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NHG > dm > Flashcards

dm Flashcards

1
Q

DM complications

A

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

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2
Q

Hba1c targets

A

<7%

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3
Q

FBG goals

A

4-7mmol/L

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4
Q

PPG TARGETS

A

<10

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5
Q

non-harm for DM

A

quit smoking
weight reduction
exercise
diet modification

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6
Q

metformin MOA

A

decrease hepatic glucose production

increase peripheral muscle glucose uptake and utilisation

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7
Q

onset of metformin

A

within days, max effects take up to 2 weeks

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8
Q

how long does it take for metformin to reach max effects

A

2 weeks

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9
Q

how is metformin excreted

A

renal

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10
Q

metformin preggo

A

b

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11
Q

metformin dosage tablets

A

250, 500, 850

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12
Q

metformin dosing

A

500-850mg OD

max 2.55g

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13
Q

ADR of metformin

A

GI, anorexia, metalic taste

long term use may decrease serum B12 concentrations

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14
Q

rare but fatal ADR of metformin

A 
lactic acidosis 
(nausea, shallow laboured breathing, mental confusion)
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15
Q

metformin contraindications

A

renal impairment

hypoxic states

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16
Q

metformin drug interactions

A

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

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17
Q

what to do if need to have contrast if on metformin

A

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

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18
Q

renal dosing for metformin

A

> 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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19
Q

name first gen SU

A

tolbutamide

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20
Q

SU is not to be used with what other DM drug

A

meglitinides

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21
Q

name 2nd gen SU (3)

A

glipizide, glicldaszide, glibenclamide

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22
Q

MOA of SU

A

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

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23
Q

important thing to note for SU

A

need functional beta cells to work

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24
Q

tolbutamide dosing

A

1-2g/day in divided doses

max 3g/day

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25
Q

tolbutamide duration of action

A

6-12 h

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26
Q

tolbutamide preggo?

A

D

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27
Q

tolbutamide potency

A

least potent SU

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28
Q

tolbutamide in renal impairment?

A

yes preferred

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29
Q

glipizide duration of action

A

12-24h

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30
Q

glipizide dosage range

A

2.5mg OD to BD

max 0mg bd

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31
Q

glipizide renal impairment?

A

yes preferred

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32
Q

glibenclamide duration of action

A

12-24h

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33
Q

glibenclamide dosage range

A

2.5mg OD-BD

max 10mg BD

34
Q

glibenclamide renal?

A

not in CrCl <50

35
Q

gliclazide dosing

A

IR 80mg OD -160mg BD (max 320mg/day)

MR 30-120mg od

36
Q

ADR of SU

A

hypoglycaemia (especially in elderly)
weight gain
blood dycrasias

37
Q

DDI of SU

A

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

38
Q

name meglitinides

A

repaglinide

nateglinide

39
Q

MOA of meglitinides

A

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

40
Q

onset of action off meglitinides vs SU

A

1h

faster than SU but shorter in duration

41
Q

ADR fo meglitinides

A

hypoglycaemia
weight gain
elevated LFT

42
Q

indications off meglitinides

A

severe hepatic disease

43
Q

thiazolidinediones MOA

A

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

44
Q

how long does thiazolidinediones work

A

up to a month

45
Q

thiazolidinediones elimination

A

liver

46
Q

name 2 thiazolidinediones

A

rosiglitazone

pioglitazone

47
Q

rosiglitazone dosing

A

4mg OD

max 8mg per day in 1-2 divided doses

48
Q

pioglitazone dosing

A

15-30mg OD

max 45mg OD

49
Q

thiazolidinediones ADR

A 
hepatotoxicity p
not if ALT >3x UNL 
edema 
fracture (especially in women) 
weight gain
50
Q

TZD boxed warning

A

increased risks of CHF (pio and rosi)

increased risk of MI (rosi)

51
Q

name alpha-glucosidase inhibitors

A

acarbose

52
Q

acarbose MOA

A

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

53
Q

Onset of acarbose

A

rapid with each meal

54
Q

acarbose preggo?

A

B

55
Q

acarbose dosing

A

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

56
Q

ADR of acarbose

A

flatulence, abdominal pain, diarrhoea

increased LFTs

57
Q

contraindications of acarbose

A

BF

GI diseases

58
Q

name GLP-1 receptor agonists

A

exenatide

liraglutide

59
Q

how does GLP-1 agonists work

A

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

60
Q

GLP-1 receptor agonist preggo?

A

C

61
Q

Name 5 DPP-IV inhibitors

A 
sitagliptin 
vildagliptin 
saxagliptin 
linagliptin 
alogliptin
62
Q

DPP_IV MOA

A

inhibit DPP-IV –> improve glucose homeostasis

63
Q

linagliptin dosing

A

5mg OD

64
Q

linagliptin renal?

A

no change!!

65
Q

sitagliptin dosing

A

100mg OD

66
Q

sitagliptin renal

A 
50mg OD (cdcl 30-50) 
25mg OD (severe renal impairment)
67
Q

sitagliptin ADR

A

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

68
Q

linagliptin ADR

A

5% nato-pharyngitis

69
Q

sitagliptin DDI

A

increase digoxin

70
Q

linagliptin DDI

A

CYP3A4 inducer (decrease linagliptin)

71
Q

special counselling for sitagliptin

A

pancreatitis

abdominal pain, n/v, fever

72
Q

name 3 SGLT-2 inhibitors

A

canagliflozin
empagliflozin
dapagliflozin

73
Q

SGLT-2 inhibitor MOA

A

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

74
Q

empagliflozin tablet strengths

A

10,25mg

75
Q

empa dosing range

A

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

76
Q

empa renal

A

eGFR < 45

no dose adjustment otherwise

77
Q

dapagliflozin tablet strength

A

5mg, 10mg

78
Q

dapa dosing

A

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

79
Q

dapa renal

A

eGFR < 45 no

otherwise ok

80
Q

SGLT-2 SE

A

hypotension
UTI
genital infection
fournier’s gangrene

81
Q

SGLT-2 contraindication

A

ESRD or dialysis

82
Q

benefit of empa

A

CV protection

NHG (9 decks)

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