Diabetes drugs tutorial Flashcards

1
Q

what is an acceptable eGFR

A

60 and above

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2
Q

when should diabetics (T2) go on statins

A

when 40 (or younger if have cardiovascular problems)

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3
Q

how should dosage of metformin be adjusted as renal function decreases

A

should also be decreased

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4
Q

what level of eGFR should metformin be stopped

A

30

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5
Q

what does monocular vision cause

A

loss of vision depth

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6
Q

what must vision be to drive

A

better than 6/12 in one eye

must have 120 degrees of arc vision

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7
Q

I’ve woken up in the morning vomiting – I can’t keep anything down. Should I stop my insulin? I’m on Novomix30, 26 units, twice daily. Concern is DKA

A

Keep going with insulin, insulin requirement increases when your unwell

try and take carbs

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8
Q

what is the advice for T1DM and alcohol

A

Can drink just need to be careful, avoid drinks with high sugar content. Risk is hypoglycaemia , often later in the night as alcohol blocks the release of sugar from the liver.

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9
Q

can SUs cause hypos

A

yes

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10
Q

how do SUs affect weight

A

cause gain via appetite increase

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11
Q

do SUs need functioning B cells to work

A

yes

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12
Q

name the only biguanide

A

metformin

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13
Q

what are the roles of metformin

A

reduces hepatic gluconeogenesis
increases glucose uptake in skeletal muscle
reduces carb absorption
increases fatty acid oxidation

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14
Q

does metformin cause hypos

A

no

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15
Q

what are the most common SEs of metformin

A

anorexia, diarrhoea, nausea

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16
Q

why should metformin not be given to patients with renal or hepatic disease

A

as might cause lactic acidosis

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17
Q

what can metformin be combined with

A

SUs, insulin, glitazones

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18
Q

what are glitazones

A

thiazolidinediones (TZDs)

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19
Q

what do TZDs bind to and where

A

PPARgamma

in liver, adipose tissue and skeletal muscle

20
Q

what is the role of TZDs

A

increase lipogenesis,

enhanced uptake of fatty acids and glucose

21
Q

what are the most common side effects of TZDs

A

weight gain and fluid retention

22
Q

why are TZDs contraindicated in patients with heart problems

A

as SE of fluid retention can exacerbate heart failure

23
Q

what do TZDs double the risk of

A

fractures

24
Q

what releases GLP1

A

L cells throughout ileum and colon

25
Q

what does GLP1 do

A

when released stimulates insulin

26
Q

what is exenatie

A

GLP1 receptor agonist

27
Q

what is the action of GLP1 RAs

A

increase insulin secretion
suppresses glucagon secretion
slows gastric emptying

28
Q

how do GLP1 RAs affect weight

A

causes loss

29
Q

can GLP1 RAs cause hypos

A

yes

30
Q

how are GLP1 RAs administered

A

injected before first and last meals of the day

31
Q

what releases GIP

A

K cells in duodenum and proximal jejnum

32
Q

what does DPP4 do

A

inhibits GIP and GLP1 - stops the release of insulin

33
Q

what do DPP4 inhibitors do

A

competitively inhibit DDP4 = lowing blood sugar

34
Q

how do DPP4 inhibitors affect weight

A

are weight neutral

35
Q

how does metformin affect weight

A

causes weight loss

36
Q

how much do oral agents lower HbA1c

A

by 1-2%

37
Q

how does insulin affect weight

A

causes gain

38
Q

when would you use a GLP1 analogue

A

if patients are very overweight

39
Q

what drug is being used less and less

A

TZDs, should be low on the list when prescribing

40
Q

what is the max metformin dose

A

3g in 24 hrs

41
Q

should you give GLP1s in pregnancy

A

no

42
Q

should you give TZDs in pregnancy

A

no

43
Q

is metformin okay in pregnancy

A

yes

44
Q

can you give SUs in pregnancy

A

no

45
Q

should you give DPP4 agonists in pregnancy

A

no

46
Q

is insulin okay in pregnancy

A

yes

47
Q

what should expecting mothers with poor glycaemic control on metformin switch to

A

insulin therapy