OSCE - drug counselling Flashcards
When drug counselling about metformin, what few questions should you ask before jumping in to explaining the drug ?
- What have you tried before this ?
- How are your symptoms now ? Increased frequency ? Increased thirst ?
What is it important to check before prescribing metformin ?
- Any allergies ?
- Important to check CI / cautions : have you ever been told you have any problems with you liver or kidney ?
- Are you on any regular medications ?
- Do you take anything regularly over the counter
what is metformin and why do we use it
- Long term treatment to help control your blood sugar
- We often use it as the first port of call as it usually quite beneficial and helps to control your blood sugar without it going too low.
why start metformin ?
- So : a hormone called insulin is usually in control of keeping your blood sugar at the right level.
- In T2DM - our cells stop responding to insulin meaning the sugar cant get in and our blood sugar levels get too high
- The high levels = increased thirst, increased urination
- If too high for too long it can start causing more longer term damage to our organs.
How does metformin work ?
- Metformin acts to lower these high blood sugar levels when we eat by reducing the amount of sugar released from our liver and increasing the amount of sugar taken up by our cells
Timeline of metformin
Taken once a day at the same time, with or just after a meal
How to take meformin
- Prescribed as a tablet
- The dose will be increased gradually to find the one that works for you
Length of metformin treatment
Lifelong if it works for you
Missed dose ?
Take the next as soon as you remember, never two in a day !
Monitoring of metformin
- So we will check you kidney function before you start metformin and then once or twice a year just to monitor some of the possible SE of the medication
- If this is first diagnosis we will check HbA1c every 3 mnths to check your blood sugars are where we want them
Important SE of metformin
- GI upset (Nausea, diarrhoea, abdo pain) : if this happens there is another type of metformin we can switch too to help manage this
2 more important SE
- B12 deficiency : any SOB, fatigue, pins and needles. GET IN TOUCH
- IF you’re ever actyually unwell, make sure your healthcare provider is aware you are metformin - it might need to be stopped in acute illness !
Moving forward ?
- Make sure your still keeping up with lifestyle advice (diet, exercise, low alcohol, no smoking)
- ATTEND your diabetic reviews !
To check before beginning gliclazide consultation
- Current control / Sx
- Current PMH, drugs, allergies and over the counter
How does gliclazide work ?
Increases insulin secretion to keep our blood sugar levels where they need to be
How to take gliclazide
- Tablet form, usually taken once a day with breakfast
- We will titrate this up to a dose that works for you if needed
Missed gliclazide ?
Skip this dose, never take 2 in a day and continue as normal
Duration and monitoring of gliclazide
- Lifelong
- No monitoring unless new DM, HbA1c every 3 mnths
SE of gliclazide
Weight gain, tummy upset, nausea
Serious SE of gliclazide
HYPOGLYCAEMIA
Every feel suddenly dizzy, blurred vision, shaky, sweaty
Seek medical attention
In the mean time try and have something sugary : jelly babies, orange juice
Moving forward on gliclazide
- Keep up lifestyle changes !!
- Attend DM review !!
Important to check before SGLT2 inhibitor
- Current Sx, management and SE
- PMH, drugs and allergies !
- Anything over the counter
How do SGLT2 inhibitors work
- Reduce absorption of glucose and so increase excretion in urine
- Check they understand why this is important !
How is SGLT-2 inhibitor taken
- Tablet
- OD
- Can be titrated up if needed
Duration and missed dose SGLT2
Lifelong
Take the next one, never two in a day
Monitoring of SGLT2 ?
- Renal function before
- Annually
SE of SGLT2
- Constipation, nausea
- UTI / thrush
Severe SE of SGLT2
- Fournier’s = any swelling, redness, fever, actuely unwell = seek medical attention
- DKA = any N&V, weight loss, abdominal pain = medical help
- Always tell healthcare provider you are on it !!
Moving forward with SGLT2
- DM review !!
- Lifestyle modifications
