Lipid update 180821 Flashcards
SPRINT research study
found reducing BP with thiazide diuretic reduces CHD risk
PCSK9 inhibitors
works by inhibiting PCSK9 which regulates LDL receptor expression and increases plasma LDL
when are PCSK9 inhibitors used
in statin intolerate, uncontrolled lipids patients
UKPDS
found that good glocose control in new T2DM patients significantly reduces death ev en after stopping tight control (legacy effect)
accord study
tight control of glucose in longterm T2DM increases mortality
SGLT2 inhibitors
e.g. empagliflozin
reduces glucose re-uptake in kidneys leading to osmotic diuresis 0 reduces glucose and BP
GLP1 analogues
secreted from gut L cells signals pancreas to make insulin, direct effect on appetite and gastric emptying - incretin effect
DPP4 inhibitors (gliptins)
DPP4 breaks down GLP1
out of metformin +DPP4, METFORMIN +SGLT2 inhibitor and metformin +GLP-1R agonist which one is WORSE
DPP4
nice management of T2DM step 1
metformin (biguanide)
NICE management of T2DM step 2 dual therapy
Dual therapy:
1st: Metformin + Sulphonylureas (glibenclamide)
1st: Metformin + Thiazolidinedione (pioglitazone)
1st: Metformin + Gliptins (DPP4 inhibitor; i.e. sitagliptin)
2nd: Metformin + SGLT-2i (empagliflozin)
NICE management of T2DM triple therapy
Triple therapy:
1st: Metformin + Sulphonylureas + Gliptin
1st: Metformin + Sulphonylurea + Thiazolidinedione
1st: Metformin + Sulphonylurea/Thiazolidinedione + SGLT-2 inhibitors
2nd: Insulin
sulphonylureas vs GLP1
In contrast to GLP-1, sulfonylureas such as tolbutamide stimulate insulin secretion even at very low blood glucose concentrations and, therefore, can provoke severe hypoglycemia; however, their insulinotropic potency decreases with falling glucose levels
