A 65-year-old lady attends the pharmacy for renewal of medications. Her prescription includes metformin and gliclazide which she has been taking for the past two years. You note she is newly started on empagliflozin. He blood pressure is 100/65 mm Hg. Her fasting plasma glucose was 7.0 mmol/L. Her renal function is normal.

a) For what disease is she taking these medications? (1 mark)

b) What is the most common side effect of metformin? What preparation may help reduce this adverse effect? (2 marks)

c) What class of drug does gliclazide belong to? What is the mechanism of action of gliclazide? (3 marks)

d) Give TWO risk factors that will increase the risk of hypoclycemia in patients being treated with gliclazide. (2 marks)

e) What class of drug does empagliflozin beling to? What is its mechanism of action? Name THREE potential adverse effects associated with this class of drugs. (6 marks)

f) Apart from glucose lowering effects, give TWO additional beneficial effects of empagliflozin (2 marks)

g) She is due to a colonoscopy in three days time. She will be receiving bowel preparation the day before the colonoscopy. She will be fasted from midnight and the procedure will be performed at 9:00 am on the next day. How would you advise her on her usual glucose lowering medications? What are the potential risks if her usual glucose lowering medications are continued? (4 marks)

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