T2DM - Drugs

Question 1

Biguanides;
E.g. ?.

Decrease ? ? production, and increase ? ? sensitivity
Do not pose a risk of ? when used ?
Do not start if eGFR is - review dose if
Monitor renal function ?

Answer 1

met
hepatic glucose
peripheral insulin
hypo
alone
30
45
annually

Question 2

Met
CI’s

0 eGFR for standard release, or for modified release.
o ? addiction.
o People at risk of ? ?, e.g. DKA.
o People at risk of tissue ?, e.g. ?/? failure.

Answer 2

30
45
alcohol
lactic acidosis
hypoxia
resp/cardio

Question 3

Met

Side effects;

o GI effects: ?, ?, ? pain, ? of appetite.
—• Generally resolve ?.
o ? ?: rare but serious, occurs due to drug accumulation.
• ? onset with non-specific symptoms.
• More common when combined with ?.
o Vitamin ? deficiency.

Answer 3

n+V
abdo
loss
spont
lactic acidosis
insidious
alcohol
B12

Question 4

Sulphonylureas;

E.g. Tolbutamide, ?, glibenclamide.
Increase insulin ?.
o Thus only work if some residual ? of ? cells.
? is short acting, ? is medium acting, and ?
long-acting.
o ? rarely used if there is a risk of hypoglycaemia

Answer 4

gliclazide
secretion
fx
pancreatic
tolbutamide
gliclazide
glibenclamide
glib

Question 5

Sulphonylureas

Prescribe with caution in;
o The ?: risks of hypoglycemic events.
o The obese: will encourage ? ?.
Side effects are generally few, and well-tolerated;
o ? disturbances, ? dysfunction.

Answer 5

elderly
wt gain
GI
liver

Question 6

Thiazolidinediones;

E.g. ?.
Generally ? line drug behind biguanides and sulphonylureas.
PPARy activators, increase peripheral ? ?.

Answer 6

pioglitazone
3rrd
insulin sensitivity

Question 7

Thiazolidinediones

Side effects;
o ? ?.
• Redistribution of ectopically stored ?.
o ? ?: contraindicated in CCF.
o ? dysfunction: monitor ?.
o Association with ? cancer: assess risk factors.

Answer 7

wt gain
lipid
fluid retention
liver
LFTs
bladder

Question 8

Gliptins;
E.g. sitagliptin.

DPP-4 inhibitors, thus increase post-? insulin ?.
Avoid in ?, ? or ? dysfunction. . .
Side effects are ? disturbances, and rarely acute ?.

Answer 8

prandial
release
cardiac, renal, hepatic
GI
pancreatitis

Question 9

GLP-1 mimetics;
E.g. ?
NICE recommend that if ? therapy is ineffective, then the ?/? can be replaced by GLP-1 mimetics if;
o The patient has a BMI >?.
o The patient has a BMI , and;
—-• ? ? would benefit other comorbidities.
—-• Insulin therapy would have negative ? impacts.
Again side effects are ? disturbances, and rarely acute ?

Answer 9

enaxatide
gliptin/pioglitazone
35
35
wt loss
occupational
GI
pancreatitis