diabetes Flashcards
Side effects of metformin
Nausea/vomiting/diarrhoea
Lactic acidosis - medical emergency
Can you take metformin if you have kidney damage
the kidenys excrete metformin important not to give if have kidney problems (also shouldn’t have contrast unless stopped metformin 48hrs before!)
Stop in AKI
Can you take metformin if you have liver damage
Should not take if have severe liver problems as liver clears lactic acid, therefore both risk factors for lactic acidosis
Can you take metformin if you have heart failure
Shouldn’t have metformin if heart failure, heart may not be sending enough blood to kidneys
Can you take metformin in pregnancy
yes
Examples of sulfonylureas
Glimepiride
Glyburide
Glipizide
Side effects of Sulfonylureas
Hypoglycaemia (sweating, dizziness, confusion)
Weight gain
Increased risk of cardiac events
Can you give sulfonylureas in pregnancy
not recommended
Examples of meglitinides
(prandin) Repalinide
(starlit) Nateglinide
Side effects of Meglitinides
Hypoglycaemia, weight gain
can you have meglitinides in pregnancy
not suggested
examples of Thiazolidinediones
Pioglitazone
side effects of pioglitazones
weight gain
increase in peripheral fat mass
anaemia
Increased risk HF
fluid retention
which conditions mean you should not take pioglitazone
Current liver or heart problems
Hx of bladder cancer
not recommended in pregnancy
Examples of DPP-4 inhibitors
Sitagliptin
Saxagliptin
Linagliptin
Side effects of DPP-4 inhibitors
Joint pain, headache, increased risk of pancreatitis
When are DPP-4 contraindicated
ketoacidosis, pregnancy
Examples of GLP-1 receptor agonist
Exanatide, Victoza
Side effects of GLP-1 receptor agonist
- Decreased appetite
- Asthenia (weakness)
- Constipation/diarrhoea
- Dizziness
- GI discomfort and disorders
- Headache
- Nausea/vomiting
- Skin reactions
Treatment regime when taking GLP1 receptors agonists
Must take in combination with metformin and/or sulfonylurea or pioglitazone (3rd line)
when are GLP1 receptor agonists contraindicated
ketoacidosis and severe GI disease
Caution in elderly as can cause weight loss and pancreatitis
pregnancy/breastfeeding - women should be on effective contraception for 12 weeks after discontinuing
Examples of SGLT2 inhibitors
Canagliflozin
Dapagliflozin
Empaglifozin
Side effects of SGLT2 inhibitors
- Balanoposthitis (inflammation of foreskin and gland)
- Consipation
- Dyslipidemia
- Hypoglycaemia (incombination with sulfynolurea or insulin)
- Nausea
- Thirst
- Urinary disorders and urinary sepsis
- DKA (rapid weight loss, nausea/vomiting, abdo pain, fast and deep breathing, sleepiness, sweet smell to breath)
When to give SGLT2 inhibitors
as monotherapy if metformin inappropriate or with insulin
when are SGLT2 inhibitors contraindicated
ketoacidosis and caution in elderly
pregnancy
