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Aspen Medical Practice > Diabetes > Flashcards

Diabetes Flashcards

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USMLE® Step 1 flashcards
1
Q

Name 3 suphonylureas

A
  1. gliclazide
  2. glimepride
  3. glipizide
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2
Q

moa - suphonylureas

A

Act directly on B-cells in pancreas to simulate insulin production

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3
Q

What are main disdvantages of suphonylureas? (4)

A
  1. higher risk of hypoglycaemia
  2. Weight gain
  3. Glucose-lowering effect wanes with time
  4. Many drug interactions
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4
Q

suphonylureas and hypos - what increases the risk? (2)

A

increased fraility and falling eGFR (reduce dose if eGFR <45)

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5
Q

Name 3 “Gliptins” (from list of 5)

A
  1. sitagliptin
  2. saxagliptan
  3. linagliptan
  4. alogliptan
  5. vildagliptan
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6
Q

MOA - Gliptans

A

Inhibit DPP4 enzyme that usually inactivates GLP1 - therefore physiological effect of GLP1 is prolonged.

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7
Q

What is GLP1?

A

A hormone (incretin) released from the intestine in response to eating.

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8
Q

What does GLP1 do? (4)

A
  1. Increases insulin production from Beta pancreas cells.
  2. Suppresses glucagon release from Alpha cells
  3. Slows gastric emptying.
  4. Reduces appetite
    NOTE: GLP1 secretion is impaired with T2DM.
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9
Q

Which medications are good for fraility/ renal impairment?

A
  1. DPP4 Inhibitors (Gliptans)
  2. ?
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10
Q

What class to these belong to?
sitagliptin, saxagliptan, linagliptan, alogliptan, vildagliptan

A

DPP4 Inhibitors - gliptans

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11
Q

What is the full name of SGLT2 Inhibitors?

A

Sodium-Glucose Co-Transporter-2 Inhibitors

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12
Q

Give 2 examples of SGLT2-Inhibitors (4)

A
  1. dapaglifozin
  2. empaglifozin
  3. canagliflozin
  4. ertugliflozin
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13
Q

MOA - SGLT2-Inhibitors

A

increases renal secretion of glucose

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14
Q

Given the MOA of SGLT2 Inhibitors - what are the side effects? (2)

A
  1. Increase incidence of genitourinary infections - e.g. thrush (note this should reduce as glycaemic levels are controlled)
  2. mild risk of volume depletion
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15
Q

Given the MOA of SGLT2 Inhibitors - what can reduce it’s efficacy?

A

Decreased renal function

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16
Q

SGLT2 Inhibitors and the elderly - what do you need to be careful of?

A

Combined use of diuretics causing volume depletion, e.g. dapaglifozin

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17
Q

Which medication is associated with euglycaemic DKA?

A

SGLT2 Inhibitors, e.g. dapaglifozin

18
Q

Which medication would you give for HF patients? (HFrEF)

A

SGLT2 Inhibitors, e.g. dapaglifozin or empaglifozin

19
Q

What do ACEi and SGLT2 medications have in common?

A

Both are renal protective

20
Q

SGLT2s are cardiac and renal protective, but if patient has CKD, what’s the problem?

A

Not much glycaemic control! (if eGFR <45)

21
Q

Which SGLT2 would be preferred

A

Dapaglifozin

22
Q

SADMAN includes which diabetic medication?

A

SGLT2, e.g. dapaglifozin or empaglifozin

23
Q

When should you avoid using SGLT2s?

A
  1. If on ketogenic diet
  2. Acutely unwell patient
  3. Past history of DKA
  4. Alcohol abuse/ high consumption
24
Q

What must you always do before starting SGLT2s? e.g. dapaglifozin or empaglifozin

A

Review other diabetic medications , and reduce dose by 25% if risk of hypoglycaemia.

25
Q

What are the symptoms of DKA?

A

nausea, vomiting, abdominal pain, stupor, fatigue, difficulty breathing. Check ketones!

26
Q

If metformin is not well-tolerated, what would be a good subsitute?

A

SGLT2,
e.g. dapaglifozin or empaglifozin

27
Q

What does GLP1 (RA) stand for?

A

Glucagon-Like Peptide Receptor Agonists

28
Q

Name 2 GLP1 receptor agnoist medications (5)

A
  1. Semaglutide
  2. dulaglutide
  3. lixisenatide
  4. liraglutide
  5. exenatide
29
Q

What’s the advantages of GLP1 medications (5)(e.g. semaglutide)

A
  1. Potent
  2. Promotes weight loss
  3. low risk of hypoglycaemia
  4. can be use in moderate-severe renal function
  5. Some CVD protection
30
Q

Disadvantages of GLP1 medications (3) e.g. semaglutide

A
  1. Injectable
  2. GI s/e common
    3.expensive
31
Q

Why stop a gliptan if starting a GLP1 medication?

A

Because they both affect the same pathway. GLP1 “trumps” the gliptin

32
Q

MOA - pioglitazone

A

affects expression of genes which has the effect of potentiating the effect of insulin.

33
Q

Advantages of pioglitazone? (7)

A
  1. Potent
  2. Reduces insulin resistance
  3. Low cost
  4. low risk of hypoglycaemia
  5. Improves lipid profile
  6. Can be used in CKD down to low eGFRs
34
Q

Disadvantages of pioglitazone? (5)

A
  1. Significant weight gain (oedema and subcutaneous adipose tissue - not visceral!)
  2. CONTRAINDICATED in HF
  3. need to check for haematuria before starting - now discounted risk of bladder cancer
  4. Increased fracture risk (do FRAX score)
  5. Slow onset of action - benefits can take up to 3 months.
35
Q

What’s the problem with recognising hypogycaemia in the elderly?

A

often loss of typical autonomic responses such as palpitations, and sweating.

36
Q

How might a hypo present within the elderly?

A

confusion, drowsiness, unsteadiness, light-headedness - consider if >75 yrs with HbA1c <53

37
Q

Why is a higher HbA1c associated with lower average blood glucose in older people? (2)

A
  1. Lower RBC turnover
  2. Their cell membranes are more friable and prone to glycosylation
38
Q

With frailty there is a loss of adipose tissue - what implication does this have?

A

Less insulin needed as underlying insulin resistance declines.

39
Q

Why is it important to monitor eGFR?

A

As eGFR falls, the risk of hypoglycaemia increases as excretion on medication takes longer - especially with the elderly.

40
Q

What HbA1c levels are most favourable with frailty?

A

59-64 range

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099963/

41
Q

When is HbA1c unrealiable and falsely elevated?

A
  1. IDA - RBC span is increased (less turnover), therefore more glucose exposure.
  2. Vit B12 deficiency (less RBC turnover)
  3. Chronic blood loss
  4. Pregnancy ( can be up or down)

Aspen Medical Practice (4 decks)

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