Type II Diabetes

Question 1

What are the classes of drugs used to treat type II Diabetes?

Answer 1

Insulin secretagogues, insulin sensitizers, alpha-glucosidase inhibitor, Dipeptidyl Peptidase IV (DPP-IV) inhibitors, Glucagon-like peptide-1 (GLP-1) Mimetic, Sodium-glucose co-transporter 2 (SGLT2) inhibitors

Question 2

What do Insulin secretagogues do?

Answer 2

Increase basal and/or postprandial insulin levels.
They reduce microalbuminuria
ACTIONS DEPEND OF FUNCTION BETA CELLS

Question 3

What types of drugs are Insulin secretagogues?

Answer 3

Solfonylureas (1-2 times daily) and Meglitinides (3-4 times daily)

Question 4

What are the adverse effects of insulin secretagogues?

Answer 4

Weight gain, hypoglycaemia

Question 5

What is the MOA of Sulfonylureas?

Answer 5

↑ insulin secretion
↓ hepatic clearance of
insulin
↓ Glucagon levels

Question 6

What drugs are Sulfonylureas?

Answer 6

Glibenclamide & Gliclazide (Long acting 24 hrs)
Glipazide & Glimepiride (Short acting 12-24 hrs)

Question 7

Where are Sulfonylureas’ metabolised?

Answer 7

In the liver

Question 8

T or F - Sulfonylureas’ do not cross the placenta

Answer 8

False, they do

Question 9

What are the CI for Sulfonylureas’?

Answer 9

Hepatic/renal impairment

Question 10

What are the adverse effects of Sulfonylureas’?

Answer 10

Hypoglycemia, nausea, vomiting, allergic skin reactions,
minor disulfiram-like reactions, headache, cardiotoxicity

Question 11

What are the drug interactions of Sulfonylureas’?

Answer 11

Aspirin & Sulphonamides potentiate the effects of SUs
Hepatic enzyme inducers, corticosteroids, oral
contraceptives ↓ the effects of SUs
β-blockers mask the signs of hypoglycemia

Question 12

What are the two types of Meglitinides?

Answer 12

Repaglinide and Nateglanide

Question 13

T or F - Meglitinides have a slow onset and long duration of action?

Answer 13

False. They have a rapid onset and are short acting

Question 14

What is the MOA of Meglitinides?

Answer 14

Bind to ATP-dependent K+ channels,
causing insulin release

Question 15

What drugs can Meglitinides be combined with?

Answer 15

metformin or thiazolidinediones

Question 16

What are the adverse effects of Meglitinides?

Answer 16

Hypoglycemia
Upper respiratory tract infections
Weight gain
Bronchitis
Headache

Question 17

What drugs are Thiazolidinediones?

Answer 17

Rosiglitazone (withdrawn) and Pioglitazone

Question 18

What is the MOA of Thiazolidinediones?

Answer 18

Agonist at peroxisome proliferator-activated receptor – γ (PPARγ). Induces insulin genes

Question 19

What are the therapeutic uses of Thiazolidinediones?

Answer 19

Monotherapy
With Sulfonylureas
With Metformin
With injected insulin

Question 20

What are the cautions with Thiazolidinediones?

Answer 20

Heart failure

Question 21

What are the adverse effects of Thiazolidinediones?

Answer 21

Fluid retention (oedema)
Weight gain
Anaemia
CVD
Increased risk of cardiac ischaemia

Question 22

What drug is a Biguanide?

Answer 22

Metformin

Question 23

What is the use of Metformin?

Answer 23

Obese pts- decrease their body weight

Question 24

What is the MOA of Metformin?

Answer 24

Decrease hepatic glucose synthesis and increase glucose uptake from muscles

Question 25

What are the therapeutic uses of Metformin?

Answer 25

In combination with SUs, meglitinide, thiazolidinediones, insulin, or α-glucosidase inhibitor

Question 26

What are the adverse effects of Metformin?

Answer 26

GI disturbances – abdominal discomfort and diarrhoea, metallic taste, mild anorexia Lactic acidosis

Question 27

What are the CI of Metformin?

Answer 27

Renal Impairment & hepatic disease * Alcohol abuse * If predisposed to CV collapse, acute CHF, severe infection * History of lactic acidosis

Question 28

What is the drug that belongs to the α-glucosidase inhibitor class?

Answer 28

Acarbose

Question 29

What is the MOA of Acarbose?

Answer 29

* Inhibits the breakdown of complex CHO in small intestine * Delays CHO absorption * Inhibits glucoamylase > sucrase > maltase > dextranase

Question 30

What are the benefits of Acarbose?

Answer 30

* ↓s postprandial hyperglycemia (hypoglycemia – rare) * No effect on lipids or insulin levels

Question 31

What are the adverse effects of Acarbose?

Answer 31

GI disturbances * Dose-dependent toxicity

Question 32

What can Acarbose be combined with?

Answer 32

Can be combined with insulin, metformin or sulfonylureas – additive effect

Question 33

What are the CI of Acarbose?

Answer 33

* Inflammatory bowel disease, GI obstruction, cirrhosis

Question 34

What drugs are Dipeptidyl Peptidase IV (DPP-IV) Inhibitors?

Answer 34

Sitagliptin, Vildagliptin, Saxagliptin

Question 35

What is the MOA of DPP-IV inhibitors?

Answer 35

Inhibits DPP-IV. Extend action of insulin while suppressing release of glucagon

Question 36

What can DPP-IV inhibitors be combined with?

Answer 36

Insulin, metformin or sulfonylureas – additive effect

Question 37

What are the adverse effects of DPP-IV inhibitors?

Answer 37

Gastrointestinal discomfort, peripheral oedema, liver dysfunction

Question 38

What is the caution associated with DPP-IV inhibitors?

Answer 38

Renal impairment

Question 39

What are Glucagon-like peptide-1 (GLP-1) drugs?

Answer 39

Dulaglutide, Exenatide, Liraglutide, Semaglutide

Question 40

What is another name GLP-1 drugs?

Answer 40

Incretin Mimetics

Question 41

What is the MOA for GLP-1 drugs?

Answer 41

Incretin mimetic. Increase Insulin secretion and decrease glucagon secretion

Question 42

What are 2 additional benefits of GLP-1 drugs?

Answer 42

Promote weight loss and cardiovascular benefits

Question 43

What are the adverse effects of GLP-1 drugs?

Answer 43

* Hypoglycemia, * Nausea, vomiting, rash * pancreatitis

Question 44

What are the contraindications for GLP-1 drugs?

Answer 44

Type 1 diabetes, ketoacidosis, severe renal impairment. * Not for use in pregnancy

Question 45

What drugs are Sodium-glucose co-transporter 2 (SGLT2) inhibitors?

Answer 45

Dapagliflozin, Canagliflozin, Empagliflozin

Question 46

What is the MOA of SGLT2 inhibitors?

Answer 46

Competitive, selective inhibitor of SGLT-2 – preventing kidneys from reabsorbing glucose into the blood

Question 47

What are the CI for SGLT2 inhibitors?

Answer 47

Renal impairment * Not for use in pregnancy or lactation

Question 48

What can SGLT2 inhibitors be combined with?

Answer 48

Can be combined with metformin, pioglitazone or sitagliptin

Question 49

What are the AE of SGLT2 inhibitors?

Answer 49

Increased risk of genital and urinary tract infections * Hypotension