Paper II — 2021 May (Supplementary) (2010 Scheme) — Q1
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Paper II
2021 May (Supplementary) (2010 Scheme)
Question
Classify Oral Anti diabetic drugs. Describe the mechanism of action,
therapeutic uses and adverse effects of Metformin.
(2+2+1+1)2. A 30 years old male patient admitted to hospital with a complaint of fever with chills
since 5 days. Severe headache and yellowish discolouration of conjunctiva present.
He is drowsy and irritable. Peripheral smear shows gametocytes of plasmodium
falciparum. He is using chloroquine since onset of fever but fever not subsided.
(a) What is the diagnosis of the clinical condition 1 mark(s)
(b) Classify drugs used in malaria 2 mark(s)
(c) Describe the management of above condition 2 mark(s)
(d) Mention two regimens of artemisinin based combination therapy 1 mark(s)
Q16 marksEssays
Answer
Question 1 — Oral antidiabetic drugs and Metformin
Classification of oral antidiabetic drugs
Sulfonylureas: Glibenclamide, Glimepiride
Biguanides: Metformin
Alpha-glucosidase inhibitors: Acarbose
Thiazolidinediones: Pioglitazone
DPP-4 inhibitors: Sitagliptin
SGLT2 inhibitors: Dapagliflozin
Mechanism of action of Metformin
Reduces hepatic gluconeogenesis, increases peripheral insulin sensitivity/glucose uptake by tissues, and mildly decreases intestinal glucose absorption
Does not stimulate insulin secretion (insulin-independent action) — does not cause hypoglycaemia when used alone
Therapeutic uses
First-line drug for type 2 diabetes mellitus (especially in obese/overweight patients)
PCOS (off-label, improves insulin resistance)
Adverse effects
GI upset (nausea, diarrhoea) — common
Lactic acidosis (rare but serious, especially with renal impairment)
Vitamin B12 deficiency with long-term use
Contraindicated in renal failure, severe hepatic disease, conditions predisposing to hypoxia/lactic acidosis
Question 2 — Falciparum malaria case
(a) Diagnosis
Severe/complicated P. falciparum malaria with jaundice and cerebral involvement (drowsiness, irritability) — features suggestive of cerebral malaria, in a patient who has failed initial chloroquine therapy (indicating chloroquine-resistant P. falciparum)
