T2DM Drugs

Question 1

Metformin - side effects

Answer 1

GI upset

Lactic acidosis

Question 2

Metformin - contraindictations

Answer 2

eGFR <30

Question 3

Metformin - mechanism of action

Answer 3

Increases insulin sensitivity and decreases hepatic gluconeogenesis

Question 4

Sulfonylureas - example

Answer 4

Gliclazide

Glimepiride

Question 5

Sulfonylureas - mechanism of action

Answer 5

Stimulate beta cells to produce insulin

Question 6

Sulfonylureas - side effects

Answer 6

Hypoglycaemia
Weight gain
Hyponatraemia/SIADH

Question 7

Thiozolidinediones - example

Answer 7

Pioglitazone

Question 8

Pioglitazone - mechanism of action

Answer 8

Activate PPAT-gamma which increases adipogenesis and the uptake of fatty acids

Question 9

Pioglitazone - side effects

Answer 9

Weight gain
Fluid retention
Deranged LFTs
Fracture

Question 10

DPP-4 Inhibitor - examples

Answer 10

-gliptins

Question 11

DPP-4 inhibitors - mechanism of action

Answer 11

Increases incretin which inhibits glucagon secretion

Question 12

DPP-4 inhibitors - side effects

Answer 12

Risk of pancreatitis

Question 13

SGLT-2 Inhibitors - examples

Answer 13

-gliflozins

Question 14

SGLT-2 inhibitors - mechanism of action

Answer 14

Inhibits reabsorption of glucose in the kidneys

Question 15

SGLT-2 inhibitors - side effects

Answer 15

UTI, weight loss

Question 16

GLP-1 Agonists - example

Answer 16

-tides

Question 17

GLP-1 agonist - mechanism of action

Answer 17

Incretin mimetic - inhibits glucagon secretion

Question 18

GLP-1 agonist - side effects

Answer 18

N+V
Pancreatitis
Weight loss

Question 19

Which T2DM drug is given subcut?

Answer 19

GLP-1 agonists (-tides)

Question 20

Which of the T2DM drugs are hypoglycaemic agents?

Answer 20

Sulfonylureas

Question 21

Which cause weight gain?

Answer 21

Sulfonylureas

Pioglitazone

Question 22

Which drugs can be used as normal during surgery?

Answer 22

DPP-4 inhibitors and GLP-1 agonists

Question 23

How should metformin be altered for surgery?

Answer 23

If OD or BD - take as normal

If TDS - omit lunchtime dose

Question 24

How should sulfonylureas be altered for surgery?

Answer 24

If OD - omit

If BD - omit morning dose (if afternoon operation, omit both doses)

Question 25

How should SGLT-2 inhibitors be altered for surgery?

Answer 25

Omit dose on day

Question 26

How should patients on insulin be managed during surgery?

Answer 26

If good glycaemia control and short op - usual regime | If long op, or very bad glycaemia control (HbA1c >69) - variable rate insulin infusion.

Question 27

How should insulin doses be altered for surgery?

Answer 27

OD insulin - 20% lower dose day before and day of | BD insulin - half the morning dose on the day of only