Treatment algorhythm Flashcards

1
Q

First Line

A

Metformin

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2
Q

Second Line

A

Sulphonylureas
DPP4 inhibitors
SGLT2 inhibitors

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3
Q

Sulphonylureas (examples)

A
  • Gliclazide
  • Glipizide
  • Glibenclamide
  • Glimepiride
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4
Q

Third Line

A

Sulphonylureas
DPP4 inhibitors
SGLT2 inhibitors
GLP1 receptor agonists/insulin

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5
Q

Metformin Pros

A

Weight loss

Low risk of hypos

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6
Q

Metformin Risks

A

GI side effects
Vitamin B12 deficiency
Lactic acidosis
Reduce dose in renal impairement

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7
Q

Sulphonylurea Risks

A

Weight gain
Hypoglyceamia
Avoid in renal impairement

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8
Q

DPP4 Inhibitor (examples)

A
Alogliptin
Linagliptin
Saxagliptin
Sitagliptin
Vildagliptin
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9
Q

DPP4 Inhibitor Pros

A

Low risk of hypos
No impact on weight
Improved post-parandial control

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10
Q

DPP4 Inhibitor Risks

A

Avoid in pancreatitis
MSK pain
Reduce dose in renal impairement

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11
Q

GLP-1 Receptor antagonist (examples)

A

Dulaglutide
Exenatide
Liraglutide

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12
Q

GLP-1 Receptor antagonist Pros

A

Low risk of hypos
Weight loss
Post-parandial control
Slows kidney disease

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13
Q

GLP-1 Receptor antagonist Risks

A

Avoid in pancreatitis/MEN1/Thyroid cancer
GI side effects
Avoid in severe renal impairement

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14
Q

SGLT2 inhibitor examples

A

Dapagliflozin
Empagliflozin
Ertugliflozin

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15
Q

SGLT2 inhibitor Pros

A
Low risk of hypos
Weight loss
Reduces CVD
Reduces BP
Slows renal disease
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16
Q

SGLT2 inhibitor Risks

A
Avoid in fasting, low carb diets
GU infection
Increases Cr
Volume depletion
DKA
17
Q

Insulin Risks

A

Hypoglyceamia

Weight gain

18
Q

Alpha glucosidase inhibitors example

A

Acarbose

19
Q

Alpha glucosidase inhibitors Pros

A

Low risk of hypos
Weight unaffected
Improves post-parandial glucose

20
Q

Alpha glucosidase inhibitors Risks

A

GI side effects

Reduce dose in renal impairement

21
Q

Thiazolidinedione examples

A

Pioglitazone

Rosiglitazone

22
Q

Thiazolidinedione pros

A

Hypos unlikely

Protects against Beta cell failure

23
Q

Thiazolidinedione Risks

A
Weight gain
Peripheral oedema
Increase risk of heart failure
Macular oedema
Fractures in women
Risk of bladder cancer
24
Q

Metformin Doses

A

CrCL >/= 60 500 mg PO BD max 2g (MR OD nocte)

CrCL 30-60 500 mg PO OD max 1 g (MR OD nocte)

25
Q

Long acting Sulphonylurea doses

A

Glibenclamide 2.5 mg OD-BD max 20 mg

Glimepiride 1 mg OD max 4 mg

26
Q

Short acting Sulphonylureas doses

A

Gliclazide 40 mg OD-BD max 320 mg per day
(MR 30 mg OD mane, max 120 mg per day)

Glipizide 2.5 mg OD-BD max 40 mg

27
Q

Vildagliptin dose

A

CrCL >60 50 mg BD

CrCL <60 50 mg OD

28
Q

Triple Oral therapy

A

Metformin + sulphonylurea + DPP4 inhibitor
Metformin + sulphonylurea + Thiazolidinedione
Metformin + sulphonylurea + SGLT2 inhibitor
Metformin + sulphonylurea + Acarbose