T2DM Drugs Flashcards
Metformin - side effects
GI upset
Lactic acidosis
Metformin - contraindictations
eGFR <30
Metformin - mechanism of action
Increases insulin sensitivity and decreases hepatic gluconeogenesis
Sulfonylureas - example
Gliclazide
Glimepiride
Sulfonylureas - mechanism of action
Stimulate beta cells to produce insulin
Sulfonylureas - side effects
Hypoglycaemia
Weight gain
Hyponatraemia/SIADH
Thiozolidinediones - example
Pioglitazone
Pioglitazone - mechanism of action
Activate PPAT-gamma which increases adipogenesis and the uptake of fatty acids
Pioglitazone - side effects
Weight gain
Fluid retention
Deranged LFTs
Fracture
DPP-4 Inhibitor - examples
-gliptins
DPP-4 inhibitors - mechanism of action
Increases incretin which inhibits glucagon secretion
DPP-4 inhibitors - side effects
Risk of pancreatitis
SGLT-2 Inhibitors - examples
-gliflozins
SGLT-2 inhibitors - mechanism of action
Inhibits reabsorption of glucose in the kidneys
SGLT-2 inhibitors - side effects
UTI, weight loss
GLP-1 Agonists - example
-tides
GLP-1 agonist - mechanism of action
Incretin mimetic - inhibits glucagon secretion
GLP-1 agonist - side effects
N+V
Pancreatitis
Weight loss
Which T2DM drug is given subcut?
GLP-1 agonists (-tides)
Which of the T2DM drugs are hypoglycaemic agents?
Sulfonylureas
Which cause weight gain?
Sulfonylureas
Pioglitazone
Which drugs can be used as normal during surgery?
DPP-4 inhibitors and GLP-1 agonists
How should metformin be altered for surgery?
If OD or BD - take as normal
If TDS - omit lunchtime dose
How should sulfonylureas be altered for surgery?
If OD - omit
If BD - omit morning dose (if afternoon operation, omit both doses)
How should SGLT-2 inhibitors be altered for surgery?
Omit dose on day
How should patients on insulin be managed during surgery?
If good glycaemia control and short op - usual regime
If long op, or very bad glycaemia control (HbA1c >69) - variable rate insulin infusion.
How should insulin doses be altered for surgery?
OD insulin - 20% lower dose day before and day of
BD insulin - half the morning dose on the day of only
