DM treatment Flashcards
What are the side effects of Metformin?
Nausea
Diarrhoea
Abdominal pain
Lactic acidosis
What are the contraindications for Metformin?
GFR
What is the mode of action of Metformin?
Inhibits gluconeogenesis in the liver
Substrate used for gluconeogenesis is lactate
What is the dose of Metformin?
500mg OD after evening meal
Can be increased up to 2g OD
What drug class if Metformin?
Biguanide
What drug class is Gliclazide, Tolbutamide?
Sulfonylurea
What are the side effects of Sulfonylureas?
Hypogylcaemia
Wt gain
What is the mode of action of Sulfonylureas?
Bind ATP-sensitive K+ channel on pancreatic beta cells. Causing electric potential over the membrane to become more positive.
This opens voltage-gated Ca2+ channels.
Rise in intracellular Ca2+ leads to fusion of insulin granulae with the cell membrane, and therefore increased secretion of (pro)insulin
What are the contraindicatons for Sulfonylureas?
Need to omit on day of surgery
What alternatives can be added to Metformin + Sulfonylureas if Insulin is not acceptable?
Sitagliptin or Pioglitazone
What drug class is Stiagliptin?
DDP4 inhibitor
Prevents GLP-1 inactivation so more insulin secreted and less glucagon released
What are some of the side effects of DDP4 inhibitors (Stiagliptin)?
Nausea
Photosensitivity
Pancreatitis
Joint pain
What drug class is Pioglitazone?
Thiazolidinedione (TZD)
Modulates transcription of insulin sensitive genes causing reduction of insulin resistance
What are the side effects of Thiazolidinediones (Pioglitazone)?
Fluid retention
Peripheral oedema
Wt gain
Bladder cancer
What drug can be used if all other oral hypoglycaemics are unsuitable/ineffective?
Acarbose
