ANTIDIABETIC DRUGS: SGLT-2i

Question 1

MOA

Answer 1

Inhibits sodium-glucose co-transporter 2 in renal tubule = reduced glucose reabsorption = increased urinary excretion

Question 2

High CVD risk

Answer 2

Stabilised on metformin + SGLT2i 1st line

Question 3

Examples

Answer 3

Dapagliflozin
Empagliflozin
Canafliflozin
Ertygliflozin

Question 4

Dapagliflozin dose

Answer 4

10mg OD

Question 5

Empagliflozin (HF) dose

Answer 5

10mg OD

Question 6

Empagliflozin (T2DM)

Answer 6

10-25mg OD

Question 7

Canagliflozin dose

Answer 7

100-300mg OD (before breakfast)

Question 8

Ertugliflozin dose

Answer 8

5-15mg OD

Question 9

MHRA warning

Answer 9

• Life-threatening, and fatal cases of diabetic ketoacidosis (DKA)
• Monitor ketones if treatment interrupted for surgical procedures or illness
• Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
• Canagliflozin only: risk of lower-limb amputation (mainly toes)

Question 10

SE

Answer 10

• volume depletion
• constipation
• thirst
• nausea
• UTI, genital infection, polyuria
• hypo (in combo with insulin or SU)

Question 11

Volume depletion

Answer 11

correct hypovolaemia before starting treatment
- this drug makes you urinate a lot
- report: postural hypotension, dizziness

Question 12

Life threatening DKA

Answer 12

Moderately raised blood glucose
Stop and test for ketones if DKA suspected
Report DKA symptoms

Question 13

Canagliflozin

Answer 13

MHRA/CHM
- Increased risk of lower limb amputation (mainly toes)

Counsel pt to report:
- Skin ulceration
- Discolouration
- New pain

Stay hydrated, preventative foot care, recognise/treat foot problems early

Question 14

Cautions

Answer 14

• HT
• elderly
• DKA
• Volume depletion (correct before starting)
• Renal impairment