Type 2 Diabetes Medication

Question 1

7 drugs types

Answer 1

1. metformin
2. sulphonyureas
3. thiazolidones
4. DDP-IV inhibitor
5. SGLT-2 inhibitor
6. GLP-1 agonist
7. insulin

Question 2

mechanism of metformin

Answer 2

acts on liver and muscle to improve insulin receptor sensitivity, stimulate glucose breakdown and inhibit gluconeogenesis

Question 3

3 ways in which metformin improves insulin receptor sensitivity

Answer 3

improves receptor function, reduces fatty acid synthesis and improve glucose transport

Question 4

side effects of metformin

Answer 4

GI problems, B12 malabsorption and lactic acidosis

Question 5

pros of metformin

Answer 5

cheap, well tolerated, no weight gain, good for CV

Question 6

drugs with risk of hypos

Answer 6

sulphonylureas and insulin

Question 7

mechanism of sulphonylureas

Answer 7

binds to receptors on b-cells to close K+ channels and stimulate insulin exocytosis

Question 8

site of sulphonylureas action

Answer 8

pancreas

Question 9

side effects of sulphonylureas

Answer 9

weight gain, hypos, not good for renal or liver disease

Question 10

when are sulphonylureas indicated as a 1st line

Answer 10

when there is concern of weight loss or osmotic symptoms?

Question 11

what are the other 2nd line options for when weight gain, hypos and renal/liver disease are present

Answer 11

thiazolidinedione
DPP-IV inhibitor
SGLT-2 inhibitor

Question 12

which 2 drugs are only 3rd line options

Answer 12

GLP-1 agonist and insulin

Question 13

mechanism of thiazolidiones action

Answer 13

activated PPAR-ϒ gene in liver, muscle and fat to reduce free fatty acids and insulin resistance

Question 14

true/false thiazolidiones lower HbA1c by ~1%

Answer 14

true - not very much compared to metformin’s 12-17%

Question 15

true/false sulphonylureas can be used in pregancy and breastfeeding

Answer 15

false - it’s contraindicated

Question 16

true/false metformin can be used in pregnancy and breastfeeding

Answer 16

true

Question 17

side effects of thiazolidiones

Answer 17

weight gain, congestive cardiac failure, bladder cancer, fractures

Question 18

what test is set as a target marker in treatment

Answer 18

HbA1c

Question 19

true/false you would prescribe thiazolidinedione when there is a concern of congestive heart failure

Answer 19

false - thiazolidinedione causes fluid retention and then congestive cardicat failure.
give sulphonylurea, DPP-IV inhibitor or SGLT-2 inhibitor

Question 20

when are DPP-IV inhibitors indicated

Answer 20

when 1st line isn’t cutting the mustard and there is concern of weight gain, CCF or hypos

Question 21

mechanism of DPP-IV inhibitors

Answer 21

the DPP-4 enzyme breaks down incretins. Incretins are gut hormones that stimulate insulin release and inhibit glucagon.
therefore inhibit DPP-4 and you increase insulin release

Question 22

gut hormones acted on by DPP-4 inhibitors (gliptins)

Answer 22

incretins

Question 23

DPP-IV inhibitors are used as what line drug

Answer 23

2nd or 3rd line

Question 24

true/false DPP-IV inhibitors can be used in renal impairment

Answer 24

true

Question 25

cons of DPP-IV inhibitors

Answer 25

nausea, small glycaemic control, risk of pancreatitis/prancreatic cancer

Question 26

true/false DPP-IV inhibitors can be given in pregnancy

Answer 26

false - contraindicated

Question 27

pros of DPP-IV inhibitors

Answer 27

well tolerated, used in renal impairment, no weight gain

Question 28

what line are GLP-1 analogues

Answer 28

3rd line

Question 29

how are GLP-1 analogues administered

Answer 29

injected

Question 30

mechanism of GLP-1 analogues

Answer 30

stimulate release of incretin hormones to increase insulin release

Question 31

pros of GLP-1 analogues

Answer 31

weight loss

Question 32

cons of GLP-1 analogues

Answer 32

expensive, risk of pancreatitis/pancreatic cancer, nausea and vomiting

Question 33

increasing what hormones gives greater risk of pancreatitis and pancreatic cancer

Answer 33

incretins

Question 34

side effects of increasing incretins

Answer 34

nausea and vomiting, pancreatitis/pancreatic cancer

Question 35

which drug classes work by increasing incretin secretions

Answer 35

GLP-1 analogues and DPP-IV inhibitors

Question 36

what line are SGLT-2 inhibitors

Answer 36

2nd and 3rd line

Question 37

mechanism of SGLT-2 inhibitors

Answer 37

inhibit the SGLT-2 transporter in the proximal tubule that reabsorbs glucose

Question 38

how do SGLT-2 inhibitors cause hypotension

Answer 38

they prevent glucose reabsorption at the renal tubules and so pull across more water and reduce circulating volume

Question 39

what infection do SGLT-2 inhibitors put you at greater risk of

Answer 39

UTIs and genital infections (candidiasis) because there's more glucose for microorganisms

Question 40

pros of SGLT-2 inhibitors

Answer 40

weight loss, improves CV morbidity/mortality

Question 41

where are SGLT-2 transporters found

Answer 41

in the proximal tubule of the kidney

Question 42

cons of SGLT-2 inhibitors

Answer 42

urogenital infections, expensive, risk of DKA, can't use in renal impairment

Question 43

which drugs can be used in pregnancy/breastfeeding

Answer 43

metformin and one or two thiazolidinediones

Question 44

a drug ending in ...glitazone is what class

Answer 44

thiazolidinediones

Question 45

drugs ending in ...gliptin are what class

Answer 45

DPP-IV inhibitors

Question 46

drugs that cause weight gain

Answer 46

sulphonylureas, glitazones and insulin

Question 47

drugs that cause weight loss

Answer 47

SGLT-2 inhibitors and GLP-1 analogues

Question 48

cheapest drugs

Answer 48

metformin, sulphonylureas and glitazones

Question 49

true/false sulphonylureas, glitazones and insulin have no renal restriction

Answer 49

true - most of the other ones can't be used if eGFR < 30/60

Question 50

drug that gives increased risk of bladder cancer

Answer 50

glitazones

Question 51

order of 1st, 2nd and 3rd line treatments

Answer 51

1st: metformin (sulphonylureas) 2nd: sulphonylureas (glitazones, DPP-IV inhibitors, SGLT-2 inhibitors) 3rd: (glitazones, DPP-IV inhibitors, SGLT-2 inhibitors, GLP-1 agonists, insulin)

Question 52

what drugs can be injected

Answer 52

GLP-1 analogues and insulin

Question 53

5 step framework

Answer 53

1. set target HbA1c 2. assess risk factors to be treated 3. review current treatments 4. what are the options 5. arrange a review

Question 54

how many people with diabetes in grampian

Answer 54

28,000