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6 Endocrine > Diabetes - Oral antidiabetic meds > Flashcards

Diabetes - Oral antidiabetic meds Flashcards

1
Q

1st choice in T2DM for overweight patients

A

metformin

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2
Q

advantages of metformin 3

A

does not give hypos
lower incidence of weight gain
lower plasma insulin concentration (what does this even mean?)

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3
Q

metformin is used unlicesnsed to treat

A

polycystic ovaries - initiated by a specialist
reduces weight gain
normalises menstral cycle
improve hirsutism

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4
Q

mode of action of metformin

A

decreasing gluconeogenisis, increasing peripheral utilisation of glucose

  • only acts in the presence of endogenous insulin therefore some residual pancreatic function is required
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5
Q

metformin is contraindicated in …………… 2

A 
ketoacidosis
general aneasthsia (restart when renal funciton returns to baseline)
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6
Q

what test is metformin contraindicated in

A

iodine containing contrast media - can cause renal failure. This increases metformins risk of producing lactic acidosis

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7
Q

Main s/e of metformin

A

GI effects - slow increases in dose can improve tolerability

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8
Q

caution metformin in egfr under

A

45

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9
Q

target hba1c for diabetes

A

48-59

for those at risk of arterial disease less than 48

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10
Q

how long does hba1c measure the average of

A

2-3 months

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11
Q

1 drug class and two drugs PO that cause hypos

A

sufonylureas
nateglinide
repaglinide

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12
Q

when should pt with diebetes get an ACEi

A

nephropathy causing albuminurea or establish microalbuminurea
even if BP is normal

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13
Q

pt with diabetes are particularly suceptable to developping what electrolyte imbalance and therefore shouldnt recieve ACEi and ARB together

A

hypokalaemia

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14
Q

what effect can ACEi have on glycaemic control

when is this more likely (2)

A

potential the hypogylcaemic effect of insulin and PO diabetes meds

more likely in first weeks of treatment and in renal impairment

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15
Q

what are the treatments for painful diabetic neuropathy

1st-4th line

A 
1st initially paracetamol or NSAIDs
2nd duloxetine
3rd amitryptiline or nortryptiline
4th pregabalin
combination therapy of the above
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16
Q

are opioids useful for diabetic neuropathy pain

A

can be but usually initiated by a specilist (usually morphine, oxycodone or tramadol used. Tramadol may be tried while waiting for specialist referal)

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17
Q

what can we treat autonomic nephropathy diabeteic diarrhoea with?

A

tetracycline

codeine

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18
Q

treatments for neuuropathic postrural hypertension

A

increase salt intake
fludrocortisone
but this may cause uncomfortable oedema

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19
Q

glucosary sweating can be treated with

A

antimuscurinics

20
Q

neuropathic oedema can be treated with

A

ephidrine

21
Q

what causes DKA

A

too high glucose levels and not enough insulin

as a result body burns fatty acids for energy producing ketones

22
Q

what is included in the treatment of DKA

A

glucose (once blood levels under 14 to avoid hypos)
fluids (inclu K - clear ketones, correct hypotension & electrolytes)
soluble insulin

23
Q

How long should lifestyle be tried before using an oral antidiabetic drug

A

3 months

24
Q

when adding insulin into an oral therapy when is it given

A

at night (long acting or isophane)

25
Q

2 major complications of adding insulin into oral therapy

A

weight gain and hypo

26
Q

pregnancy appropriate oral antidiabetic drugs

A

metformin

glibencamide (for genstational diabetes) - only after 11 weeks

27
Q

when are sulfonyureas considered

A

in patients who are not overweight and in whom metformin is contraindicated

28
Q

which sufonylureas are and aren’t apprpriate in the elderly

A

glibencamide - long acting, not ok

gliclazide/tolbutamide - short acting so ok

29
Q

Problem with acarbose

A

flatulance

30
Q

What can we treat in type 1 with acarbose

A

postprandial hyperglycaemia

31
Q

Nateglinide & repaglinide should be had when

A

shortly before meal - short onset of action

32
Q

What is the only drug nateglinide is licensed with

A

metformin

33
Q

Piglitozone can be combined with what drugs

A

metformin
sulfonylureas
or both (although failure of both these drugs might indicated failing insulin secretion in which case insulin is more suitable)

34
Q

Pioglitazone MHRA warnings

A

cardiovascular side-effects and bladder cancer

35
Q

when might pioglitazone be a better choice than insulin

A

obese patient

injecting unsuitable

36
Q

Linagliptin can be combined with which drugs

A

metformin
sulfonylureas
both

37
Q

Which gliptins are licensed for use with metformin and pioglitazone

A

saxagliptin, aloglipitin & vildaglipitin

38
Q

alternative class to add onto metformin therapy if a sulfonyurea is contraindicated

A

gliptin

39
Q

What drugs are SC (apart from insulin)

A

Exanatide
Liraglutide
Lixisenatide

40
Q

What is the advantage of GLP1 ags over onsulin

Name three of these drugs

A

Associated with no weightgain but somtimes weight loss

Exanatide
Liraglutide
Lixisenatide

41
Q

What are the NICE requirements for starting a GLP1 ag

A

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

42
Q

What can we combine SGLT2 inhibitors with?

What are some examples of this class

A

Pretty much everything except dapagaflozin & pioglitasone
Canagliflozin
Dapagliflozin
Empagliflozin

43
Q

How does acarbose work?

Counselling for how to take this med?

A

Delays digestions and absorbtion of starch and sucrose by inhibiting intestinal glucosides

  • chew tablet with first mouthful of food
44
Q

Caution with DDP4 inihibitors

A

pancreatitis - persistent, severe abdopain

45
Q

Exanatide
Liraglutide or
Lixisenatide

Is the only one that doesnt require some meds to be taken 1 hour before or 4 hours after

A

Liraglutide

6 Endocrine (5 decks)

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