T2DM drugs :'(

Question 1

how sulfonylureas work

Answer 1

increase pancreatic insulin secretion

Question 2

what must be functioning in order for sulfonylureas to work

Answer 2

beta cells

Question 3

common SE SURS (2)

Answer 3

hypoglycaemia + weight gain

Question 4

rare SE SURS (4)

Answer 4

hyponatraemia // hepatotoxic // bone marrow suppression // peripheral neuropathy

Question 5

breastfeeding + pregnancy with SURS

Answer 5

no

Question 6

examples SURS

Answer 6

-ide // Gliclazide, glipizide, tolbutamide

Question 7

what type of drug is metformin

Answer 7

biguinde

Question 8

mechanism metformin (4)

Answer 8

increases insulin sensitivity // decreases hepatic gluconeoheneosis // reduces GI absorption of carbs // (activates AMPK)

Question 9

SE metformin (3)

Answer 9

GI upset // reduced B12 // lactic acidosis

Question 10

who is lactic acidosis seen with metformin

Answer 10

liver or renal failure

Question 11

contraindications metformin

Answer 11

CKD // tissue hypoxia (MI, AKI, dehydration) // iodine X rays // (alcohol abuse relative)

Question 12

at what eGFR / creatinine is metformin stopped

Answer 12

eGFR <30// creatinine >150

Question 13

why does metformin need to be titrated up slowly

Answer 13

reduce GI side effects

Question 14

if patient has SE to metformin what type should be used

Answer 14

modified release

Question 15

action Thiazolidinediones

Answer 15

PPAR gamma agonists –> reduce peripheral insulin resistance

Question 16

what is the only Thiazolidinediones used now

Answer 16

pioglitazone

Question 17

SE pioglitazone (5)

Answer 17

weight gain!! // liver impairment // fluid retention // FRACTURES // bladder cancer

Question 18

when is pioglitazone contraindicated

Answer 18

heart failure (fluid retention)

Question 19

where do SGLT2i act

Answer 19

proximal convoluted tubule kidney

Question 20

mechanism SGLT2i

Answer 20

reversibly inhibit SGLT2i –> reduce reabsroption of glucose

Question 21

SE SGLT2i

Answer 21

infection + fourniers gangrene // normoglycaemia ketoacidosis // lower limb amputation

Question 22

benefots SGLT2i

Answer 22

weight loss + good for CVD

Question 23

examples SGLT2i

Answer 23

-gliflozin, canagliflozin, dapagliflozin

Question 24

what is GLP1

Answer 24

hormone incretin released by small intestine in response to glucose –> increased insulin release (+ inhibit glucagon secretion)

Question 25

examples GLP1 analogue

Answer 25

exenatide (BD) + liraglutide (OD)

Question 26

how are GLP1 analogues administered

Answer 26

subcut 60 mins before morning meal (+ evening if exanatide)

Question 27

what meds are GLP1s used with

Answer 27

metformin + SUR

Question 28

when is GLP1 considered in T2DM

Answer 28

BMI >35 + problems with obesity // BMI <35 but insulin inappropriate

Question 29

SE GLP1 analogues

Answer 29

N+V // pancreatitis // weight loss

Question 30

what does DDP4 do

Answer 30

breakdown GLP1

Question 31

action DDP4 inhibitors

Answer 31

prevent DDP4 so increase release of GLP1 (incretin)

Question 32

action DDP4 inhibitors

Answer 32

prevent DDP4 so increase release of GLP1 (incretin)

Question 33

weight effects with DDP4

Answer 33

no weight gain

Question 34

which T2DM cause weight gain

Answer 34

SURS (Gliclazide, glipizide, tolbutamide ) // Piogliazatone

Question 35

what T2DM drugs cause weight loss

Answer 35

SGLT2 inhibitor Dapagliflozin // GLP1 agonist Exenatide // (Metformin)

Question 36

which T2DM drugs are hypoglycaemic risks

Answer 36

SURS (+ insulin)

Question 37

what T2DM should be avoided in CKD

Answer 37

SGLT2i + metformin (best = pioglitzone)

Question 38

what T2DM drug should be avoided in bone fractors

Answer 38

Pioglitazone

Question 39

what T2DM drug should be avoided in heart failure

Answer 39

Pioglitazone