Endocrine - T2DM Meds

Question 1

Common side effects for metformin?

Answer 1

Gi side effects - change to mr?

Lactic acidosis - build up of lactic acid

Question 2

Which vitamin levels are reduced in metformin use?

Answer 2

Vitamin B12 (cobalamin - folate DNA vit)

Question 3

What egfr should metformin be avoided in?

Answer 3

EGFR less than 30ml/min/1.73m^2

Question 4

If pt has AKI and takes metformin?

Answer 4

STOP IMMEDIATELY AS Lactic acidosis side effect with it can be fatal

Question 5

Long acting Sulphonyureas?

Answer 5

Gilbenclamide
Glimepride

Question 6

Sulphonyureas and elderly?

Answer 6

Avoid taking long acting Sulphonyureas

Can cause falls due to increased Hypoglycaemia risk

Question 7

Why are targets for Sulphonyureas 7.0% instead of 6.5%?

Answer 7

Increased risk of Hypoglycaemia

Question 8

Which other pt’s should avoid Sulphonyureas?

Answer 8

Hepatic & Renal failure

Elderly

Acute Porphyria pts (build up haemoglobin parts)

Question 9

Which Anti diabetic med to avoid in heart failure?

Answer 9

Pioglitazone

Question 10

Pioglitazone increases the risk of what conditions?

Answer 10

Bladder cancer
Bone fractures
Liver toxicity

BBL

Question 11

Pioglitazone bladder cancer signs to report?

Answer 11

Haematuria
Dysuria
Urinary urgency

URINE ISSUES*

Question 12

DPP - 4i examples?

Answer 12

-Gliptins

Question 13

Which DPP-4i is hepatotoxic?

Answer 13

Vildagliptan

Question 14

Which major condition can DPP-4i cause?

Answer 14

Pancreatitis - discounting severe abdominal pain

Question 15

SGLT-2i examples?

Answer 15

Canagliflozin
Empagliflozin
Dapafliglozin

Question 16

How does the MOA of sglt2i relate to its side effect of Hypovalaemia?

Answer 16

Urinate a lot therefore volume depletes

Question 17

MHRA warning of SGLT-2i?

Answer 17

1) Diabetic Ketoacidosis

Therefore monitor ketones in illness/surgey

2) Fournier gangrene (scrotum infection)

3) Canagliflozin only can risk of lower limb amputation (toes)

Question 18

Which SGLTI-2i med can cause lower limb amputation?

Answer 18

Canagliflozin

Question 19

Which condition is Empagliflozin and Dapagliflozin licensed for other than diabetes?

Answer 19

HF (Heart failure)

**NOT Canagliflozin

Question 20

Which antidiabetic med can cause UTI’s? And why?

Answer 20

SGLT-2i

Because of MOA encourages increased urination out which causes infection

Question 21

Glp-1 examples?

Answer 21

-glutides

Question 22

MHRA warning in GLP - 1 Agonist?

Answer 22

Risk of Diabetic Ketoacidosis (when used with insulin which is rapidly reduced - leading to poor glycemic control and therefore DKA)

Question 23

Which conditions can GLP-1 cause?

Answer 23

• DKA
• ACUTE PANCREATITIS (severe abdominal pain)
• DEHYDRATION (due to gi side effects)

Question 24

Which anti-diabetic meds can cause pancreatitis?

Answer 24

DPP - 4i and GLP - 1

Both lower glucagon secretion

Question 25

Which Anti-diabetic meds cause DKA?

Answer 25

SGLT-2i and GLP-1

Question 26

Acarbose side effects?

Answer 26

• GI SIDE EFFECTS
• HYPOCALCAEMIA
• LIVER disorder

Question 27

Meglitides examples?

Answer 27

Nateglinide & Repaglinide

Question 28

Meglitides side effects?

Answer 28

Stress exposure
- may need to interrupt treatment or replace with insulin to maintain glycemic control)

Question 29

Which anti-diabetic meds cause Weight gain?

Answer 29

Sulphonyureas & Pioglitazone

Question 30

Which anti-diabetics cause weight loss?

Answer 30

GLP-1 & SGLT-2

Same as those tht cause DKA

Question 31

Which antidiabetic med causes both pancreatitis and DKA?

Answer 31

GLP-1

Question 32

Which anti-diabetic med doesn’t affect weight?

Answer 32

DPP-4i

And metformin as updated 04/24

Question 33

Which anti diabetic med requires immediate medical attention if pt enters hypoglycaemic state due to risk of prolongation?

Answer 33

Gliclazide