Endocrine: Diabetic complications Flashcards
Provided there are no contra-indications, all diabetic patients with nephropathy causing proteinurea or with established microalbuminuria (at least 3 positive tests) should be treated with what drugs even if the blood pressure is normal?
An ACEi or an ARB to minimise the risk of renal deterioration, blood pressure should be carefully controlled.
Patients with diabetic nephropathy are particularly susceptible to what electrolyte imbalance?
Patients with diabetic nephropathy are particularly susceptible to developing hyperkalaemia and should not be given an ACE inhibitor together with an angiotensin-II receptor antagonist.
What drug can potentiate the hypoglycaemic effect of insulin and oral antidiabetic drugs?
ACE inhibitors can potentiate the hypoglycaemic effect of insulin and oral antidiabetic drugs; this effect is more likely during the first weeks of combined treatment and in patients with renal impairment.
Optimal diabetic control is beneficial for the management of painful neuropathy in patients with type 1 diabetes. Paracetamol or a non-steroidal anti-inflammatory drug such as ibuprofen may relieve what strength of pain?
mild to moderate
What SNRI is licensed for painful diabetic neuropathy?
Duloxetine
What TCAs can be used unlicensed if duloxetine is not suitable or ineffective in painful diabetic neuropathy?
amitriptyline hydrochloride [unlicensed use] can be used if duloxetine is ineffective or unsuitable. Nortriptyline [unlicensed use] may be better tolerated than amitriptyline hydrochloride.
If treatment with amitriptyline hydrochloride or duloxetine is inadequate, treatment with what should be trialed?
If treatment with amitriptyline hydrochloride or duloxetine is inadequate, treatment withpregabalin should be tried.
What can be tried to treat diabetic neuropathy if use of duloxetine or amitriptyline or pregabalin alone has proved unsuccessful?
Combination therapy of duloxetine or amitriptyline hydrochloride with pregabalin can be used if monotherapy at the maximum tolerated dose does not control symptoms.
What opioid can be prescribed by a GP while a patient is waiting for assessment by a specialist if other treatments have been unsuccessful?
There is evidence of efficacy for tramadol hydrochloride, morphine, and oxycodone hydrochloride; however treatment with morphine or oxycodone hydrochloride should be initiated only under specialist supervision. Tramadol hydrochloride can be prescribed while the patient is waiting for assessment by a specialist if other treatments have been unsuccessful.
Which antiepileptics are sometimes used for the treatment of neuropathic pain?
Carbamazepine and gabapentin
Which cream is licensed for painful diabetic neuropathy and may have some effect, but produces an intense burning sensation during the initial treatment period?
Capsaicin cream 0.075%
In autonomic neuropathy diabetic diarrhoea can often be managed by the unlicensed use of what antibiotic?
tetracycline
What is the best drug for autonomic neuropathy associated diarrhoea?
In autonomic neuropathy diabetic diarrhoea can often be managed by tetracycline [unlicensed use], otherwise codeine phosphate is the best drug, but other antidiarrhoeal preparations can be tried. Erythromycin (especially when given intravenously) may be beneficial for gastroparesis [unlicensed use] but this needs confirmation.
In neuropathic postural hypotension, what may help by increasing plasma volume but cause uncomfortable oedema as a side effect
In neuropathic postural hypotension increased salt intake and the use of the mineralcorticoid fludrocortisone acetate [unlicensed use] may help by increasing plasma volume, but uncomfortable oedema is a common side-effect. Fludrocortisone can also be combined with flurbiprofen and ephedrine hydrochloride [both unlicensed]. Midodrine [unlicensed], an alpha agonist, may also be useful in postural hypotension.
