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pre reg afsha endocrine > antidiabetic drugs 2 > Flashcards

antidiabetic drugs 2 Flashcards

1
Q

how does acarbose work

A

delays digestion and absorption or starch and sucrose
small but significant effect in lowering BG

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2
Q

how to take acarbose tabs

A

chew with first mouthful of food or swallow while with a little liquid immediately before food

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3
Q

common SE of acarbose include GI disorders. would you recommend antacids?

A

they are unlikely to be beneficial in treatment of SE

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4
Q

acarbose may enhance hypo effects of insulin and SUs. to counteract hypo, pt should carry

A

glucose with them

3-4 heaped teaspoonfuls of sugar dissolved in water is not effective for hypo because acarbose interferes with sucrose absorption

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5
Q

how do the gliptins work

A

DDP4 inhibitor so increases insulin secretion and lowers glucagon secretion

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6
Q

pt on alogliptin, metformin, omeprazole.

they present to pharmacy for some indigestion tabs and pain killers. upon questioning they tell you they have persistent, severe abdominal pain. what do you do

A

DDP4 inhibitors - pancreatitis!! discontinue if symptoms occur and seek medical advice

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7
Q

caution for all DDP4 inhibitors (1)

A

Hx pancreatitis

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8
Q

Alogliptin dose adjustment in RI

A

reduce dose to 12.5mg OD if CrCl 30-50ml/min

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9
Q

sitagliptin dose adjustment in RI

A

50mg OD if eGFR 30-45

25mg OD if eGFR <30

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10
Q

before starting treatment with saxagliptin, vildagliptin or alogliptin check

A

LFTs and RFTs

vildagliptin: LFT 3 monthly during first year, periodically thereafter

saxa: renal function periodically

alog: renal function periodically

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11
Q

Avoid these 2 DDP4 inhibitors in HF

A

avoid vildagliptin if severe heart failure; avoid alogliptin if moderate-to-severe heart failure.

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12
Q

what effect will alcohol consumption have on pt who takes just metformin

A

Alcohol (excessive consumption) potentially increases the risk of lactic acidosis when given with Metformin. Manufacturer advises avoid excessive alcohol consumption.

NOT HYPO BC METFORMIN CANNOT CAUSE HYPO

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13
Q

clarithromcyin and pioglitazone

A

Clarithromycin might cause hypoglycaemia when given with Pioglitazone. Manufacturer advises monitor blood glucose.

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14
Q

pioglitazone and this antiplatelet interact

A

Clopidogrel increases the exposure to Pioglitazone. Manufacturer advises monitor blood glucose and adjust dose.

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15
Q

pioglitazone and this fibrate interact

A

Gemfibrozil increases the exposure to Pioglitazone. Manufacturer advises monitor blood glucose and adjust dose.

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16
Q

which GLP1 agonist has proven CV benefit

A

liraglutide

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17
Q

how do GLP1 agonists work

A

binidng to the activator increases insulin secretion, supressed glucagon secretion and slows gastric emptying

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18
Q

what is the MHRA advice about re glp1 agonists

A

reports of DKA when concomitant insulin was rapidly reduced or discontinued

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19
Q

if a pt has severe abdominal pain with GLP1 agonists this could be

A

acute pancreatitis

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20
Q

important advice to give to pt who are taking GLP1 agonists re dehydration

A

potential risk of dehydration in relation to GI SE
ensure u avoid fluid depletion, stay hydrated

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21
Q

MHRA advice about ozempic (semglutide)

A

Vigilance required due to potentially harmful falsified products

Suspected falsified preparations should be quarantined and reported to the Yellow Card scheme.

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22
Q

contraindications to semaglutide when used for T2D

A

DKA

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23
Q

Main 2 contraindications to most GLP1-R agonists

A

ketoacidosis
severe GI disease

24
Q

Exenatide SC injection using IR medicine - what is the dosage frequency

A

BD!
Dose to be taken within 1 hour before 2 main meals ( at least 6h apart)

25
Q

Lixisenatide - SC dosing frequency

A

OD! SC injection
Take dose within 1h before meal

26
Q

Liraglutide - dosing frequency

A

OD!

