Diabetes - Oral antidiabetic meds Flashcards
1st choice in T2DM for overweight patients
metformin
advantages of metformin 3
does not give hypos
lower incidence of weight gain
lower plasma insulin concentration (what does this even mean?)
metformin is used unlicesnsed to treat
polycystic ovaries - initiated by a specialist
reduces weight gain
normalises menstral cycle
improve hirsutism
mode of action of metformin
decreasing gluconeogenisis, increasing peripheral utilisation of glucose
- only acts in the presence of endogenous insulin therefore some residual pancreatic function is required
metformin is contraindicated in …………… 2
ketoacidosis general aneasthsia (restart when renal funciton returns to baseline)
what test is metformin contraindicated in
iodine containing contrast media - can cause renal failure. This increases metformins risk of producing lactic acidosis
Main s/e of metformin
GI effects - slow increases in dose can improve tolerability
caution metformin in egfr under
45
target hba1c for diabetes
48-59
for those at risk of arterial disease less than 48
how long does hba1c measure the average of
2-3 months
1 drug class and two drugs PO that cause hypos
sufonylureas
nateglinide
repaglinide
when should pt with diebetes get an ACEi
nephropathy causing albuminurea or establish microalbuminurea
even if BP is normal
pt with diabetes are particularly suceptable to developping what electrolyte imbalance and therefore shouldnt recieve ACEi and ARB together
hypokalaemia
what effect can ACEi have on glycaemic control
when is this more likely (2)
potential the hypogylcaemic effect of insulin and PO diabetes meds
more likely in first weeks of treatment and in renal impairment
what are the treatments for painful diabetic neuropathy
1st-4th line
1st initially paracetamol or NSAIDs 2nd duloxetine 3rd amitryptiline or nortryptiline 4th pregabalin combination therapy of the above
are opioids useful for diabetic neuropathy pain
can be but usually initiated by a specilist (usually morphine, oxycodone or tramadol used. Tramadol may be tried while waiting for specialist referal)
what can we treat autonomic nephropathy diabeteic diarrhoea with?
tetracycline
codeine
treatments for neuuropathic postrural hypertension
increase salt intake
fludrocortisone
but this may cause uncomfortable oedema
glucosary sweating can be treated with
antimuscurinics
neuropathic oedema can be treated with
ephidrine
what causes DKA
too high glucose levels and not enough insulin
as a result body burns fatty acids for energy producing ketones
what is included in the treatment of DKA
glucose (once blood levels under 14 to avoid hypos)
fluids (inclu K - clear ketones, correct hypotension & electrolytes)
soluble insulin
How long should lifestyle be tried before using an oral antidiabetic drug
3 months
when adding insulin into an oral therapy when is it given
at night (long acting or isophane)
2 major complications of adding insulin into oral therapy
weight gain and hypo
pregnancy appropriate oral antidiabetic drugs
metformin
glibencamide (for genstational diabetes) - only after 11 weeks
when are sulfonyureas considered
in patients who are not overweight and in whom metformin is contraindicated
which sufonylureas are and aren’t apprpriate in the elderly
glibencamide - long acting, not ok
gliclazide/tolbutamide - short acting so ok
Problem with acarbose
flatulance
What can we treat in type 1 with acarbose
postprandial hyperglycaemia
Nateglinide & repaglinide should be had when
shortly before meal - short onset of action
What is the only drug nateglinide is licensed with
metformin
Piglitozone can be combined with what drugs
metformin
sulfonylureas
or both (although failure of both these drugs might indicated failing insulin secretion in which case insulin is more suitable)
Pioglitazone MHRA warnings
cardiovascular side-effects and bladder cancer
when might pioglitazone be a better choice than insulin
obese patient
injecting unsuitable
Linagliptin can be combined with which drugs
metformin
sulfonylureas
both
Which gliptins are licensed for use with metformin and pioglitazone
saxagliptin, aloglipitin & vildaglipitin
alternative class to add onto metformin therapy if a sulfonyurea is contraindicated
gliptin
What drugs are SC (apart from insulin)
Exanatide
Liraglutide
Lixisenatide
What is the advantage of GLP1 ags over onsulin
Name three of these drugs
Associated with no weightgain but somtimes weight loss
Exanatide
Liraglutide
Lixisenatide
What are the NICE requirements for starting a GLP1 ag
BMI over 35 and weight related comorbidities
BMI under 35 where insulin is unsuitable for occupational reasons or other comorbidites would benifit from weight loss
What can we combine SGLT2 inhibitors with?
What are some examples of this class
Pretty much everything except dapagaflozin & pioglitasone
Canagliflozin
Dapagliflozin
Empagliflozin
How does acarbose work?
Counselling for how to take this med?
Delays digestions and absorbtion of starch and sucrose by inhibiting intestinal glucosides
- chew tablet with first mouthful of food
Caution with DDP4 inihibitors
pancreatitis - persistent, severe abdopain
Exanatide
Liraglutide or
Lixisenatide
Is the only one that doesnt require some meds to be taken 1 hour before or 4 hours after
Liraglutide
