Endocrine Flashcards
Monotherapy for T2 DM what is the drug given?
Metformin
Examples of dual therapy for T2 DM?
Metformin + SU
Metformin + pioglitazone
Metformin + DPP4 inhibitor
Metformin + SGLT-2i
Examples of triple therapy for T2 DM?
Metformin + DPP4 inhibitor + SU
Metformin + pioglitazone + SU
Metformin + SGLT-2i + pioglitazone/SU
Option x2 if triple therapy doesn’t work for T2 DM?
Insulin
Metformin + SU + GLP 1 mimetic
Metformin effect on weight?
Lose
Gliclazide effect on weight?
Gain
DPP4 inhibitor effect on weight?
Same
Glitazones effect on weight?
Gain
Metformin mechanism of action?
Reduce gluconeogenesis (gluconeogenesis increased in T2DM as excess glucagon)
Increased glucose uptake and utilization in skeletal muscle (increase insulin sensitivity)
Metformin side effects?
What is rarely observed and in who specifically?
GI disturbances - subsequent weight loss
Rarely lactic acid in renal disease, hepatic disease, heart failure
Sulfonylurea (SU) - gliclazide and glipizide mechanism of action?
Stimulate B cells to secrete insulin
SU contraindication and why?
Pregnancy and breastfeeding as can cross placenta so may cause hypoglycemia in newborns.
Sulfonylurea side effects x2?
Hypoglycemia and weight gain as stimulates the appetite.
DPP4 inhibitor example?
Sitagliptin
DPP4 inhibitors mechanism of action?
Inhibit DPP4 so increased effect of incretins such as GLP-1 and GIP which will stimulate insulin secretion
What are incretins?
Group of hormones released after eating and augment secretion of insulin
Glitazone example?
Pioglitazone
Glitazone mechanism of action
Enhance uptake of fatty acids and glucose by increasing sensitivity to insulin
Glitazone side effects? x2
Fluid retention - may worsen heart failure
Weight gain - fluid retention and fat gain
Metformin effect on weight?
Lost
Sulfonylurea such as gliclazide effect on weight?
Gain
DPP4 inhibitors effect on weight?
No change
Glitazones effect on weight?
Gain
