Pharmacology: SGLT2 inhibitors Flashcards Preview

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Flashcards in Pharmacology: SGLT2 inhibitors Deck (18)
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what does SGLT2 stand for

sodium glucose transporter


what is the physiological role of SGLT 2

to reabsorb glucose(90%) in the renal tubules so it doesn't come out in urine


what effect do SGLT 2 inhibitors have on sugar/glucose uptake in the kidneys

they decrease it by about 1/4


what effect do SGLT 2 inhibitors have on urine

they make you urinate sugar


what direct systemic effects are seen with the use of SGLT 2

reduction in HF, increased urate excretion(= decreased urate in blood plasma) and renal protection


describe why SGLT 2 inhibitors reduce HF

glucose loss results in osmotic diuresis, inhibition of SGLT2 reduced Na absorption
Both of these have mild diuretics effect, may explain reduction in HF


what indirect effect do SGLT2 inhibitors have by reducing glucose

decreased insulin and increase in glucagon


what indirect effect of SGLT2 inhibitors is due to a decrease in lipolysis(due to decreased insulin which inhibits it)

increase in free fatty acids, which increase ketone body production


what is the benefit of increased FFA and ketone body production

they are fuel to cardiac myocytes and improve cardiac bioenergetics(cardiac benefit)


what is the bad effect of increased FFA and ketone body production

can increase ketosis and risk of ketoacidosis


describe the effect SGLT2 inhibitors have on weight

result in weight loss because glucose is excreted, so loss of calories and therefore weight loss(significant weight loss)


what does the glucose reducing effect of SGLT2 inhibitors rely on

the renal glucose filtration, no glucose benefit if eGFR <45ml/min and decrease benefit if <90ml/min


describe the potency of SGLT2 inhibitors

moderate, HbAC1 reduction of ~11mmol/mol.
more then DPP4i, same as GLP-1RA, less than SUs and metformin


what are the 3 commonly used SGLT2 inhibitors

Dapagliflozin, Canagliflozin, Empagliflozin


what effect do SGLT2 inhibitors have on BP and on lipids

BP = slight reduction
Lipids = slight increased in LDL and HDL cholesterol


what side effects are seen with SGLT2 inhibitors

thrush(main), fournier gangrene, hypovolemia and hypotension, DKA


in what patients should SGLT2 inhibitors be omitted

in prolonged fasting or in acute illness


where do SGLT2 inhibitors fit into the algorithim for treatment of T2DM

second line, for those with HF or chronic kidney disease/risk of, in those with compelling reason to minimise hypoglycaemia, or those with compelling reason to lose weight