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Drugs MRCP > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the mechanism of action of metformin?

A

Activation of AMP-activated protein kinase to
- increase insulin sensitivity
- decreases hepatic gluconeogenesis
- reduce GI absorption of carbohydrates

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2
Q

What are the adverse effects of metformin?

A

GI side effects - 20% - nausea, anorexia, diarrhoea
Lactic acidosis
Decreased B12 absorption

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3
Q

What are contraindications for metformin?

A

CKD - Cr >150, eGFR <30
Alcohol abuse

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4
Q

When should metformin be withheld?

A

MI
infection, sepsis
AKI, severe dehydration
48 hours post contrast

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5
Q

What are the benefits of metformin?

A

Don’t cause hypoglycaemia or weight gain

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6
Q

What are the SGLT-2 inhibitors?

A

Gliflozins

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7
Q

What is the mechanism of SGLT-2 inhibitors?

A

Inhibit sodium-glucose cotransporter 2 to prevent reabsorption of glucose in kidney

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8
Q

What are the adverse effects of SGLT-2 inhibitors?

A

UTI - due to glucosuria
Euglycaemic DKA

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9
Q

When are SGLT-2 inhibitors indicated in T2DM?

A

Established cardiovascular disease or chronic heart failure, or QRISK >10%

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10
Q

2 examples of sulfonylureas

A

Gliclazide, glimepiride

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11
Q

What is the mechanism of sulfonylureas?

A

Increase pancreatic release of insulin via ATP-K channels

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12
Q

What are the adverse effects of sulfonylureas?

A

Hypoglycaemia
Weight gain
SIADH
Cholestatic liver dysfunction

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13
Q

1 example DPP-4 inhibitor

A

Sitagliptin

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14
Q

What is the mechanism of DPP-4 inhibitors?

A

Inhibit breakdown of incretin to increase insulin secretion and inhibit glucagon secretion

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15
Q

What are the adverse effects of DPP-4 inhibitors?

A

Pancreatitis

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16
Q

What is an example of thiazolidenidione?

A

Pioglitazone

17
Q

What is the mechanism of action of pioglitazone?

A

Reduces insulin resistance in liver and peripheral tissues

18
Q

What are the adverse effects of pioglitazone?

A

Peripheral oedema
Weight gain
Liver dysfunction
Fractures

19
Q

1 example GLP-1 drug

A

Liraglutide

20
Q

What is the mechanism of GLP-1 drugs?

A

Glucagon like peptide 1
Incretin mimetic - reduces glucagon secretion

21
Q

What is the main adverse effect of GLP-1 drugs?

A

N&V

22
Q

What is the benefit of GLP-1 drugs?

A

Weight loss

23
Q

When are GLP-1 drugs indicated?

A

BMI >35
BMI <35 but not suitable for insulin or would benefit from weight loss

Drugs MRCP (7 decks)

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