Antidiabetics Flashcards
lifestyle modifications in diabetes
weight loss, diet modification, exercise
drug of choice in T2DM and why iii
Metformin
+ effects on glucose metabolism
+promotes weightloss
+studies show reduce in mortality and risk of complications
ntidiabetics are either insunotropic stimulate relase of insulin) or non-insunotropic ( x affect residual insulin production). Which fall into eitehr class?
Insunotropic: SU, metiglinide, GLP-1 mimetics, DPP4-i
Non-insunitropic: SGLT-2i, Alpha-glucodisade-i, Biguanide, Thiazolidinediones
Biguanide 1) Mechanism of action 2) Side effects (4) 3) Contraindications (4) nd Sx of metabolic disturbances 4) Effect on weight Signs of intolerance and management
1) enhace effects of insulin
2) GI - diarhoea, nausea, cramps, lactic acidosis, reduced vitB12 cobalamin absorptoion
3) contrast media, crcl <30ml/min, liver failire
4) stabilisation/loss
5) pale yellow tinge, ulcers, pins and needles, disturbed vision, irritability, depression, decline in cognitive fx
Sulfonylureas
1) Mechanism of action
2) Side effects (4)
3) Contraindications (4) nd Sx of metabolic disturbances
1) stimulates insulin secretion from pancreas B-cells.
2) Hypoglycaemia, weight gain, Haematological changes, allergic skin rxns, alcohol intolerance
3) severe CV morbidity, obesity, sulfonamide allergy, severe liver/kidney failure
Thiazolinediones
1) Mechanism of action
2) Side effects (4)
3) Contraindications (4)
4) MHRA!
4) Patients should be asked to report? (2)
Pioglitazone Rosiglitazone
1) Insulin sensitizer ↑ glucose utilization and ↓ hepatic glucose production
2) fluid retention and oedema, weight ↑, increased risk of HF and osteoporosis. R= ↑risk of CVD complications
3) Heart Failure - current or hx, Liver failure. Bladder cancer - current ot hx ,macrohematuria of unknown origin
4) Avoid in hx/active: bladder cancer & HF
5) i) haematuria, dysuria or urinary urgency
ii) N, V, abdopain, fatigue and dark urine (liver tox reports out there)
iii) HF Sx
DPP4-i
1) Mechanism of action
2) Side effects
3) Contraindications
4) MHRA! and pt to report?
5) ?weight changes and ?hypo
6) Dosing in renal function
Alogliptin 25mg/dy Linagliptin 5mg/dy Sxagliptin 5mg/dy Sitagliptin 100mg/dy Vilgagliptin 50mg bd.
1) Increase endogenous incretin → insulin secretion and decreased glucagon & emptying
2) GI - constipation, headache, dizziness URTI/UTI, acute pancreatitis
3) Liver/Renal failure, Ketoacidosis
4) Pancreatitis - Report persistent severe abdo pain
5) No wt change No hypo unless + insulin
6) Mild: 50-80; none Mod: 30-50: 50% of all but Lina Severe: <30ml/min: 75% ASita, 50%: SaxV
SGLT-2i
1) Mechanism of action
2) Side effects
3) Contraindications
4) MHRA
5) Effect on weigh and BP
5) Class interactions!
-gliflozins. Cana, Dapa, Empa
1) reduce re-absorption of glucose → glycosuria and polyuria
2) UTIs, genital infections, dehydration (polyuria), DKA
3) CKD, DKA, recurrent UTIs e.g. abnormal structures
4) i) DKA
i) inform of DKA signs, test, caution in DKA risk factors, disc if DKA suspect, start when resolved, interrupt if surgery/monitor ketones during temp susp.
ii) Fournier’s gangrene (necrotising fascitis of genitalia or perineum
Report: severe pain, tenderness, erythema r swelling in genitals accompanied by fever.
4) weight loss, reduced BP (correct hypovolemia stat)
5) hypotension
GLP1 agonists (incretin mimetics)
1) Mechanism of action
2) Side effects
3) Contraindications
4) Separation of admin
5) MHRA!
Exenatide IR/MR bUDUREON, Liraglutide od, Dulaglutide, Albiglutide ow
SC inj
1) Increase insulin secretion, redude glucagon, slow emptying ↑ feeling of satiety, ↓ weight)
2) GI - diarrhoea, consipation, n/v, pancreatitis risk
3) Pre-existing GI motility disorders/severe GI disease, Chronic pancreatitis or familty hx f tumours, ketoacidosis
4) Exenatide standard release - 1hr before or 4hr after
5) Pancreatitis! R= severe abdo pain
Effective concentration M/R Exenatide ~12weeks, Semglutide ~ 2 months
Alpha-glucosidase -i
1) Mechanism of action
2) Side effects
3) Contraindications
4) Administration
5) What causes bulk of SE? OTC management of SE
Acarbose
1) dec intestinal absoprtion of glucose
2) GI: disorders: Flatulence, discomfort, diarrhoea (may need to reduce dose)
3) IBD, hernia, conditions ass with malabsoprtiom, severe renal failure
4) swallow whole with first mouthful of food of w/liquid immediately before food
5) Undigested carbs in colon, degraded bybbacteria = gas. Antacids with Mg and Al unlikely beneficial for SE
Meglitinides
1) Mechanism of action
2) Side effects
3) Contraindications
4) Administration
Repaglinide
1) enhances insulin secretion similar to SU. + postprandial peak in glucose
2) abdominal pain, diarrhoea, hypofailure, weight gain, hepatoxoxicity
3) Severe liver and renal failure, ketoacidosis
4) before meals
Hb1Ac 48mmol/mol
diabetes diagnosis
Hb1AC 42 - 47 mmol/mol
pre-diabetes
Hb1ac below 42mmol/mol (6%)
non-diabetic
Normal HB1AC
20-40MMOL/MOL
