Antidiabetic medication Flashcards
when will metformin (biguanide) only work?
if some Bcells work in islet of langherhans
how does metformin (biguanide) work
decreases glucogensis and increases peripheral utilisation of glucose
s/e of metformin (biguanide)
-lactic acidosis - avoid if EGFR <30
-GI s/e = high dose slowly or give MR
-can lower vit B12
-stop if pt = AKI
sulphonylureas MoA
Augments insulin secretion
examples of short acting sulphonylureas
gliclazide
tolbutamide
examples of long-acting sulphonylurea
glibericlamide
glimepiride
why should you avoid long-acting sulphonylurea in elderly?
it is assoc with prolonged and fatal cases of hypoglyc
s/e sulphonylurea
high risk of hypoglyc
tx in hosp (target = 7.0% x 6.5%)
when should you avoid sulphonylureas?
-avoid in acute porphyria
-avoid in hepatic + renal failure
MoA of pioglitazone
decreases peripheral insulin resistance
when should you avoid pioglitazone
in pts with history of HF
high risk of?
pioglitazone S/E
-high risk of bladder cancer
-high risk of bone factors
-high risk of liver toxicity
pioglitazone s/e
what should you review with bladder cancer and when
safety and efficacy after 3-6MT
s/e pioglitazone
when should you not tx pt who develop bladder cancer
if they have an inadequate response
pioglitazone s/e
what signs should you report if bladder cancer is suspected
haematuria
dysuria
urinary urgency
pioglitazone S/E
What sings of liver toxicity should you report?
nausea, vomiting, abdominal pain, fatigue + dark urine
examples of Dipeptidyl peptidase 4- inhibitors (DPP-4i)
vildagliptin
aloglipitin
linagliptin
saxagliptin
sitagliptin
vildagliptin, aloglipitin, linagliptin, saxagliptin, sitagliptin
MoA of DPP-4i
inhibits DPP-4i to inc insulin secretion and lower glucagon secretion
vildagliptin, aloglipitin, linagliptin, saxagliptin, sitagliptin
what can DPP-4i cause and the symptoms
pancreatitis
-x treat if symptoms of acute pancreatitis develop
-persistent, severe, abdominal pain
vildagliptin, aloglipitin, linagliptin, saxagliptin, sitagliptin
which DPP-4i is most hepatotoxic?
vildagliptin
Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin
MoA of sodium glucose co-transporter 2 inhibitors (SGLT-2i)
inhibit sodium glucose co-transporter 2 in renal proximal convulated tubule = more urine = less blood glucose level
Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin
MHRA warnings with SGLT-2i
-life-threatening + cases of diabetic ketoacidosis
-if tx interrupted for surgery/illness then monitor ketones
-Fournier’s gangrene (necrotising fasciitis of genitalia or perineum)
-canagliflozin only: risk of lower-limb amputation (toes)
Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin
monitoring for SGLT-2i
renal function
Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin
tx if volume depletion occurs with SGLT-2i
volume depletion correct hypovolaemia before starting tx
dulaglutide, exenatide, liraglutide,
lixesenatide
MoA of GLP-1 agonist
inc insulin secretion
supress glucagon secretion slows gastric emptying
dulaglutide, exenatide, liraglutide, lixesenatide
MHRA warning of GLP-1 agonist
risk of diabetic ketoacidosis when concimitant insulin was dec rapidly
dulaglutide, exenatide, liraglutide, lixesenatide
GLP-1 agonist s/e
-acute pancreatitis - pt warned of severe abdominal pain
-dehydration risk due to GI s/e avoid fluid deplation
examples of GLP-1 agonist
dulaglutide
exenatide
liraglutide
lixesenatide
MoA of acarbose
delays digestion + absorption of starch and sucrose
acarbose s/e
-high risk of GI s/e may decrease dose
examples of meglitides
nateglinide
repaglinide
nateglinide
repaglinide
MoA of meglitides
stimulatess insulin secretion
nateglinide, repaglinide
s/e and tx of meglitides
stress exposure = tx with interruption + replacement with insulin to maintain glycaemic control
Which antidiabetics increase weight?
PIS
sulphonylureas
insulin
pioglitazone
Which antidiabetics has neutral effect on weight?
DPP-4i
metformin
Which antidiabetics lowers weight?
GLP-1 + SGLT-2i
