T2DM Drugs

Question 1

Name the 4 actions of T2DM drugs.

Answer 1

1. increase insulin secretion
2. decrease insulin resistance and reduce hepatic glucose output
3. slow glucose absorption in GI tract
4. enhance glucose excretion by kidney

Question 2

name the 4 classes of drug that increase insulin secretion.

Answer 2

sulfonylureas
glinides (meglitinides)
incretic analogues
DPP-4 inhibitors

Question 3

name the 2 classes of drug that decrease insulin resistance and hepatic glucose output

Answer 3

biguanides and thiazolidinediones (glitazones)

Question 4

name the class of drug that slows glucose absorption from the GI tract

Answer 4

alpha-glucosidase inhibitor

Question 5

name the class of drug that enhances glucose excretion by the kidney

Answer 5

sodium glucose type-2 (SGLT2) inhibitors

Question 6

are alpha-glucosidase inhibitors and sodium glucose type-2 (SGLT2) inhibitors insulin dependent?

Answer 6

no

Question 7

SUR1 subunits regulate __________ channel activity

Answer 7

SUR1 subunits regulate POTASSIUM channel activity

Question 8

___ binding to each of the Kir6.2 subunits closes the channel causing ______________ of the ____ cell and _______ release

Answer 8

ATP binding to each of the Kir6.2 subunits closes the channel causing DEPOLARIZATION of the BETA cell and INSULIN release

Question 9

ADP-Mg2+ binding to the SUR1 subunits ______ the channel maintaining the resting potential of the ____ cell and _________ insulin secretion

Answer 9

ADP-Mg2+ binding to the SUR1 subunits OPENS the channel maintaining the resting potential of the BETA cell and INHIBITS insulin secretion

Question 10

sulfonylureas used in T2DM bind to SUR1 and _____ the channel causing _____________ and insulin release independent of plasma ________ concentration

Answer 10

sulfonylureas used in T2DM bind to SUR1 and CLOSE the channel causing DEPOLARIZATION and insulin release independent of plasma GLUCOSE concentration

Question 11

what do sulfonylurea drugs end in?

Answer 11

-ide

Question 12

give an example of a sulfonylurea

Answer 12

glipizide

gliclazide

Question 13

SUs, in the long term, reduce what complications?

Answer 13

microvascular

Question 14

SUs are used first line if the patient is intolerant to what?

Answer 14

metformin

Question 15

SUs are often used in combination with what?

Answer 15

metformin

Question 16

SUs adverse effect?

Answer 16

weight gain

Question 17

SUs should be avoided in who?

Answer 17

elderly, pregnancy and CKD

Question 18

what do glinides (meglitinides) end in?

Answer 18

-glinide

Question 19

give an example of a glinide

Answer 19

repaglinide and netaglinide

Question 20

glinides should not be used in who?

Answer 20

severe hepatic impairment, pregnancy and breast feeding

Question 21

ingestion of food stimulates release of what?

Answer 21

glucagon peptide like-1 (GLP-1) and GIP

Question 22

GLP-1 and GIP enhance _______ release from beta cells and ________ uptake whereas GLP-1 decreases _________ release from alpha cells

both resulting in decreased blood glucose

Answer 22

GLP-1 and GIP enhance _______ release from beta cells and ________ uptake whereas GLP-1 decreases _________ release from alpha cells

both resulting in decreased blood glucose

Question 23

what is the other name for DPP-4 inhibitors

Answer 23

gliptins

Question 24

what do DPP-4s end in?

Answer 24

-gliptin

Question 25

give an example of a DPP-4 inhibitor

Answer 25

sitagliptin

Question 26

what does DPP-4 stand for?

Answer 26

dipeptidyl peptidase-4

Question 27

DPP-4s are usually prescribed in combination with what?

Answer 27

metformin or SU

Question 28

what is the main adverse effect of a gliptin?

Answer 28

DPP-4 inhibitor adverse effect = NAUSEA

Question 29

is there hypoglycaemia or weight gain in gliptins?

Answer 29

no

Question 30

can SUs cause hypoglycaemia?

Answer 30

no

Question 31

can glinides cause hypoglycaemia?

Answer 31

no

Question 32

incretin analogues are peptides that mimic the action of what?

Answer 32

GLP-1

Question 33

what do incretin analogues end in?

Answer 33

-tide

Question 34

how are incretin analogues administered?

Answer 34

SC injection

Question 35

name an incretin analogue

Answer 35

extenatide extenatide liraglutide

Question 36

what can incretin analogues cause loss of?

Answer 36

weight loss

Question 37

do incretin analogues cause hypoglycaemia?

Answer 37

no

Question 38

2 side effects of incretin analogues?

Answer 38

nausea pancreatitis - rare

Question 39

name the infrequently used in the UK, brush border enzyme inhibitor that breaks down starch and disaccharides to absorbable glucose

Answer 39

alpha-glucosidase inhibitors

Question 40

name an example of a alpha-glucosidase inhibitor

Answer 40

acarbose miglitol voglibose

Question 41

alpha-glucosidase inhibitor adverse effects?

Answer 41

``` flactulence loose stools diarrhoea abdominal pain bloating ```

Question 42

do alpha-glucosidase inhibitors pose risk of hypoglycaemia?

Answer 42

no

Question 43

name the first line agent in the treatment of T2DM

Answer 43

metformin unless SEVERE hepatic/renal impairment

Question 44

what does metformin reduce and increase?

Answer 44

reduce: hepatic gluconeogenesis carbohydrate absorption increase: glucose uptake by muscle fatty acid oxidation

Question 45

metformin is what class of drug?

Answer 45

biguanide

Question 46

does metformin cause hypoglycaemia?

Answer 46

no

Question 47

does metformin cause weight gain?

Answer 47

no - weight loss

Question 48

name the 2 adverse effects of metformin

Answer 48

GI upset lactic acidosis - rare

Question 49

thiazolidinediones are also known as what?

Answer 49

TZDs and glitazones

Question 50

do thiazolidinediones cause hypoglycaemia?

Answer 50

no

Question 51

do thiazolidinediones cause weight gain?

Answer 51

yes

Question 52

what do thiazolidinediones end in?

Answer 52

-glitazone

Question 53

name a thiazolidinedione drug

Answer 53

pioglitazone

Question 54

thiazolidinedione adverse effects?

Answer 54

weight gain increased bone fracture risk fluid retention

Question 55

name the new drug class that is not dependent on insulin

Answer 55

sodium-glucose cotransporter (SGLT2) inhibitors

Question 56

what do SGLT2 inhibitors end in?

Answer 56

-agliflozin

Question 57

give an example of a SGLT2 inhibitor

Answer 57

empagliflozin canagliflozin dapagliflozin

Question 58

do SGLT2 inhibitors cause hypoglycaemia?

Answer 58

no

Question 59

do SGLT2 inhibitors cause weight gain?

Answer 59

no - weight loss

Question 60

name the drug that can cause hypoglycaemia

Answer 60

SUs - glipizide glinides can also cause but not as much as SUs