Endocrine system Flashcards
Facts about metformin
First choice for all patients except CI
Does metformin make you gain weight or cause hypoglycaemia?
No
State the side effects of Metformin
Lactic acidosis
What is the contraindicationof metformin
DKA( Acute metabolic acidosis)
Avoid if egfr is < 30ml/min because it can cause RF which increases risk of lactic acidosis
State the MOA of Biguanide
Decreases gluconeogenesis and increases peripheral utilisation of glucose. Acts only in the presence of insulin, so only effective when there is some function of pancreatic cells
Is metformin safe in BF and pregnancy?
Yes it is.
Caution while on Biguanide
Conditions which worsen renal function and risk factors for Lactic acidosis
Monitoring for metformin
Renal function before starting treatment and atleast annually
Patients and carers advice for metformin
Inform patients of risk of lactic acidosis and how to recognise signs
Signs of Lactic acidosis
Dyspnoea (difficulty breathing)
Muscle cramp
Abdominal pain
Hypothermia
Asthenia ( gen. Body weakness/lack of energy)
State the drugs in the class Sulphonylureas
Gliclazide
Glimepiride
Tolbutamide
Glipizide
Facts about Sulphonylureas
Can cause hypoglycaemia
Can make you gain weight
Hypo more likely with LA ones eg glimepiride
For pt metformin is CI or underweight
Is Sulphonylureas safe in BF and pregnancy?
No
Is Sulphonylureas safe during surgery?
Avoid on the day of surgery, use insulin instead
Avoid long acting in elderly due to risk of hypos. Give short acting instead
State the MOA of Sulphonylureas
Augment insulin secretion and consequently only effective when some residual pancreatic beta cells activity is present
State the side effects of Sulphonylureas
Nausea, vomiting, diarrhoea and Constipation
Hepatic impairment (jaundice, Hepatitis, heptathlon failure)
Allergic skin reactions in first 6-8weeks
Cautions an contraindications with Sulphonylureas safe
Presence of ketoacidosis
Avoid in acute porphyria
Avoid or reduce dose in renal or hepatic impairment
Caution elderly and pts with G6PD deficiency
Facts about about alpha glucosidase inhibitor
Affects the absorption of sucrose
Interferes with sucrose absorption
What is the MOA of Acarbose
Acarbose, an inhibitor of intestinal alpha glucosidases, delays the digestion and absorption of starch and sucrose; it has a small but significant effect in lowering blood glucose.
State how to tx hypoglycaemia on patient taking Acarbose
Give glucose
State the side effects of Acarbose
Diarrhoea (may need to reduce dose); gastrointestinal discomfort; gastrointestinal disorders
Uncommon
Nausea; vomiting
Frequency not known
Acute generalised exanthematous pustulosis (AGEP); thrombocytopenia
Is acarbose safe during pregnancy and breastfeeding?
Avoid
Is acarbose safe in renal impairment?
Avoid if creatinine clearance less than 25 mL/minute.
Is acarbose safe in severe renal impairment?
Manufacturer advises avoid in severe impairment.
Acarbose is contraindicated in?
Disorders of digestion or absorption; hernia (condition may deteriorate); inflammatory bowel disease; predisposition to intestinal obstruction
Pregnancy and breastfeeding
Avoid in severe hepatic impairment
Monitoring requirements while on acarbose
Liver function
State how to admi
Manufacturer advises tablets should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food.
Patients and carer advice while on Acarbose
Antacids unlikely to be beneficial for treating side-effects.
To counteract possible hypoglycaemia, patients receiving insulin or a sulfonylurea as well as acarbose need to carry glucose (not sucrose—acarbose interferes with sucrose absorption).
Patients should be given advice on how to administer acarbose tablets.
What is the MOA of Thiazolidinediones eg Pioglitazone
reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration.
