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Refreshers > T2DM > Flashcards

T2DM Flashcards

1
Q

what is the cause of t2dm

A

insulin deficiency and bodys inability to effectively use it

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2
Q

why might type 2 diabetes be present and go undiagnosed for a number of years

A

symptoms slower in onset and less severe

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3
Q

why is t2dm classfied as a cardiorenal metabolic syndrome

A

micro and macro vascular complications mean it has a significant effect on mortality and morbidity

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4
Q

the prevalence increases with different risk factors, list some of these

A

age
obesity
lack of physical exercise
htn
elevated blood lipids

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5
Q

list some modifiable risk factors for t2dm

A

blood pressure
cholesterol
inactivity
obesity
diet
alcohol
smoking

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6
Q

list some non modifiable risk factors for t2dm

A

age
sex
ethnicity
genetics
socioeconomic status

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7
Q

what is the term given to diabetic damage to the small blood vessels such as those in the eyes (retinopathy), kidneys (nephropathy) and feet/legs (neuropathy)

A

microvascular disease

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8
Q

what is the term given to the complications that diabetes causes to the medium to large blood vessels which can lead to:
coronary artery disease
cerebrovascular disease
peripheral vascular disease

A

macrovascular disease

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9
Q

drug class of metformin

A

biguanide

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10
Q

moa of metformin

A

potentiation of insulin action stimulates tissue uptake of glucose and reduces GI absorption of carbohydrates

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11
Q

metformin commonly causes gi disturbances but is useful first line for what reason

A

weight neutral

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12
Q

drug class of the following

gliclazide
glibenclamide
glimipiride

A

sulfonurea

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13
Q

moa of gliclazide and other sulfonureas

A

increase pancreatic beta cells sensitivity to glucose = more insulin to be released from storage granules for a given glucose load

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14
Q

sulfonureas like gliclazide are well tolerated but limited by what side effects

A

weight gain and hypoglycaemia

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15
Q

drug class of nateglinide and repaglinide

A

meglitinide

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16
Q

meglitinides moa

A

inhibit atp sensitive k channels
depolarization of ca channels
intracellular conc of ca increases
stimulates insulin release

17
Q

benefits of meglitinides

A

rapid onset action
short duration
can be used flexibly around mealtimes
can be adjusted around eating habits

18
Q

what is the drug class of pioglitazone and other glitazones/ thiazolidinediones

A

ppar agonist
enhance insulin sensitivity and promote glucose uptake utilization in peripheral tissue
suppress gluconeogenesis

19
Q

use of pioglitazone must be continually reviewed and treatment stopped if response is insufficient, what are the associated long term side effects

A

hf and bladder cancer

20
Q

how do dpp4 inhibitors/ gliptins work

A

block normal enzymatic inactivation of incretins, dpp4 and gip
increase endogenous insulin in response to glucose post prandially
reduce amount of glucose produced by liver

21
Q

true or false, dpp4 inhibitors do not require dose adjustments in the case of renal failure

A

false

22
Q

give some benefits of dpp4 inhibitors over sulfonylureas

A

not associated with weight gain and less hypoglycaemia

23
Q

dulaglutide and similar ending drugs are glp1 receptor agonists, how do they work

A

bind and activate glp1 receptor
increase insulin secretion
suppresses glucagon secretion
slow gastric emptying
lower blood glucose levels

24
Q

true or false, glp 1 receptor agonists have been reserved for combination therapy when other treatment options have failed

A

true

25
Q

name a glp 1 receptor agonist that has been shown to have cv benefit and should be considered in patients with t2dm and established cvd

A

liraglutide

26
Q

give one advantage of glp 1 receptor agonists esp injections in terms of side effect profile

A

positive effect on weight

27
Q

sglt2 inhibitors are also known as gliflozins, how do they work

A

block glucose reabs in kidneys
promote excretion of excess glucose in urine

28
Q

sglt2 inhibitors may be suitable for some patients when first line options are not appropriate but use is associated with risk of what?

A

DKA

29
Q

which of the oral antidiabetic drugs is contraindicated in patients with heart failure

A

pioglitazone

30
Q

All patients with Type 2 diabetes with chronic heart failure or established atherosclerotic CVD should be offered which class of drugs as soon as metformin tolerability is confirmed? Why?

A

sglt2 inhibitor with proven cv benefit as they have been proven to have cv outcomes

31
Q

For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol . For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of

A

53

32
Q
A

Refreshers (10 decks)

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