T2DM Meds

Question 1

What is the MOA of metformon?

Answer 1

Primarily reduces hepatic glucose output

But also causes skeletal muscles to utilise glucose.

Has a complex pathway involving AMP Kinase. Leading to metabolic changes like weight loss

Question 2

What are the common side effects of metformin?

Answer 2

GI upset

Lactic acidosis

Question 3

When should metformin be held?

Answer 3

In AKI, severe tissue hypoxia and if a pt is being give contrast media

Question 4

What is the MOA of sulphonylureas?

Answer 4

These stimulate pancreatic insulin secretion by blocking the ATP K channels in the beta cells. This causes a depolarisation opening the voltage gated calcium channels. As ca goes up leads to insulin secretion

Question 5

Name the sulphonylureas (5)

Answer 5

Glicazide 
Glipizide
Glibenclamide 
Tolbutamide 
Glimepride

Question 6

What sulphonylurea has the biggest risk of hypoglycaemia?

Answer 6

Glibenclamide

Question 7

What are the side effects of sulphonylureas?

Answer 7

GI upset 
Hypoglycaemia 
Hypersensitivity reaction 
Hepatic toxicity (cholestatic jaundice)
Agranulocytosis

Question 8

What drugs can further increase the risk of hypoglycaemia?

Answer 8

Other antidiabetic medication

Alcohol

Question 9

What is the MOA of pioglitazone?

Answer 9

Activates specific nuclear receptors leading to an increase sensitivity to insulin in the liver, fat and skeletal muscles.

Also reduces hepatic glucose output and increase peripheral glucose uptake

Question 10

What are the increased risk for a patient taking pioglitazone?

Answer 10

Heart failure

Bladder cancer

Question 11

Whats the MOA of dipeptidylpeptidase-4 inhibitors?

Answer 11

The incretins (GLP-1 and glucose dependent insulinotropic peptide) are released by the intestine. These promote insulin secretion and suppress glucagon release, lowering blood glucose. 
DPP-4 rapidly inactivate the incretin via hydrolysis. So these of course inhibut DPP-4.

Question 12

Why is there a low risk of hypoglycaemia with DPP-4 inhibitors when not taken with insulin or sulphonylureas?

Answer 12

Because incretin release is glucose dependent, so they do not stimulate insulin release at normal levels or suppress glucogon when blood glucose are low

Question 13

What are the side effects woth DPP-4 inhibitors?

Answer 13

GI upset
Headaches
Nasopharyngitis
Peripheral oedema
Hypoglycaemia (when prescribed with other drugs that can cause Hypoglycaemia)
Small risk of acute pracreatitis

Question 14

Which DPP-4 is used when a patient has poor renal function?

Answer 14

Linagliptin

Question 15

Do DPP-4 inhibitors cause weight gain?

Answer 15

No

Question 16

What must you monitor for a patient severely unwell whilst taking a SGLT-2 inhibitor?

Answer 16

Ketones as these come with a risk of diabetic ketoacidosis

Question 17

What SGLT-2 inhibitor increases the risk of of lower limb amputation?

Answer 17

Canagliflozin

Question 18

What major risk is there with SGLT-2 below the belt?

Answer 18

Fourniers gangrene

Question 19

What is the HAb1c target for a T2DM pt on monotherapt?

Answer 19

<48mmol/L

Question 20

What is the HbA1c target for a patient on 2 or more antidiabetic treatments?

Answer 20

<53mmol/L

Question 21

What HbA1c result would trigger an intensity to treatment ?

Answer 21

> 58mmol/L

Question 22

What factors would affect changing the HbA1c target?

Answer 22

Elderly, frail or pts who are at high risk of hypos

Question 23

When would a DPP-4 inhibitor be added to metformin therapy?

Answer 23

When sulphonylureas are contraindicated or there’s a high risk of hypos

Question 24

What two drugs must not be used togther in triple therapy?

Answer 24

Pioglitazone and dapaglifazin