Endocrinology

Question 1

Metformin

Answer 1

MOA: reduces hepatic glucose output, lowers fasting glucose levels

Contraindications: renal impairement (<30), severe hepatic impairement

Precautions: suspend treatment during acute disease

Adverse events:

• GIT side effects (improved with XR)
• Lactic acidosis
• Weight neutral

Question 2

SGLT-2 Inhibitors

Answer 2

Inhibits the Na-Glu cotransporter to induce urinary glucose loss and decrease blood glucose levels

Contraindications: diminised efficacy with renal impairement (<45)

Precautions:

• avoid with loop diuretics, low carb intake, bowel prep, preop
• cease if fasted or unwell

Adverse events:

• dehydration. dizziness
• genitourinary infections (need adequate fluid intake and meticulous toileting hygiene)
• euglycaemic ketoacidosis; Fournier’s gangrene
• weight loss

Improved cardiovascular outcomes and reduced risk of nephropathy

Question 3

DPP4-Inhibitors

Answer 3

MOA: decreased inactivation of glucagon-like peptide (GLP-1) increasing availability
Stimulated beta cell insulin release

Contraindications

• pancreatitis
• hospitalisation due to heart failure

Adverse events:

• rash
• pancreatitis
• GI disturbances
• weight neutral

Question 4

Sulfonylureas

Answer 4

Triggers insulin release in a glucose-independent manner

Contraindications: severe renal and hepatic impairement

Precautions
- hypoglycaemia

Adverse S/E
- weight gain

Going out of favour

Question 5

GLP-1 Receptor Agonists

Answer 5

MOA: stimulated beta-cell insuline release and slows gastric emptying

Contraindications:
- avoid with history of pancreatitis or pancreatic malignancy

Precautions

• Dosage adjustment in mod-severe renal impairement
• increase risk of pancreatitis

Adverse Effects:

• Nausea/vomiting
• Weight loss

Semaglutide not with insulin

Question 6

Acarbose

Answer 6

MOA: slows intestinal carbohydrate absorption and reduces postprandial glucose levels

Contraindications: severe renal impairement (<25)

Precautions:
- GI disorders associated with malabsorption

S/E

• bloating and flatulence
• weight neutral

Question 7

Thiazolidinediones

Answer 7

MOA: trasncription factor peroxisome proliferator - activated receptor PPAR-y agonists
Lowers glucose levels through insulin sensitisation

Precautions: symptomatic heart failure

S/E

• fluid retention, heart failure
• increase risk of non-axial fractures in women
• increased risk of bladder cancer
• weight gain