4.8 Diabetes Mellitus Medications Flashcards
What is the mechanism of biguanides (such as metformin)? What is its effect on BGL in normoglycaemic states? How is it cleared?
- Reduces hepatic gluconeogenesis
- Has little effect on glucose in normoglycaemic states; no effect on insulin etc.
- Excreted predominantly renally
Contraindications for biguanides (like metformin)
- Hepatic/renal failure (why?)
- Conditions that involve prolonged tissue hypoxia (why?)
Side effects of bigaunides (like metformin)
- GI adverse effects (nausea/vomiting)
- Hypoglycaemia risk
- Lactic acidosis
Sulphonylurea mechanism
“Flog” the pancreas to produce more insulin.
Contraindications of sulphonylureas
- Renal/hepatic impairment
- Hypoglycaemia risk (?forgetfullness, cog. impairment etc.)
Side effects of sulphonylureas
- Hypoglycaemia
- Weight gain
- Allergic rxn (sulphur drugs)
DPP4 inhibitor mech
- Inhibit dipeptidyl peptidase 4, which breaks down incretins
- This increases incretin level, reducing glucagon and increasing insulin
DPP4 inhibitor suffix
-gliptin
Contraindications for DPP4 inhibitors
Almost none. Only other drugs that can cause hypoglycaemia.
True or false: DPP4 inhibitors are generally well tolerated, and show no significant side effects
True (!)
Effect of SGLT2 inhibitor on UTI risk
Increase.
SGLT2 inhibitor suffix
-Gliflozin
Contraindications for SGLT2 inhibitors
- Hypoglycaemia casuing drugs
- Volume depleting drugs (like diuretics)
- Ketoacidosis risk
Side effects of SGLT2 inhibitors
- Polyuria
- Polydypsia
- Euglycaemic ketoacidosis (SGLT2is have glucagonotropic effect due to glycosurea)
How are GLP-1s administered typically?
Injection. They are proteins; hard to orally take since they’ll be broken down by Pepsin etc.
