLT2 inhibitor
c.glicazide
d.glucagon like peptide
b,SGLT2 inhibitor
proven CV benefit
what is the second line drug for type 2 diabetes
a.metformin
b,SGLT2 inhibitor
c.glicazide
d.glucagon like peptide
b,SGLT2 inhibitor
which of these is not an effect of biguanides eg metformin
a.actiavtes liver AMP kinase, reduces liver glucose output
b.increases liver, muscle and fat cell sensitivity to insulin
c.enhances glucose peripheral uptake and utilisation
d.deactivates liver AMP kinase, reducing liver glucose output
d.deactivates liver AMP kinase, reducing liver glucose output
main side effect of biguanides eg metformin
a.hypoglycaemia
b.weight loss
c.GI adverse effects eg nausea diarrhoea
c.GI adverse effects eg nausea diarrhoea
effect minimised by gradually increasing dose
over many weeks
cardioprotective effect outweighs go concerns in patient with mild to moderate liver dysfunction, adequate renal function, or cardiac impairment
in which situation should metformin be stopped (2 choices)
a. serum creatinine above 130 micromol /l
b. grr less than 45 ml/ min
c.serum creatinine above 150 micro mol/l
d.gfr less than 30 mil/min
c.serum creatinine above 150 micro mol/l
d.gfr less than 30 mil/min
a and b indicate metformin use should be reviewed
which diabetes drug binds to the sulfonylurea receptor closing k channels so k remains in cell depolarising it , increasing calcium influx leading to B cell depolarisation and insulin release
a.metformin
b.gliclazide
c.exanatide
d.sitagliptin
b.glicazide
sulfonylurea- clazide
which diabetes drugs may be antagonised by corticosteroids and thiazide like diuretics
a.biguanides
b.sulfonylureas
c.glucagon like peptide
d.insulin
b.sulfonylureas
which drugs may lead to prolonged hypoglycaemia (esp with alcohol and beta blockers) and weight gain
a.biguanides
b.sulfonylureas
c.glucagon like peptide
d.insulin
b.sulfonylureas
which cells produce glucagon like peptide 1
a.b cells
b.a cells
c.d cells
d. f cells
e.l cells
e.l cells in the small intestine
what stimulates production of glp 1 in the small intestine
a.sympathetic ns
b.lipids and carbs
c.glucose
d.insulin
b.lipids and carbs ( food)
what type of receptor does glp 1 bind to on beta cells to trigger insulin secretion
a.g protein coupled
b.muscarinic
c.cytoplasmic
a.g protein coupled
what is the function of dipeptidyl peptidase IV
a.insulin degradation
b.glp 1 degradation
c.glucagon degradation
d. glut 4 degradation
b.glp 1 degradation
- tide
glp 1 analogues
-gliptin
dipeptidyl peptidase IV inhibitors
overall effect of glp 1 analogues
a.increase blood glucose
b.decrease blood glucose
b.decrease blood glucose
increases insulin secretion
decreases hepatic glucose output
increases peripheral glucose uptake
how are glp 1 analogues given?
a.subcutaneous injection
b.orally
c.IV
d.inhaled
a.subcutaneous injection
daily or weekly
prescribed as 2x 3 ml refilled pens
what is the most common side effect of glp1 analogues eg eventide, liraglutide
a.weight gain
b.weight loss
c.GI upset
d.hypoglycaemia
b.weight loss
also cause nausea , dyspepsia , dizziness
who should glp 1 analogues not be used in
a.people w osteoporosis
b.people with thyroid disease
c.people with gastroparesis
c.people with gastroparesis
and if egfr below 30
how are Dipeptidyl peptidase inhibitors taken
a.subcutaneous injection
b.orally
c.IV
d.inhaled
b.orally
as tablets
nasopharyngitis, upper resp tract infection, headache and peripheral oedema are side effects of which diabetes drug
a.sitagliptin
b.metformin
c.liraglutide
d.insulin
e.glicazide
a.sitagliptin - DDPIV
metformin - biguanide
liraglutide - glucagon like protein 1 analogue
glicazide - sulfonylurea
