Diabetes and endocrine Flashcards
Main 2 SE of metformin
GI upset
Lactic acidosis
What drug can be prescribed to aid weight loss in obese patients?
Orlistat
Inhibits pancreatic lipase
SE: diarrhoea, flatulence
Must show continued weight loss at 3 months to continue meds
What is carbimazole?
Anti-thyroid
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production and reduces peripheral conversion of T4 to T3
Adverse effects of carbimazole
Agranulocytosis (urgent FBC if signs of infection)
Dizziness and ataxia
Drowsiness
SIADH
P450 inducer
Crosses placenta so use low dose in pregnancy
Main SE of insulin
Lipodystrophy, hypoglycaemia, weight gain
Main SE sulphonylureas + example
Hypoglycaemia, weight gain, hyponatraemia
Gliclazide
Main SE of thiazolidenodiones and example
Pioglitazone
Weight gain, fluid retention
Main SE of DPP4-i and example
Increased risk of pancreatitis
Sitagliptin
Main SE SGLT-2i and example
UTIs
Dapagliflozin
Main SE GLP agonist and example
N&V, pancreatitis
Liraglutide
If metformin isn’t enough, what can you add?
Gliptin/sulphonylurea/pioglitazone/SGLT-2i
In DKA, describe the insulin regime
Should try to stick with pt’s own long acting insulin
Use insulin infusion on top (5units/hr)
Glucose 10% infusion should be started when BM<14
Most important SE of pioglitazone to be aware of
Increased risk of bladder cancer
Heart failure risk when taken with insulin
Liver toxicity
Advice with bisphosphonate prescribing
Regular dental check up, good oral hygiene (osteonecrosis of jaw)
Avoid taking iron tablets until 2-3hrs after as they reduce bisphosphonate absorption
Swallow tablet whole, plenty of water, sitting or standing 30m before breakfast or another oral medication
1st line management of adult with DKA
500ml fluid bolus NaCl 0.9% if BP<90, over 15mins
Then NaCl 0.9% 1L over 1 hr
With sodium chloride 0.9% insulin IV infusion to a concentration of 1 unit/mL; infuse at a fixed rate of 0.1 units/kg/hour
