diabetes

Question 1

Side effects of metformin

Answer 1

Nausea/vomiting/diarrhoea
Lactic acidosis - medical emergency

Question 2

Can you take metformin if you have kidney damage

Answer 2

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

Question 3

Can you take metformin if you have liver damage

Answer 3

Should not take if have severe liver problems as liver clears lactic acid, therefore both risk factors for lactic acidosis

Question 4

Can you take metformin if you have heart failure

Answer 4

Shouldn’t have metformin if heart failure, heart may not be sending enough blood to kidneys

Question 5

Can you take metformin in pregnancy

Answer 5

yes

Question 6

Examples of sulfonylureas

Answer 6

Glimepiride
Glyburide
Glipizide

Question 7

Side effects of Sulfonylureas

Answer 7

Hypoglycaemia (sweating, dizziness, confusion)
Weight gain
Increased risk of cardiac events

Question 8

Can you give sulfonylureas in pregnancy

Answer 8

not recommended

Question 9

Examples of meglitinides

Answer 9

(prandin) Repalinide
(starlit) Nateglinide

Question 10

Side effects of Meglitinides

Answer 10

Hypoglycaemia, weight gain

Question 11

can you have meglitinides in pregnancy

Answer 11

not suggested

Question 12

examples of Thiazolidinediones

Answer 12

Pioglitazone

Question 13

side effects of pioglitazones

Answer 13

weight gain
increase in peripheral fat mass
anaemia
Increased risk HF
fluid retention

Question 14

which conditions mean you should not take pioglitazone

Answer 14

Current liver or heart problems
Hx of bladder cancer
not recommended in pregnancy

Question 15

Examples of DPP-4 inhibitors

Answer 15

Sitagliptin
Saxagliptin
Linagliptin

Question 16

Side effects of DPP-4 inhibitors

Answer 16

Joint pain, headache, increased risk of pancreatitis

Question 17

When are DPP-4 contraindicated

Answer 17

ketoacidosis, pregnancy

Question 18

Examples of GLP-1 receptor agonist

Answer 18

Exanatide, Victoza

Question 19

Side effects of GLP-1 receptor agonist

Answer 19

• Decreased appetite
• Asthenia (weakness)
• Constipation/diarrhoea
• Dizziness
• GI discomfort and disorders
• Headache
• Nausea/vomiting
• Skin reactions

Question 20

Treatment regime when taking GLP1 receptors agonists

Answer 20

Must take in combination with metformin and/or sulfonylurea or pioglitazone (3rd line)

Question 21

when are GLP1 receptor agonists contraindicated

Answer 21

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

Question 22

Examples of SGLT2 inhibitors

Answer 22

Canagliflozin
Dapagliflozin
Empaglifozin

Question 23

Side effects of SGLT2 inhibitors

Answer 23

• 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)

Question 24

When to give SGLT2 inhibitors

Answer 24

as monotherapy if metformin inappropriate or with insulin

Question 25

when are SGLT2 inhibitors contraindicated

Answer 25

ketoacidosis and caution in elderly
pregnancy