anti diabetic drugs incl insulin Flashcards
does metformin cause weight loss
neutral to weight loss
does not cause weight gain
does metformin cause hypoglycaemia and why
no because it does not stimulate insulin secretion, it just lowers basal and postprandial BG levels
which SU’s are more likely to cause hypoglycaemia
long acting e.g. glimepiride can cause severe, prolonged and sometimes fatal cases
do SU’s cause weight loss and why
no are associated with modest weight gain probably due to increased plasma insulin concentrations
what drug class is pioglitazone
thiazolidinedione
how does pioglitazone work
reduces peripheral insulin resistance leading to reduced BG conc
if a pioglitazone is given, which concomitant anti diabetic drugs dose may need to be reduced?
Su’s and insulin dose may need to be reduced
why is concomitant use of insulin with pioglitazone cautioned?
risk of HF
MHRA safety advice for pioglitazone - CV safety
- increased risk of HF when pioglitazone + insulin, esp in pt with predisposing factors e.g. previous MI
- closely monitor pt who take pioglitazone for signs of HF
- discontinue if any deterioration in cardiac status
- do not use in pt with with HF or Hx HF
which anti diabetic drug must not be used in heart failure?
pioglitazone
which anti diabetic drug has MHRA safety risk of bladder cancer
pioglitazone
MHRA: pioglitazone risk of bladder cancer advice
- small increased risk of bladder cancer but in pt who respond well to treatment, benefits of pioglitazone outweighs the risk
- do not use in active bladder cancer or Hx bladder cancer, or in pt with univestigsted microscopy haematuria
- use with caution in elderly as risk increases with age
- pt must report haematuria, dysuria, urinary urgency
pioglitazone holds a small increased risk of bladder cancer. therefore, before initiating treatment, what should you do
- assess pt with RF e.g. age, smoking status, exposure to certain occupational and chemotherapy agents, or previous radiation therapy to pelvic region
- investigate any microscopic haemturia
- do not give to pt with active bladder cancer or previous Hx
- caution in elderly as increased risk
- review safety and efface cy after 3-6 months and stop if pt do not respond adequately
pioglitazone is contraindicated in…
DKA
Hx HF
previous or active bladder cancer
uninvestigated microscopic haematuria
what are some common side effects of pioglitazone
bone fracture, increased risk of infection, numbness, visual impairment, weight gain
cautions for pioglitazone
- elderly (increased risk HF, fractures, bladder cancer)
- increased risk bone fractures, esp in women
- RF for bladder cancer
- RF HF
- concomitant use with insulin (risk of HF)
does pioglitazone cause weight gain
yes
what to do if jaundice occurs while on pioglitazone
discontinue, rare reports of liver dysfunction
pioglitazone in P & BF
avoid
monitoring pioglitazone
monitor liver function before and periodically thereafter
a pt comes into the pharmacy and says they have been feeling nauseous lately, with abdominal pain, very tired and have dark urine. you look at their pmr and see they are on pioglitazone. what do you do
seek immediate medical attention
discontinue if jaundice
pioglitazone in liver impairment
avoid
when does pioglitazone need to be reviewed
after 3-6 months and regularly thereafter
what are the DDP4 inhibitors?
-gliptins
do DDP4 inhibitors cause weight gain
glipitins do not