Type two diabetes (R1): pharmacology

Question 1

Insulin
- 3 ADRs?

Answer 1

Hypoglycaemia + weight gain
Lipodystrophy

Question 2

Sulfonylureas
- MOA?
- Names?

Answer 2

Inactivates K+ channel in beta cells –> depolarisation –> increased insulin secretion

Gli- prefix, eg. gliclazide

Question 3

Sulfonylureas
- Binds to what blood protein
- How is it excreted
- Hence, longer duration of action in ______ and ______ impairment –> beware.

Answer 3

Albumin (made by liver)
Excreted renally

Question 4

Sulfonylureas
- 2 ADRs?

Answer 4

Hypoglycaemia (too much insulin production) + weight gain

Question 5

Metformin
- Is it the first line drug to treat T2DM?
- MOA?

Answer 5

Yes

MOA
- Reduces hepatic GNG
- Increases tissue utilisation of glucose (eg. liver, muscle, fat)
- Reduces carbohydrate absorption from the intesitne

Question 6

Metformin
- Can it cause hypoglycaemia when used on its own?
- Contraindications?

Answer 6

• No
• Renal + hepatic impairment

Question 7

Metformin
- ADRs?

Answer 7

Question 8

SGLT2 inhibitors
- MOA?
- Is it protective cardiac and renal wise?

Answer 8

Inhibits SGLT2 cotransporter in the proximal convoluted tubule (ie. reduces glucose reabsorption)
Greater glucose excretion –> lowered BGls

Potentially

Question 9

SGLT2 inhibitors
- Naming?
- Risk of hypoglycaemia?

Answer 9

-gliflozin: eg. empagliflozin, dapagliflozin
- Low risk of hypoglycaemia when used on its own, increased when combined with insulin or sulfonylureas

Question 10

SGLT2 inhibitors
- ADRs?

Answer 10

Glucosuria –> UTIs and thrush, balanitis
Osmotic excretion of water –> polyuria, hypotension, dehydration
Euglycemic ketoacidosis

Question 11

GLP-1 analogues
- Glucagon like peptide 1
- MOA?

Answer 11

Increases insulin secretion + decreased glucagon secretion –> decreased BGls
Decreased appetite
Slows gastric emptying

Question 12

GLP-1 analogues
- Examples?
- Risk of hypoglycaemia?
- Route of administration?

Answer 12

• Semaglutide (eg. Ozempic, Wegovy)
• Low risk of hypoglycaemia when used on its own, increased when combined with insulin or sulfonylureas
• Subcutaneous injection

Question 13

GLP-1 analogies
- ADRs?

Answer 13

GI related ADRs
Fatigue
Rare pancreatitis

Question 14

DPP-4 inhibitors
- MOA?

Answer 14

Inhibit dipeptidyl peptidase 4 –> reduce inhibition of GLP-1

Question 15

DPP-4 inhibitors
- Naming?
- RIsk of hypoglycaemia?

Answer 15

• gliptin: eg. sitagliptin, linagliptin
• Low risk of hypoglycaemia when used on its own, increased when combined with insulin or sulfonylureas

Question 16

DPP-4 inhibitors
- ADRs?

Answer 16

Mild GI ADRs
Headache
MSK pain