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Endocrine > T2DM Medications > Flashcards

T2DM Medications Flashcards

1
Q

Is metformin insulin dependent?

A

Yes

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2
Q

How does metformin affect weight?

A

It is weight neutral/losing - patient will not gain weight.

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3
Q

What is an issue to watch for in patients taking metformin?

A

MALA (metformin-associated lactic acidosis)

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4
Q

What is the process by which metformin may cause lactic acidosis?

A

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.

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5
Q

How can MALA be prevented in patients presenting with an AKI?

A

Reduce dosage of metformin in these patients.

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6
Q

What is the first-line management for T2DM?

A

Metformin and lifestyle management.

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7
Q

Are sulfonylureas independent of glucose?

A

Yes - action does not require specific glucose load. They can cause hypoglycaemia.

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8
Q

Do patients gain weight on sulfonylureas?

A

Yes, as appetite is elevated.

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9
Q

Which form of T2DM medication binds to transcription factors, resulting in increased activity of targeted genes during transcription?

A

Thiazolidinediones (TZDs) - e.g. pioglitazone.

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10
Q

Which group experiences the greatest benefit on TZDs?

A

Obese women

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11
Q

How do TZDs affect BP/Weight?

A

Reduce BP, but can raise weight.

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12
Q

How may TZDs affect bone density?

A

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.

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13
Q

Can TZDs cause hypoglycaemia?

A

No, as they are insulin sensitisers (not secretagogues).

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14
Q

What are incretins?

A

Hormones released by the gut which amplify the amount of insulin released from pancreatic beta cells.

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15
Q

What cells secrete GIP?

A

K cells

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16
Q

What are the 2 main incretin hormones?

A

GIP
GLP-1

17
Q

What is the role of DPP4?

A

Breaks down GIP and GLP-1 (the main incretins in circulation), allowing for them to be cleared through the kidneys.

18
Q

What are the roles of GLP-1?

A

Increases insulin secretion
Inhibits glucagon secretion
Reduces appetite (on hypothalamus)
Decreases rate of gastric emptying (in stomach)
Increases heart rate

19
Q

What is the mechanism of DPP4 inhibitors?

A

Inhibits the DPP4 enzyme, which prevents inactivation of the incretins, allowing their effect on insulin to be maximised.

20
Q

Are DPP4 inhibitors glucose-dependent?

A

Yes

21
Q

What impact do DPP4 inhibitors have on weight?

A

They are weight-neutral.

22
Q

How are GLP-1 receptor agonists taken?

A

Subcutaneously

23
Q

How do GLP-1 receptor agonists work?

A

Mimic GLP-1 , thus lowering glucagon, reducing appetite and delaying gastric emptying (as a result, weight will be lost).

24
Q

What are common side-effects of GLP-1 agonists?

A

Severe nausea and vomiting (will subside after the first 6 weeks of administration)
Increased risk of gallstones and pancreatitis

25
Q

If SGLT2 inhibitors are poorly tolerated, which diabetes medication is second-line in those with CHF/CKD?

A

GLP-1 receptor agonists

26
Q

Can GLP-1 receptor agonists or DPP4 inhibitors cause hypoglycaemia?

A

No

27
Q

Is SGLT1 or SGLT2 more active in sugar resorption?

A

SGLT-2 resorbs around 90% all sugar.

28
Q

What is glycosuria?

A

The presence of glucose in the urine.

Occurs when blood glucose is above a particular threshold.

29
Q

Do SGLT2 inhibitors cause weight loss?

A

Yes, a lot at first - will plateau.

30
Q

Can SGLT2 inhibitors cause DKA?

A

Yes

31
Q

What is the glucose-lowering ability of SGLT2 inhibitors dependent on?

A

Renal glucose filtration

32
Q

What is the most common side-effect of SGLT2 inhibitors?

A

Thrush

33
Q

Should SGLT2 inhibitors be halted during the concurrent illness?

A

Yes, as there is a risk of DKA and hypovolaemia in periods of acute illness/prolonged fasting.

34
Q

Patients with diabetes, plus HF/CKD should be given which T2DM medication?

A

SGLT2 inhibitors

Endocrine (11 decks)

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