Type 2 diabetes Drugs

Question 1

What are Biguanides?

Answer 1

Insulin sensitizers

Question 2

What drug class is Metaformin?

Answer 2

Biguanide

Question 3

What are the usual dosages for Metaformin?

Answer 3

500, 850 or 1000mg tablets

Question 4

What is the usual starting dosage for Metaformin?

Answer 4

500mg

Question 5

What effect does metaformin have on hyperglycaemia?

Answer 5

Reduces HbA1c by 15/20mmolL by lowering insulin resistance

Question 6

Does metaformin make you gain weight?

Answer 6

No- weight neutral

Question 7

Does metaformin cause Hypoglycaemia?

Answer 7

Not when used as a monotherapy

Question 8

What properties other than reducing insluin resistance does metaformin have?

Answer 8

Reduces triglycerides and LDL

Minor reduction in BP

Safe in pregnancy

USed in Polycucstic Ovarian Syndrome

Used in Non-alcholic fatty liver disease

Question 9

What are the adverse effects of Metaformin?

Answer 9

GI side affects:- anorexia, nausea , diahrrhoea. abdo pain

Lactic acidosis (rare but serious)

Liver failure

Interference with vitamin B12 and folic acid absorption

Question 10

Give examples of some Sulphonylureas

Answer 10

“Gli__ides”

Glicazide

Glipizide

Glibenclamide

Glimepiride

Question 11

What is the mechanism of action of Sulphonylureas?

Answer 11

Blocks the ATP potassium ion channel mimicing the role of ATP

Question 12

What effect do Sulphonylureas have on blood glucose levels?

Answer 12

Reduce HbA1c by 15/20mmol/mmol by increasing insulin secretion.

More rapid change than metaformin or other insulin sensitisers

Question 13

What are the adverse effects of using sulphonylureas?

Answer 13

Hypoglycaemia

Weight gain

GI upset

Question 14

What are the 1st and 2nd line treatments for type 2 diabetes?

Answer 14

1. Metaformin
2. Gli___ides ( Sulphonylureas)

Question 15

What are Thiazolidinediones?

Answer 15

PPARgamma agonists

Question 16

What is the only available Thiazolidinedione (TZD)

Answer 16

Pioglitazone

Question 17

What is the mechanisim of action of Pioglitazone?

Answer 17

Question 18

What effect does piaglitazone have on HbA1c?

Answer 18

Reduces HbA1c by 15-20mmol/mol by increasing insulin sensativity

Question 19

What are the adverse effects of TZDs?

Answer 19

Weight gain:- very common due to increase in subcutaneous fat and fluid retention

Heart Failure:- Fluid retention results in doubling of risk of admission with heart failure

Question 20

What does this graph show?

Answer 20

Drugs are great at the start but then start to loose their effect

Question 21

What are the benefits of DPP4 inhibitors?

Answer 21

Promote insulin secretion without hypoglycaemia

Suppress glucagon

Weight neutral

Question 22

What are the downsides of DPP4 inhibitors?

Answer 22

Not that potent

pancreatitis

Pancreatic cancer

Question 23

How do you spot a SGLT2 inhibitor?

Answer 23

“____flozin”

Question 24

What do SGLT2 inhibitors?

Answer 24

Make you pee sugar

Question 25

What are the four ways in which type 2 diabetes drugs can work?

Answer 25

Increase insulin secreation Decrease insulin resistance Slowdown Glucose absorption in the GI tract Enhance glucose excretion by the kidneys

Question 26

What drug classes increase insulin secretion?

Answer 26

Sulfonylureas DPP-4 inhibitors

Question 27

What do Glinides do?

Answer 27

Similar to sulfonylureas they bind to SUR1 to close K+ channels and trigger insulin release

Question 28

Name two Glinides

Answer 28

repaglinide Nateglinide

Question 29

How do glinides differ from sulfonylureas?

Answer 29

Have rapid onset/offset kinetics so are less likely to cause hypogycaemia

Question 30

How is GLP-1 and GIP released?

Answer 30

Ingestion of food stimulates GLP-1 and GIP release from enteroendocrine cells in the small intestine.

Question 31

What does GLP-1 do?

Answer 31

Enhances insulin release from prancreatic beta cells and delays gastric emptying. Results in enhanced glucose uptake and utilization Also decreases glucagon release from pancreatic alpha cells

Question 32

How do incretin analogues work?

Answer 32

They mimic the action of GLP-1 but are longer lasting

Question 33

Give and example of an incretin analogue

Answer 33

Extenatide

Question 34

How is Etenatide administered?

Answer 34

subcutaneous injection twice daily

Question 35

What effect do incretin analogues/extenatide have?

Answer 35

increase insulin secretion supress glucagon secretion slows gastric emptying decreases appetite

Question 36

What is a longer acting version of extenatide?

Answer 36

Liraglutide

Question 37

What is DPP-4 ?

Answer 37

Enzyme which rapidly terminates the action of GLP1 and GIP

Question 38

How do Gliptins work?

Answer 38

Competativly inhibit DPP-4 prolonging the actions of GLP-1 and GIP

Question 39

Give an example of a Gliptin?

Answer 39

Sitagliptin

Question 40

What is alpha-glucosidase?

Answer 40

enzyme which breacks down statch and disaccharides into absorbable glucose

Question 41

How do alpha glucosidae inhibitors work?

Answer 41

Inhibit alpha glucosidase delaying absoption of glucose thus reducing postprandial increase in blood glucose