diabetic drugs and statins Flashcards
which diabetic drugs cause weight gain, weight loss and neutral weight
weight gain - sulphynlureas and glitazones
weight loss - metformin, sglt2 inhibitors, incretin mimics
weight neutral - dpp4 inhibitors
which diabetic drug can be used in low renal function
dpp4 inhibitors
which diabetic drug has hypoglycaemia risk
sulphonylurea
which diabetic drug has side effect of water retention
glitazones
examples of incretin mimics
exanatide
example of sglt2 inhibitors
dapagliflozin
what are -gliptins
dpp4 inhibitors
what is tuolbutamide
sulphonylurea
which diabetic works thru transcriptional factor chances
glitazones
mechanism of action of glitazones
transcriptional factor change causing
increased lipogenesis
decreased lipolysis
decreased plasma FFA
mechanism of action of metformin
decreased hepatic gluconeogenesis
increased fatty acid oxidation
decreased LDL and VLDL
increased peripheral muscle glucose uptake
what do sulphonylureas do?
increase insulin secretion
how do -flozins work?
sglt2 inhibitor in kidney, reduce glucose reabsorption
side effect of -flozins
UTI
how do statins work?
inhibit cholesterol synthesis by inhibiting HMG-CoA reductase
side effects of statins
deranged LFTS
mylagia
myositis - increased CK
what are some drug interactions of statins
do not use with cyp3a4 inhibitors e.g. macrolide antibiotics, amlodipine, verapamil
causes of high anion gap metabolic ketoacidosis
MUD PILES
methanol/metformin uraemia DKA paracetamol iron/isoniazid lactic acidosis ethanol/ethylene glycol salicyclic acid
why does dehydration occur in DKA?
due to high osmolality of blood from increased glucose and ketones, kidneys increase diuresis
3 criteria needed for diagnosis of DKA
BM >11 mmol/l
ketones >3 mmol/L
pH <7.3 OR bicarb <15
management steps for patient in DKA
1) fluid bolus 0.9% nacl
2) insulin infusion 0.1 u/kg/hour
3) potassium chloride + IVT
4) glucose + IVT
5) further investigations
6) extra monitoring
how is insulin regime recommenced after DKA is over?
if not previously on insulin, give fast acting insulin with meal, remove insulin infusion 30 mins later
why is continuous cardiac monitoring important in DKA ?
risk of hypo or hyper kalaemia
how is insulin infusion prepared in DKA?
infuse 50 units of insulin with 50 mls of saline, give at rate of 0.1 units/kg/hour
what kind of insulin to use in DKA?
fast acting e.g. actrapid or novorapid
