Diabetes: Medications Flashcards
What class of drugs is metformin?
Biguanides
What is mechanism of action of metformin?
Increases peripheral insulin sensitivity + enhances hepatic glucose uptake
= lowers blood glucose levels
What is dosage of metformin?
The starting dose is generally 500mg once or twice daily, with a maximum dose of 2000mg (aka 2g) daily.
The dosing may vary based on the patient’s renal function and individual response to the drug.
What are side effects of metformin?
- Nausea
- Vomiting
- Abdominal discomfort
- Diarrhoea
- Lactic acidosis is a rare but serious adverse effect
can use modified release if pt experiencing these ADRs
What are contraindications of metformin use?
- Severe renal or hepatic impairment
- Acute conditions that may affect kidney function, or cause significant risk of hypoxia or dehydration –> would be part of STOPP START
What drug class is gliclazide?
Sulfonylureas
What is mechanism of action of gliclazide?
Stimulate pancreatic beta cells so promote the release of insulin
What is dosage of gliclazide?
- starting dose is40-80mg daily.
- max dose is 320mg daily
What are side effects of gliclazide?
- hypoglycaemia = as we are stimulating more insulin to be released –> so more glucose stored in cells = less in blood = low blood sugar
- weight gain = as increases appetitie
- nausea
- diarrhoea
- allergic reaction
What are contraindications of gliclazide?
- T1 DM
- DKA
- Severe renal or hepatic impairment
What class of drug is pioglitazone?
Thiazolidinediones
What is mechanism of action of pioglitazone?
Increase peripheral insulin sensitivity, so lower blood glucose levels.
What is dosage of pioglitazone?
- initial dose = 15-30mg OD
- max dose = 45mg
What are side effects of pioglitazone?
- weight gain
- fluid retention –> can lead to HF
- increased risk of fractures
- increased risk bladder cancer (but benefits outweigh this risk acc to CKS NICE). Need to assess this risk before starting treatment - ask about age, smoking, radiation / chemo exposure, haematuria.
- visual impairments
- numbness/ pins and needles
Note: why fluid retention? –> collecting duct of kidney seems to have higher reabsorption when on this drug.
Contraindications for pioglitazone?
- Heart failure ( having drug could worsen it)
- Hepatic impairmetn
- Bladder cancer or uninvestiagted macroscopic haematuria
What class of drug is dapagliflozin?
SGLT2 inhibitor
Mechanism of action of dapagliflozin?
Increase urinary glucose excretion so reduce levels of glucose in blood.
Dosage of dapagliflozin?
10mg OD
Side effects of dapagliflozin?
- genital fungal infections
- UTIs
- euglycaemic DKA
- Increased risk of LL amputation
Contraindications of dapagliflozin?
- Severe renal impairment
- ESRD
What drug class is sitagliptin?
DPP4 inhibitor
What is mechanism of action of sitagliptin?
- Inhibit enzyme DPP4
- This enzyme normally breaks down incretin hormones ( which stimulate insulin production)
- If this breakdown is inhibited = increases insulin production
- reduces glucagon hormone (starvation hormone)
What is standard dose of sitagliptin?
100mg OD
What are side effects of sitagliptin?
- Nasopharyngitis
- URTI
- Headache
- Pancreatitis
Contraindications of sitagliptin use?
- Pts with Hx of pancreatitis
- dose needs to be adjusted in renal impairment
What drug class is exenatide?
GLP1 analogue
What is mechanism of action of exenatide?
Like GLP1, exenatide:
* stimulates insulin secretion
* reduces glucagon secretion
* delay gastric emptying
* reduce appetite
What is dosage of exenatide?
- 5mcg injected subcut BD
- Can be increased to 10mcg BD
What are side effects of exenatide?
- GI disturbance
- hypoglycaemia
- pancreatitis
- weight loss
What are contraindications of exenatide?
- In pts with Hx of pancreatitis
- In pts with severe renal impairment
What class of drug is Acarbose?
Intestinal alpha-glucosidase inhibitors
What is mechanism of action of acarbose?
Delay digestion of carbs in the small intestine, so slow down absorption of glucose and reduce postprandial peaks of glucose
Dosage of acarbose?
- Starts at 50mg TDS
- Increased to 100mg TDS
What are side effects of acarbose?
GI disturbance
* abdo pain
* diarrhoea
* flatulance
Contraindications for acarbose?
- IBD
- colonic ulceration
- partial intestinal obstruction or predisposition to intestinal obstruction
- severe hepatic impairment