27
Q

Discontinue Saxenda (liraglutide) if the following does not improve

A

Discontinue if at least 5% of initial body-weight has not been lost after 12 weeks at maximum dose

28
Q

name the only meglitinide in the UK and state its MOA

A

repaglinide
stimulates insulin secretion
SE:hypo

29
Q

name the dual GIP receptor and GLP1 receptor agonsist and how does it work

A

increases insulin sensitivity and secretion
suppresses glucagon secretion and slows gastric emptying

30
Q

what is the MHRA advice re tirzetapide about

A

GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

31
Q

Tirzetapide delays gastric emptying, esp after the first dose. What does this mean

A

Has the potential to slow the rate of absorption of concomitant oral medicines.
The risk of a delayed effect should be considered for oral medicines where a rapid onset of action is important. Monitor patients on oral medicines with a narrow therapeutic index, especially at the start of tirzepatide treatment and after dose increases.

32
Q

Mounjaro missed dose

A

If a dose is more than 4 days late, the missed dose should be omitted and the next dose administered at the normal time.

33
Q

patient is on an SGLT2i and tells you they feel dizzy. what does this mean

A

sign of volume depletion - report these e.g. postural hypotension and dizziness

34
Q

how do sulphonylyreas work

A

mainly act by augmenting insulin secretion and consequently re effective only when there is some residual pancreatic beta cell activity present

during long term admin they also have an extrapancreatic action

35
Q

when are SUs CI

A

presence of ketoacidsosis

36
Q

max dose gliclazide IR

A

320mg a day

37
Q

max dose gliclazide MR

A

120mg a day

38
Q

this abx is predicted to increase the exposure to gliclazide - monitor BG levels.

hint: Ch

A

chloramphenicol

39
Q

interaction with gliclazide and fibrates

A

increased risk of hypo
no recommendation or class of severity

40
Q

gliclazide and azoles (miconazole, fluconazole, voriconazole) interaction

A

Miconazole is predicted to increase the exposure to Gliclazide. Manufacturer advises use with caution and adjust dose.

41
Q

4 common SE for all SU

A

Abdominal pain; diarrhoea; hypoglycaemia; nausea

42
Q

if necessary, this SU which is principally metabolised in the liver can be used in RI but careful monitoring of BGC is essential

A

gliclazide

43
Q

all SU have the following 3 cautions

A

Can encourage weight gain; elderly; G6PD deficiency

44
Q

Sulfonylureas should be avoided where possible in acute porphyrias but this one is thought to be safe.

A

glipizide

45
Q

which drug has common SE of increased risk fractures

A

pioglitazone

46
Q

which drug class has common SE of dyslipidaemia

A

SGLT2i

47
Q

do all SGLT2 have risk of lower limb amputation, esp the toes

A

no, just canagliflozin

48
Q

is pioglitazone hepatotoxic or nephrotoxic

A

hepatotoxic.
LFTs needed before and regularly thereafter. rare reports of liver dysfunction. avoid in hepatic impairment

49
Q

are SGLT2Is hepatotoxic or nephrotoxic

A

nephrotoxic
avoid initiation if baseline eGFR <30, caution in <60
think about their MOA - they block the SGLT2 cotransporter in proximal renal tubule to prevent reabsorption of glucose and promote its urinary excretion

50
Q

which drug should you stop if there has not been adequate response after 3-6 months of starting it

A

pioglitazone due to its risks e.g. bladder cancer, CV risk etc

51
Q

be aware of signs of volume depletion such as dizziness and postural hypotension with this class

A

SGLT2i

52
Q

increased risk of HF if insulin is also given with this drug, caution

A

pioglitazone

53
Q

patient with T2D reports feeling very tired, has pins and needles, sore and red tongue with mouth ulcers, muscle weakness and their vision has changed. what do you suspect?

A

B12 deficiency with metformin - check levels

54
Q

name 2 classes that have been linked to pancreatitis

A

DDP4i (gliptins)
GLP1 agonists

55
Q

which ones can cause dehydration (3)

A

metformin (due to GI SE, this increases risk of lactic acidosis)
SGLT2is (due to their MOA)
GLP1 agonists (due to GI SE)

56
Q

which ones are associated with weight loss (2), weight gain (3) and weight neutral (2)

A

loss: GLP1, SGLT2i

gain: insulin, SU, pioglitazone

neutral: metformin, DDPI

57
Q

which antidiabetic drug is cautioned in G6PD deficiency

A

SU’s have possible risk of haemolysis in some G6PD-deficient individuals

pre reg afsha endocrine (29 decks)

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