Anti-diabetic drugs Flashcards
Oral hypoglycemics
sulphonylureas, GLP-1 agonist, DDi, Meglitinides
Insulin sensitizers
metformin, pioglitazone
Metformin: MOA
- DEC hepatic gluconeogenesis
- INC peripheral use
Metformin
First line: T2 diabetes
- Safe in pregnancy + breastfeeding
- PCOS (unlicensed)
Metformin: side effects
GI disturbance: N, V + D
- Counsel: Take w or after food or meal
Lactic acidosis
- Counsel: report symptoms: dyspnoea, abdominal pain, hypothermia, asthenia
NOT for:
- Renal impairment eGFR <30: AKI risk, sepsis, shock, dehydration
- Tissue hypoxia (acute HF, resp failure, MIL, liver impairment)
- Low vitamin B12
Sulphonylurea: MOA
INC insulin secretion
Sulphonylurea: LA
glimepiride
Sulphonylurea: elderly, RI
Gliclazide, tolbutamide
Sulphonylurea: side effect
- Hypoglycaemia – treat in hospital
- Hyponatraemia – glipizide, gliclazide
- Weight gain
- Jaundice
- Allergic dermatitis
Sulphonylurea: interaction
ACEi/ARB -> INC hypoglycaemia
Pioglitazone: MOA
Dec peripheral resistance
Pioglitazone: side effect
Heart failure
- MHRA: monitor signs of HF: oedema, dyspnoea
Bladder cancer
- MHRA: report haematuria, dysuria, urgency
- CI: investigated macroscopic haematuria
Hepatotoxicity
- Counsel: report signs of liver disorder eg. Persistent vomiting, abdominal pain, dark urine, jaundice
SGLT2i: MOA
Inhibits sodium glucose co-transporter 2: INC excretion
SGLT2i: side effect
Atypical diabetic ketoacidosis
- MHRA: report DKA signs, stop + test ketones
- Monitor ketones if temporarily stopped: serious illness/major surgery
Volume depletion
- Counsel: hydrate, report dizziness + postural hypotension
Fournier’s gangrene
- MHRA: report severe pain, tender, red + swollen genitals or perineum, accompanied w fever or malaise
Dapagliflozin: do not use in type 1
Canagliflozin: lower limb amputation
- Counsel: report skin ulcers, discolouration + new pain
DPPi (gliptins): MOA
- Inhibit dipeptidylpeptidase-4
- INC incretin tf insulin secretion
DPPi (gliptins): Side effects
Pancreatitis
- Counsel: report persistent severe abdominal pain
Hepatotoxicity (vildagliptin)
- Counsel: report signs of liver disorder (persistent vomiting, abdominal pain, dark urine, jaundice
GLP1 agonist: MOA
- Acts on GLP-1 (incretin) receptors
- INC insulin secretion
GLP1 agonist: BMI
- > 35: psychological/medical issue with obesity
- <35: job complications w insulin, weight loss
Which GLP1 are not stored in the fridge?
exenatide and lixisenatide
GLP1: side effects
Pancreatitis
- Counsel: report persistent severe abdominal pain
GI disturbance: N, V + D
Diabetic ketoacidosis:
- MHRA: when insulin stopped
- Report DKA symptom
GLP1: on contraception
MR exenatide, lixisenatide
GLP1: missed dose
do not administer after a meal
- If >12H late, continue next dose (liraglutide)
- Inject <1H before next meal (lixisenatide)
- Continue with next dose (exenatide)
- Inject <3 days of next weekly dose (dulaglutide)
Acarbose: MOA
- Inhibits a-glucosidase
- DEC starch + sucrose absorption
Acarbose: side effect
- Flatulence – improves w time, antacids do not help
- Diarrhoea – red dose or w/draw
- Counsel: chew w first mouthful of food or swallow whole w little liquid immediately before food, carry glucose (not sucrose) to counteract hypo
