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PRE-REG own > Endocrine: Oral Anti-diabetic drugs > Flashcards

Endocrine: Oral Anti-diabetic drugs Flashcards

1
Q

Name 2 key side effects of metformin

A

Lactic acidosis (if renal impairment or tissue hypoxia)

GI upset - take with or after meals

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2
Q

What is a less common side effect of metfomin to do with vitamins?

A

Reduced vitamin B12 absorption

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3
Q

How often is renal function monitored with metformin

A

baseline and annually (if risk factors then 2x yearly)

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4
Q

What are key side effects of SGLT2 inhibitors?

A
  1. DKA - reporting DKA symptoms e.g. nausea, vomiting, fast breathing, sweet smelling breath, different odours to sweat, confusion, fatigue (MHRA ALERT)
  2. Hypovolaemia - postural hypotension and dizziness, polyuria, thirst, UTI
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5
Q

What is an MHRA alert regarding canagliflozin?

A

Risk of lower limb amputations so counsel patients to report any skin ulcers/discoloration/pain - preventative foot care and hydration

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6
Q

What is an MHRA alert regarding canagliflozin?

A

Risk of lower limb amputations so counsel patients to report any skin ulcers/discoloration/pain - preventative foot care and hydration

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7
Q

What is an MHRA alert regarding SGLT2i/dapagliflozin?

A

Fourniers gangrene - necrotising fascitis of genitalia and perineum
Report any severe pain, tenderness and swelling in those areas

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8
Q

What are key side effects of meglitinides and a counselling point

A

Hypersensitivity reactions
N&V Napglinide
Visual disturbance with rapaglinide

Counselling: take 30 min before main meal
Caution driving due to hypoglycaemia

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9
Q

What are key side effects of meglitinides and a counselling point

A

Hypersensitivity reactions
N&V Napglinide
Visual disturbance with rapaglinide

Counselling: take 30 min before main meal
Caution driving due to hypoglycaemia

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10
Q

What are the short acting sulfonylureas?

A

Gliclazide

Tolbutamide

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11
Q

What situations are the short acting sulfonylureas preferred over long acting?

A

Elderly

renal impairment

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12
Q

What are the long acting Ssulonylureas?

A

Glibenclamide

Glimepiride

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13
Q

Which sulfonylureas cause the most risk of hypoglycaemia?

A

Long acting SU e.g. glmepiride, glibenclamide

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14
Q

What is a contraindication of sulfonylureas

A

Acute porphyrias

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15
Q

What are 5 key side effects of sulfonylureas

A
  1. Hyponatraemia (glipizide, glimepiride)
  2. Hypoglycamia (esp glibenclamide-long acting)
  3. Weight gain
  4. Skin rashes
  5. Jaundice
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16
Q

Which sulfonylureas are most commonly associated with causing hyponatraemia

A

Glipizide

Glimepiride

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17
Q

Do NSAIDS interact with SUs? why?

A

Yes. - reduced renal excretion of drug- inhibition of pg in renal glomerulus

18
Q

Name 2 interactions of SUs

A

Warfarin
ACEi
- hypoglycaemia risk

19
Q

Which drug does NICE recommend to only continue of HbA1c is reduced by 0.5% in 6 months?

A

Pioglitazone

20
Q

Which drug does NICE recommend to only continue if after 6 months there is a weight loss of at least 3% and reduction in HbA1c of at least 1%?

A

GLP-1 agonists (e.g. semaglutide, exenatide etc)

21
Q

What are 3 key main side effects of pioglitazone

A
  1. heart failure
  2. bladder cancer
  3. hepatotoxicity
22
Q

What are counselling points for pioglitazone

A
  • cardiac effects-
  • blood in urine, difficulty urination/pain and urgency = bladder Ca
  • Dark urine, fatigue, jaundice, pruritis, abdo pain - stop if jaundice occurs
23
Q

What are contraindications of pioglitazone

A 
Heart failure/history 
Hepatic impairment
DKA
bladder cancer
haematuria
24
Q

What oral anti-diabetics cause weight gain

A

pioglitazone

sulfonylureas

25
Q

Do gliptins (DPP4i) have less or more risk of hypoglycaemia

A

Less

26
Q

What is a side effect to counsel patients on in DPP4i?

A

Pancreatitis - severe persistent abdominal pain

27
Q

What does vildagliptin cause

A

Liver toxicity

28
Q

What is a key side effect of GLP1 agonists

A

Pancreatitis-severe persistent abdominal pain

29
Q

What is the MHRA warning regarding GLP-1 agonists?

A

Risk of diabetic ketoacidosis when concomitant insulin is rapidly reduced/stopped - need to dose reduce carefully and stepwise

30
Q

Which GLP1 agonists do you need contraception for?

A

MR exenatide
lixisenatide
albiglutide
semaglutide

31
Q

How long after stopping semaglutide do you need to continue contraception?

A

2 months

32
Q

How long after stopping MR exenatide do you need to continue contraception?

A

12 weeks

33
Q

When are GLP1 agonists used in treatment pathway

A
  • BMI >35kg/m2 OR

- insulin cannot be used and BMI<35

34
Q

Would you hold SGLT2i in surgery

A

Yes

35
Q

What is a counselling point for ascarbose

A

Tablet should be chewed with first mouthful of food or swallowed whole with little liquid immediately before bed

36
Q

if 2 or more antidiabetic drugs are initiated what is the target HbA1c?

A

53 mmol/l

37
Q

What is 1st line after diet and lifestyle interventions fail?

A

metformin
- increase gradually

  • if GI issues - MR preparation
38
Q

What are alternative 1st line options if metformin c/i or not tolerated

A

DPP4inhibitor e.g. gliptins
Sulfonylurea
pioglitazone

39
Q

What is the HbA1c aim if a sulfonulyrea is used?

A

53 mmol /l due to hypoglycaemia risk

40
Q

Which sulfonylurea can be used in pregnancy

A

Glibenclamide in 2/3 trimester

PRE-REG own (35 decks)

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