lecture 20

Question 1

when should you stop a type 2 drug

Answer 1

not until your at triple therapy/ adding injectables or no change in hba1c in 6months

Question 2

How do biguanides work and an example

Answer 2

eg metformin
decreases gluconeogenesis and intestinal glucose absorption.
increases peripheral insulin sensitivity
(first line - standard release 2g daily - titrate up to this though)

Question 3

Advantages of metformin

Answer 3

reduction of hba1c by 1-2%, no weight gain, no hypos, cost effective

Question 4

Sodium glucose co transporter 2 inhivitors ( SGLT2)

Answer 4

eg. dapagliflozin
blocks SGLT2 in renal tubule, decreasing glucose reabsorption and increasing urinary glucose excretion
decreases hba1c by 5mmol.mol, causes weight loss and reduces bp, no hypos
these can take time to exert effect

Question 5

disadvantages of SGLT2

Answer 5

polyuria, genital infections, caution in renal impairment

Question 6

how do sulpholylureas work and examples

Answer 6

eg. glic;azide/glipizide
stimulate bancreatic beta cells to release insulin
they decrease hna1c nu 1-2% , are fast acting and inexpensive
however they cause weight gain and hypos

Question 7

How do thiazolidinediones eg pioglitazone work and side effects

Answer 7

by activating PPAR-y to increase insulin sensitivity and decrease free fatty acids - this increases glucose uptake
hba1c is decreased by 1%
useful in renal failure as a substitute for metformin , also low risk of hypos
they can cause weight gain

Question 8

pioglitazone is contra indicated in

Answer 8

pts with hf , fractures and haematuria

Question 9

how do DPP-4 inhibitors (gliptins) work

Answer 9

inhibit dpp4 enzyme, which increases GLP-1 and GIP levels - this causes glucose-dependant insulin release and secreased glucagon
cause no weight gain , less incidence of hypo with sulfonylureas
so alt between glitazone when weight problem

Question 10

how do meglitinides work

Answer 10

stimulate rapid acting insulin secretion from pancreatic beta cells eg repaglinide
can be used alone or with metformin , but can cause weight gain, hypos and are expensive

Question 11

hypoglycaemia signs and symptoms

Answer 11

blood glucose under 4mmol - sweaty, hungry cold,, tingling lips , loss of conciousness, confused, irritable, tired, dizzy

Question 12

what injection used for a hypo

Answer 12

glucagon

Question 13

medication for hypothyroidism

Answer 13

levothyroxine
sometimes liothyronine

Question 14

medications for hyperthyroidism

Answer 14

carbimazole and propythiouracil

Question 15

when is carbimazole contraindicated

Answer 15

in pts with blood disorders - tell doctor immediately of symptoms of neutropenia or agranulocytosis - sore throat, ulcer,bruising,fever