DM Flashcards
dpp4 NAMES
sitagliptin, linagliptin, saxagliptin
dpp4 MOA
T2DM with metformin wheere uncontrolled by single agent or metformin is CI
MOA dpp4
prevent incretin degreddation and increase plasma conc of active forms.
action is glucose dependant
MOA DPP4
- GI upset
- headache
- nasopharyngitis
- peripheral oedema
- hypoglycaemia if in combo with sulphonylurea and insulin
- acute pancreatitis
CI DPP4
- Hypersenstivity
- t1dm
- ketoacidosis
- pregnancy
- breastfeeding
- elderly - caution >80yr
- hx pancreatitis -caution
- moderate to severe renal imapirment - lower dose
what forms can you get dpp4 in
- alone
- fixed dose with metformin
target hba1c if on dpp4
- if monotherapy <48
- dual = <53
insulin indications
- T1DM or bad T2DM
- IV Diabetic emergencies
- hyperkalaemia
MOA insulin
like endogenous. drives k+ into cells
different types fo insulin
short acting - actrapid. intermediate actin - humulin
logn actin - lantus/levemir
-rapid - novorapid
- biphasic; rapid and intermediate acting = novomix
SE insulin
hypoglycaemia, lipohypertrophy
CI insulin
caution in renal impaired. as clearance reduced
metofrmin indications
T2DM
MOA metformin
- lowers BG by reducing hepatic glucose output and increasing glucose uptake and utilisation by skeletal muscle. works by increasing AMP kinase - does the above. also get small weight loss
SE metformin
- GI upset
- lactic acidosis
Relative CI to metformin
use with caution if GFR<45 AND stop if <30
- hepatic impairment
- chronic alcohol abuse
when should you withhold metformin acutely
- AKI
- Severe tissue hypoxia
- acute alcohol intoxication
- before and for 47hrs post contast
- XR or surgery to be done
common starting dose of metformin
500mg OD with breakfast and increase gradually
sulphonylureas indications
- T2DM
MOA sulphonylureas
- stimulate pancreatic insulins ecretion. block ATP dependant k+ channels in pancreatic b cell membranes = depolarisation and open VGCC = increase intracellular ca = secrete insulin
only useful if residual pancreaetic function left
SE sulphonylureas
- dose related; GI upset (nausea, vomiting, diarhroea and constipation)
- hypoglyczemia
- hypersensitivity reactions, agranulocytosis, haem abnormalities
dose reductin in which patients
- hepatic impairment
- renal impairment
careful in those at increased risk of hypos e.g. hepatic inpairment, malnutrition, adrenal or pituitary insufficiency and elderly
what drug masks symptoms of hypoglycaemia
BB
name a sulphonylurea
gliclazide
