Antidiabetics - SGLT2 inhibitors

Question 1

What are diuretics?

1 - drugs that increase water, Na+ and Cl- excretion
2 - drugs that decrease water, Na+ and Cl- excretion
3 - drugs that increase water, K+ excretion
4 -drugs that decrease water, K+ excretion

Answer 1

1 - drugs that increase water, Na+ and Cl- excretion

• reduce fluid retention

Question 2

Where in the kidneys is blood filtered to form the filtrate?

1 - efferent arteriole
2 - afferent arteriole
3 - glomerulus
4 - juxtaglomerular

Answer 2

3 - glomerulus

Question 3

Once the filtrate is formed from the glomerulus, what happens to the fluid as it move through the tubules and out of the collecting duct as urine?

1 - only glucose is reabsorbed
2 - Na+ and K+ only are reabsorbed
3 - lots of ions and fluids are reabsorbed

Answer 3

3 - lots of ions and fluids are reabsorbed

• H2O, ions (K+, Na+, Cl-)
• what is left is urine

Question 4

Where are ions mainly re-absorbed in the renal system?

1 - loop of henle
2 - distal convoluted tubule
3 - proximal tubule
4 - collecting duct

Answer 4

3 - proximal tubule
- location of most diuretics actions

Question 5

Water passively follows ion re-absorption in the distal tubules of the renal system, which ion specifically does it follow?

1 - Na+
2 - K+
3 -Cl-
4 - HCO3-

Answer 5

1 - Na+
- due to osmosis (H2O dilutes Na+ in blood)

Question 6

Labels the parts of the renal tubules using the labels below:

1 - loop of henle
2 - distal convoluted tubule
3 - proximal tubule
4 - collecting duct

Answer 6

1 - proximal tubule
2 - loop of henle
3 - distal convoluted tubule
4 - collecting duct

Question 7

In normal physiology glucose passes through the glomerulus, into the filtrate and then through the collecting tubules. 100% is then reabsorbed by sodium-dependent glucose co-transporters (SGLT-2). Where in the renal tubules are sodium-dependent glucose co-transporters (SGLT-2) located?

1 - proximal convoluted tubules
2 - loop of henley
3 - collecting ducts
4 - distal convoluted tubules

Answer 7

1 - proximal convoluted tubules

Question 8

If there is hyperglycaemia, like when it occurs in T2DM there is too much glucose in the blood. What level must the blood glucose reach in order for the convoluted proximal tubule not to be able to absorb 100% of the glucose?

1 - >1mmol/L
2 - >5mmol/L
3 - >10mmol/L
4 - >20mmol/L

Answer 8

3 - >10mmol/L

Question 9

Which of the following is the core sodium-dependent glucose co-transporters (SGLT-2) inhibitor that we need to be aware of?

1 - Gliclazide
2 - Metformin
3 - Dapagliflozin
4 - Linagliptin

Answer 9

3 - Dapagliflozin

Question 10

In a normal healthy person glucose passes through the glomerulus, into the filtrate and then through the collecting tubules. 100% of the glucose is then reabsorbed along with Na+, mainly in the convoluted proximal tubule by sodium-dependent glucose co-transporters (SGLT-2) (except if glucose is above 10mmol/L). What is the mechanism of action of (SGLT-2) inhibitors?

1 - inhibit SGLT-2, K+ and glucose are not reabsorbed
2 - inhibit SGLT-2, Na+ and glucose are not reabsorbed
3 - activate SGLT-2, Na+ and glucose are not reabsorbed
4 - activate SGLT-2, Na+ and glucose are reabsorbed

Answer 10

2 - inhibit SGLT-2, Na+ and glucose are not reabsorbed

Question 11

Do sodium-dependent glucose co-transporters (SGLT-2) inhibitors affect insulin secretion?

Answer 11

• no

Question 12

Sodium-dependent glucose co-transporters (SGLT-2) inhibitors are an anti-diabetic medication, with the drug we need to know being Dapagliflozin. When can Dapagliflozin be used for treatment for hyperglycaemia in T2DM?

1 - if metformin is not tolerated
2 - part of dual therapy
3 - part of triple therapy
4 - all of the above

Answer 12

4 - all of the above

Question 13

In addition to being used to treat hyperglycaemia in T2DM, what other 2 conditions can SGLT-2 inhibitors be used to treat?

1 - hypertension
2 - heart failure with reduced ejection fraction
3 - CKD with albuminuria
4 - Mobitz type I block

Answer 13

2 - heart failure with reduced ejection fraction
- when other heart failure medications are insufficient to improve symptoms
- remove Na+ and fluid so beneficial

3 - CKD with albuminuria
- used with ACE-I or ARB-2

Question 14

As SGLT-2 inhibitors (Dapagliflozin) cause osmotic diuresis (H2O follows Na+ and then K+ follows, all with glucose) which of the following can SGLT-2 inhibitors cause as an adverse event?

1 - excessive thirst
2 - hypovolaemia
3 - electrolyte disturbance
4 - all of the above

Answer 14

4 - all of the above

Question 15

SGLT-2 inhibitors (Dapagliflozin) are used to excrete glucose in the urine, causing glycosuria. Can this increase or decrease the risk of infection?

Answer 15

• increased risk of UTIs
• severe but rarely it can cause Fourniers gangrene (necrotic infection of perineum)
• contact GP if any symptoms of UTIs

Question 16

In an acute illness that can cause hypotension or volume depletion, should SGLT-2 inhibitors (Dapagliflozin) be continued?

Answer 16

• no
• they can cause hypovolaemia

Question 17

Why should BP drugs and diuretics be used with caution in patients taking SGLT-2 inhibitors (Dapagliflozin)?

1 - increases risk of hypoglycaemia
2 - increased risk of DKA
3 - increased risk of HHA
4 - increased risk of hypovolaemia

Answer 17

4 - increased risk of hypovolaemia
- all can result in loss of fluids

Question 18

Which of the following if combined with SGLT-2 inhibitors (Dapagliflozin) can increase the risk of hypoglycaemia?

1 - metformin
2 - insulin
3 - DPP-4 inhibitors
4 - GLP-1
5 - alcohol
6 - all of the above

Answer 18

6 - all of the above
- all can cause hypoglycaemia
- together this risk is accentuated

Question 19

What is typically a starting dose of SGLT-2 inhibitors (Dapagliflozin)?

1 - 10mg OD
2 - 40mg OD
3 - 80mg OD
4 - 320mg OD

Answer 19

1 - 10mg OD
- need to adjust BP medication

Question 20

How are SGLT-2 inhibitors (Dapagliflozin) administered?

1 - orally
2 - IV
3 - SC
4 - MI

Answer 20

1 - orally
- can be with or without food
- should be taken same time of the day, BUT can be any time

Question 21

Which of the following should be assessed prior to administering SGLT-2 inhibitors (Dapagliflozin)?

1 - renal function
2 - liver function
3 - ejection fraction
4 - peripheral oedema

Answer 21

1 - renal function