Thiazolidines - Pioglitazone Flashcards
1
Q
What is an example of a thiazolidine?
A
Pioglitazone
2
Q
What are contrainidications for thiazolidines?
A
- Hepatic impairment
- History of bladder cancer
- Heart failure
- Pregnancy / breast feeding
3
Q
When would you want to be cautious when using thiazolidines?
A
- Cardiovascular disease
- Risk of fractures
- Acute porphyria
- Risk of bladder cancer/ uninvestigated macroscopic haematuria
4
Q
When would you consider prescribing a pioglitazone?
A
- Single agent in overweight patients where metformin is contraindicated or not tolerated.
- Second agent to metformin/sulphonylurea where blood glucose control is inadequate on one drug and the metformin/sulphonylurea combination is contraindicated or not tolerated.
- Third agent with metformin and a sulphonylurea where blood glucose control is inadequate as an alternative to starting
5
Q
What is the mechanism of action of pioglitazone?
A
Act via a range of actions by activating PPARy. These lead to increased sensitivity of muscle and fat tissue to insulin, thereby increasing glucose uptake.
6
Q
Do Thiazolidines increase weight?
A
Yes
7
Q
What are side effects of thiazolidines?
A
- Gastrointestinal upset
- Weight gain
- Oedema
- Hepatic toxicity
- Visual disturbance
- Impotence
- Anaemia
- Hypoaesthesia
- Bladder cancer (very rare)
8
Q
Does pioglitazone cause hypoglycaemia?
A
No
9
Q
What drugs can pioglitazone interact with?
A
Antidiabetic drugs - can cause hypoglycaemia and cardiac failure
