Diabetes Meds Flashcards
What should be the first line anti-hypertensive in patients with T2DM?
ACE-I
Except if may become pregnant or afro-caribbean origin
What is the initial drug treatment for patients with T2DM?
Standard release metformin
What are adverse effects of metformin?
GI upset
Lactic acidosis
Altered LFTs/Hepatitis
Reduced B12 absorption
What investigations should you do before and during metformin treatment?
Renal function before and at least annually.
Caution if eGFR <45
Stop if eGFR <30
Give examples of sulphonylureas.
Gliclazide
Tolbutamide
Glipizide
Glimepiride
What is the MOA of sulphonylureas?
Stimulate insulin release by binding to and closing ATP-sensitive K+ channels on beta cells, causing depolarised and opening of voltage dependent calcium channels.
Which patient group might you be cautious to prescribe sulphonylureas for?
Elderly - risk of hypoglycaemia, especially if levels accumulate in renal impairment.
Obesity - patient can put weight on due to increased insulin release.
Metformin is weight-neutral.
Give an example of a thiazolidinedione.
Pioglitazone
Which patients would you not offer pioglitazone to?
HF
Hepatic Impairment
Bladder cancer - current or history of
What adverse effects are associated with Pioglitazone?
Water retention
Weight gain
Eye problems
Long term use associated with: HF, macular oedema, bone fractures, bladder cancer.
What is the MOA of DPP4 inhibitors?
Inhibit enzyme DPP4 which breaks down incretin (GLP-1). Higher levels of GLP-1 delays gastric emptying, inhibits glucagon release and increases insulin secretion.
Give examples of DPP4 inhibitors.
Sitagliptin
Saxagliptin
Linagliptin
Alogliptin
What adverse effects are associated with DPP4 inhibitors?
Acute pancreatitis - avoid if history of alcohol abuse or pancreatitis.
Give examples of SGLT2 inhibitors.
Dapagliflozin
Canagliflozin
Empagliflozin
What is the MOA of SGLT2 inhibitors?
Inhibit reabsorption of glucose in the PCT of kidneys, increasing urine excretion of glucose.
What must renal function be in order for SGLT2 to be prescribed?
eGFR 60 or more
What are adverse effects associated with SGLT2 inhibitors?
Kidney injury Infections - genital and UTI Amputations Lactic acidosis Bone fractures
Give examples of GLP-1 analogues.
Exenatide
Liraglutide
What is the MOA of GLP-1 analogues?
Slows gastric emptying
Inhibits glucagon release
Stimulates insulin release
Which patient group may benefit from GLP-1 analogue?
Obese - promotes weight loss.
Must loose 3% weight in 6 months.
How are GLP-1 analogues delivered?
Injection
Why might sulphonylureas be less effective in more advanced diabetes?
Require functioning beta cells to work
What are adverse effects of insulin?
Hypoglycaemia Hyperglycaemia Lipodystrophy Painful injections Insulin allergies Weight gain
What are potential dangers of missing out insulin?
Hyperglycaemia
HHS
When is metformin CI?
Risk factors for lactic acidosis - compromised renal function, with other nephrotoxic drugs.
At what stage would you begin drug therapy for patients with T2DM?
If Hba1c is 6.5% (48) on lifestyle modifications.
At what stage do you intensify drug treatment regime?
If Hba1c is 7% (58) on lifestyle modifications.
