Endocrine/Metabolic Flashcards
What is the mechanism of action of metformin hydrochloride?
Metformin’s main effects include: decreasing gluconeogenesis
increasing peripheral utilisation of glucose
Why is metformin not so useful if there are no functioning pancreatic islet cells?
As it acts only in the presence of endogenous insulin, so only if the islet cells are functioning
What dose is recommended for treating adults with T2DM, using the immediate-release metformin?
500mg once daily for at least 1 week (dose to be taken with breakfast) and then 500mg twice daily for at least 1 week (with breakfast and evening meal), then 500mg three times a day with each meal.
What is the maximum dose of immediate-release metformin that can be taken in one day?
2g
Other than as monotherapy/combination therapy for people with T2DM, when else is metformin indicated for use?
- Reduction in risk/delay of onset of T2DM
2. Polycystic ovary syndrome
What are the common side effects of taking metformin? (5)
- Abdominal pain
- Anorexia
- Diarrhoea
- Lactic acidosis
- Vomiting
Why is metformin given in doses which are slowly built up over time?
To minimise the risk of GI side effects
Name some of the sulfonylureas?
- Glibenclamide
- Gliclazide
- Glimepiride
- Glipizide
How does the sulfonylureas work?
They act mainly by augmenting insulin secretion and consequently are effective only when some residual pancreatic beta-cell activity is present
What is the doseage of sulfonylureas?
Using immediate-release tablets:
40-80mg daily, increased if necessary up to 160mg one daily - dose to be taken with breakfast
What is the maximuim dose of gliclazide daily?
320mg
What are the main cautions associated with the use of any sulfonylureas?
Can encourage weight gain
Should not be used in someone with G6PD deficiency
In addition to weight gain, what is the other risk of using sulfonylureas?
They may cause hypoglycaemia
What is acarbose?
Acarbose is an inhibitor of intestinal alpha glucosidases, delaying the digestion and absorption of starch and sucrose, it has a small but significant effect in lowering blood glucose
