T2DM Medications Flashcards
Is metformin insulin dependent?
Yes
How does metformin affect weight?
It is weight neutral/losing - patient will not gain weight.
What is an issue to watch for in patients taking metformin?
MALA (metformin-associated lactic acidosis)
What is the process by which metformin may cause lactic acidosis?
Metformin increases the production of lactate, which is normally cleared via the kidneys.
In the event of an acute kidney injury, this may accumulate - resulting in acidosis.
How can MALA be prevented in patients presenting with an AKI?
Reduce dosage of metformin in these patients.
What is the first-line management for T2DM?
Metformin and lifestyle management.
Are sulfonylureas independent of glucose?
Yes - action does not require specific glucose load. They can cause hypoglycaemia.
Do patients gain weight on sulfonylureas?
Yes, as appetite is elevated.
Which form of T2DM medication binds to transcription factors, resulting in increased activity of targeted genes during transcription?
Thiazolidinediones (TZDs) - e.g. pioglitazone.
Which group experiences the greatest benefit on TZDs?
Obese women
How do TZDs affect BP/Weight?
Reduce BP, but can raise weight.
How may TZDs affect bone density?
May decrease as fat accumulation occurs within the bone marrow. Consequentially, fracture risk is doubled in those taking TZDs.
Thus, beware prescribing these in the elderly.
Can TZDs cause hypoglycaemia?
No, as they are insulin sensitisers (not secretagogues).
What are incretins?
Hormones released by the gut which amplify the amount of insulin released from pancreatic beta cells.
What cells secrete GIP?
K cells
What are the 2 main incretin hormones?
GIP
GLP-1
What is the role of DPP4?
Breaks down GIP and GLP-1 (the main incretins in circulation), allowing for them to be cleared through the kidneys.
What are the roles of GLP-1?
Increases insulin secretion
Inhibits glucagon secretion
Reduces appetite (on hypothalamus)
Decreases rate of gastric emptying (in stomach)
Increases heart rate
What is the mechanism of DPP4 inhibitors?
Inhibits the DPP4 enzyme, which prevents inactivation of the incretins, allowing their effect on insulin to be maximised.
Are DPP4 inhibitors glucose-dependent?
Yes
What impact do DPP4 inhibitors have on weight?
They are weight-neutral.
How are GLP-1 receptor agonists taken?
Subcutaneously
How do GLP-1 receptor agonists work?
Mimic GLP-1 , thus lowering glucagon, reducing appetite and delaying gastric emptying (as a result, weight will be lost).
What are common side-effects of GLP-1 agonists?
Severe nausea and vomiting (will subside after the first 6 weeks of administration)
Increased risk of gallstones and pancreatitis
