T2DM drugs :'( Flashcards
how sulfonylureas work
increase pancreatic insulin secretion
what must be functioning in order for sulfonylureas to work
beta cells
common SE SURS (2)
hypoglycaemia + weight gain
rare SE SURS (4)
hyponatraemia // hepatotoxic // bone marrow suppression // peripheral neuropathy
breastfeeding + pregnancy with SURS
no
examples SURS
-ide // Gliclazide, glipizide, tolbutamide
what type of drug is metformin
biguinde
mechanism metformin (4)
increases insulin sensitivity // decreases hepatic gluconeoheneosis // reduces GI absorption of carbs // (activates AMPK)
SE metformin (3)
GI upset // reduced B12 // lactic acidosis
who is lactic acidosis seen with metformin
liver or renal failure
contraindications metformin
CKD // tissue hypoxia (MI, AKI, dehydration) // iodine X rays // (alcohol abuse relative)
at what eGFR / creatinine is metformin stopped
eGFR <30// creatinine >150
why does metformin need to be titrated up slowly
reduce GI side effects
if patient has SE to metformin what type should be used
modified release
action Thiazolidinediones
PPAR gamma agonists –> reduce peripheral insulin resistance
what is the only Thiazolidinediones used now
pioglitazone
SE pioglitazone (5)
weight gain!! // liver impairment // fluid retention // FRACTURES // bladder cancer
when is pioglitazone contraindicated
heart failure (fluid retention)
where do SGLT2i act
proximal convoluted tubule kidney
mechanism SGLT2i
reversibly inhibit SGLT2i –> reduce reabsroption of glucose
SE SGLT2i
infection + fourniers gangrene // normoglycaemia ketoacidosis // lower limb amputation
benefots SGLT2i
weight loss + good for CVD
examples SGLT2i
-gliflozin, canagliflozin, dapagliflozin
what is GLP1
hormone incretin released by small intestine in response to glucose –> increased insulin release (+ inhibit glucagon secretion)
examples GLP1 analogue
exenatide (BD) + liraglutide (OD)
how are GLP1 analogues administered
subcut 60 mins before morning meal (+ evening if exanatide)
what meds are GLP1s used with
metformin + SUR
when is GLP1 considered in T2DM
BMI >35 + problems with obesity // BMI <35 but insulin inappropriate
SE GLP1 analogues
N+V // pancreatitis // weight loss
what does DDP4 do
breakdown GLP1
action DDP4 inhibitors
prevent DDP4 so increase release of GLP1 (incretin)
action DDP4 inhibitors
prevent DDP4 so increase release of GLP1 (incretin)
weight effects with DDP4
no weight gain
which T2DM cause weight gain
SURS (Gliclazide, glipizide, tolbutamide ) // Piogliazatone
what T2DM drugs cause weight loss
SGLT2 inhibitor Dapagliflozin // GLP1 agonist Exenatide // (Metformin)
which T2DM drugs are hypoglycaemic risks
SURS (+ insulin)
what T2DM should be avoided in CKD
SGLT2i + metformin (best = pioglitzone)
what T2DM drug should be avoided in bone fractors
Pioglitazone
what T2DM drug should be avoided in heart failure
Pioglitazone
