dm Flashcards by eden leow

DM complications

retinopathy, blindness, nephropathy, kidney failure, CVD by 2-4 times
neuropathy

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Hba1c targets

<7%

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FBG goals

4-7mmol/L

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PPG TARGETS

<10

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non-harm for DM

quit smoking
weight reduction
exercise
diet modification

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metformin MOA

decrease hepatic glucose production

increase peripheral muscle glucose uptake and utilisation

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onset of metformin

within days, max effects take up to 2 weeks

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how long does it take for metformin to reach max effects

2 weeks

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how is metformin excreted

renal

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metformin preggo

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metformin dosage tablets

250, 500, 850

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metformin dosing

500-850mg OD

max 2.55g

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ADR of metformin

GI, anorexia, metalic taste

long term use may decrease serum B12 concentrations

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rare but fatal ADR of metformin

lactic acidosis 
(nausea, shallow laboured breathing, mental confusion)

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metformin contraindications

renal impairment

hypoxic states

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metformin drug interactions

alcohol
iodinated contrast material
cationic drugs may increase metformin by competing for renal tubular transport

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what to do if need to have contrast if on metformin

temporarily hold metformin x 48 hours after contrast. restart when renal function returns to normal post procedure

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renal dosing for metformin

> 60: no renal contraindication to metformin
45-60: continue use, monitor every 3-6 months
30-45: lower dose (50%), monitor every 3 months. don’t start metformin
<30: stop metformin

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name first gen SU

tolbutamide

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SU is not to be used with what other DM drug

meglitinides

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name 2nd gen SU (3)

glipizide, glicldaszide, glibenclamide

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MOA of SU

stimulate insulin secretion by blocking K+ channel of the beta cells
secondary: decrease hepatic glucose output and increase insulin sensitivity

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important thing to note for SU

need functional beta cells to work

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tolbutamide dosing

1-2g/day in divided doses

max 3g/day

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tolbutamide duration of action

6-12 h

tolbutamide preggo?

tolbutamide potency

least potent SU

tolbutamide in renal impairment?

yes preferred

glipizide duration of action

12-24h

glipizide dosage range

2.5mg OD to BD | max 0mg bd

glipizide renal impairment?

yes preferred

glibenclamide duration of action

12-24h

glibenclamide dosage range

2.5mg OD-BD | max 10mg BD

glibenclamide renal?

not in CrCl <50

gliclazide dosing

IR 80mg OD -160mg BD (max 320mg/day) | MR 30-120mg od

ADR of SU

hypoglycaemia (especially in elderly) weight gain blood dycrasias

DDI of SU

BB (mask s/sx of hypo) alcohol CYP2C9 inhibitors increase glipizide

name meglitinides

repaglinide | nateglinide

MOA of meglitinides

stimulate insulin secretion by binding to a different site within the SU receptor of the beta cells

onset of action off meglitinides vs SU

1h | faster than SU but shorter in duration

ADR fo meglitinides

hypoglycaemia weight gain elevated LFT

indications off meglitinides

severe hepatic disease

thiazolidinediones MOA

peroxisome proliferator activated receptors agonist to promote glucose uptake into target cells decrease insulin resistance, increase insulin sensitivity

how long does thiazolidinediones work

up to a month

thiazolidinediones elimination

liver

name 2 thiazolidinediones

rosiglitazone | pioglitazone

rosiglitazone dosing

4mg OD | max 8mg per day in 1-2 divided doses

pioglitazone dosing

15-30mg OD | max 45mg OD

thiazolidinediones ADR

``` hepatotoxicity p not if ALT >3x UNL edema fracture (especially in women) weight gain ```

TZD boxed warning

increased risks of CHF (pio and rosi) | increased risk of MI (rosi)

name alpha-glucosidase inhibitors

acarbose

acarbose MOA

delay glucose absorption and decrease PPG by competitively inhibiting brush border enzyme required for breakdown of complex carbo

Onset of acarbose

rapid with each meal

acarbose preggo?

acarbose dosing

25mg bd-tds. 150mg/day (less than 60kg) 300mg/day (>60kg)

ADR of acarbose

flatulence, abdominal pain, diarrhoea | increased LFTs

contraindications of acarbose

BF | GI diseases

name GLP-1 receptor agonists

exenatide | liraglutide

how does GLP-1 agonists work

bind to GLP-1 receptor stimulate insulin production in response to high BG inhibition of glucagon release slowing the rate of gastric emptying

GLP-1 receptor agonist preggo?

Name 5 DPP-IV inhibitors

``` sitagliptin vildagliptin saxagliptin linagliptin alogliptin ```

DPP_IV MOA

inhibit DPP-IV --> improve glucose homeostasis

linagliptin dosing

5mg OD

linagliptin renal?

no change!!

sitagliptin dosing

100mg OD

sitagliptin renal

``` 50mg OD (cdcl 30-50) 25mg OD (severe renal impairment) ```

sitagliptin ADR

acute pancreatitis, HA, N/V, abdominal pain, skin reaction, angioedema

linagliptin ADR

5% nato-pharyngitis

sitagliptin DDI

increase digoxin

linagliptin DDI

CYP3A4 inducer (decrease linagliptin)

special counselling for sitagliptin

pancreatitis | abdominal pain, n/v, fever

name 3 SGLT-2 inhibitors

canagliflozin empagliflozin dapagliflozin

SGLT-2 inhibitor MOA

inhibit SGLT2 --> increase glucose excretion through urine --> decrease blood glucose

empagliflozin tablet strengths

10,25mg

empa dosing range

10mg OD with or without food, may increase to 25mg OD

empa renal

eGFR < 45 | no dose adjustment otherwise

dapagliflozin tablet strength

5mg, 10mg

dapa dosing

5mg OD with or without food. up to 10mg OD

dapa renal

eGFR < 45 no | otherwise ok

SGLT-2 SE

hypotension UTI genital infection fournier's gangrene

SGLT-2 contraindication

ESRD or dialysis

benefit of empa

CV protection