Endo

Question 1

SGLT-2 inhibitors

Answer 1

-gliflozins
inhibit glucose reabsorption at the proximal tubule
hyperglucagonaemia -> beta-hydroxybuterate - induces low grade ketosis ‘thrifty substrate’
cardiovascular mortality benefit
wt loss, BP reduction

SEs - Euglycaemic KA
- Balanitis/thrush

dapag eGFR <60
empag eGFR <45

Question 2

GLP-1 analogues

Answer 2

-tides

exenatide
liraglutide
albiglutide

incretin mimetic
agonists at the GLP-1 receptor of beta cells

enhance insulin secretion
suppress glucagon
delayed gastric emptying
hypothalamic anorectic effects

wt loss
cardiovascular benefit/BP/ stroke>MI

Pancreatitis
N&V

Question 3

Thiazolidinediones TZD

Answer 3

-glitazones

Binds to PPAR-y nuclear transcription factor which increases insulin sensitivity in tissues

Fluid retention and risk of heart failure
fracture risk in post menopausal women
MI (rosi)

Question 4

Acarbose

Answer 4

α-glucosidase inhibitor -> decr hydrolysis of carbs -> decr glucose absorption

Question 5

DPP-4 inhibitors

Answer 5

-gliptins

inhibits breakdown of GLP-1 by DPP4 therefore
incretin effect

weight neutral
no hypos

URTIs
linagliptin - no renal adjustment
Others all renal

Question 6

Sulfonylureas

Answer 6

Gli-
Gliclazide, glipizide, glibenclamide, glimeparide

closes K+ channels in beta cells -> depolarisation -> insulin release via increased calcium flux

HbA1c 1-2%

Hypoglycaemia
weight gain

Question 7

Metformin

Answer 7

↓ gluconeogenesis
↑ glycolysis
↑ peripheral glucose uptake in muscles (glycogenesis)
AMP-activated protein kinase

improves HbA1c by 1-2

Weight neutral
No hypoglycemia
↓ TG
Improvement in cardiovascular mortality

Diarrhoea
Lactic acidosis (C/I if CrCl < 30)