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PHAM01 > Wk 16: Diabetes management > Flashcards

Wk 16: Diabetes management Flashcards

1
Q

What do you take when you experience GI disturbance on metformin?

A

Change to MR prep

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2
Q

When would you switch to GLP-1 mimetic?

A

If triple therapy w/ metformin + 2 other oral drugs ineffective:

  • BMI >35
  • BMI <35 + insulin has occupational implications + weight loss
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3
Q

What is an example of a SU?

A

Gliclazide

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4
Q

What is an example of a SGLT2 inhibitor?

A

Flozin: Dapagliflozin

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5
Q

What is an example of a DPP4 inhibitor?

A

Gliptin: sitagliptin

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6
Q

What is an example of a GLP-1 mimetic?

A

Tide;
- Oral: semaglutide

  • Injection: exenatide
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7
Q

What are the risks of metformin?

A
  • Lactic acidosis

Renal impairment:
- <45 max 1g

  • <30 stop
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8
Q

What is lactic acidosis?

A
  • Risk factor: dehydration + illness
  • Symptoms: nausea, thirst, vom, abdominal pain
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9
Q

What are the risks of SU?

A
  • Hypo risk (esp renal impairment)
  • Weight gain
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10
Q

What are the benefits of DPP-4 inhibitors?

A
  • Hypo risk: low
  • Weight: neutral
  • Linagliptin no dose red in renal
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11
Q

What are the risks of DPP4-inhibitors?

A
  • Least effective control
  • Pancreatitis: report severe abd pain
  • Cholangiocarcinoma
  • IBD + HF
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12
Q

What are the benefits of GLP-1 mimetics?

A
  • Weight loss
  • CV benefits if CVD + injection
  • Renal benfits: slows albuminuria
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13
Q

What are the risks of GLP-1 mimetics?

A
  • Pancreatitis
  • Cholangiocarcinoma
  • GI disturbance
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14
Q

What are the benefits of pioglitazone?

A
  • Hypo risk: low
  • Safe in renal impairment
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15
Q

What are the risks of pioglitazone?

A

Review at 3-6 months

  • Weight gain
  • CI HF (insulin/Hx MI)
  • CI bladder cancer: report dysuria, urinary urgency
  • Fracture
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16
Q

What are the risks of SGLT2 inhibitors?

A
  • Urinary infection
  • Diabetic ketoacidosis
  • Lower limb amputation (canagliflozin)
  • Fournier’s gangrene
17
Q

How would you monitor for diabetic ketoacidosis in a patient taking SGLT2 inhibitors?

A
  • Report: rapid weight loss, fast breathing, N+V, sweet smelling breath
  • Discontinue if suspected
  • Test ketone >14mmol/L + during surgery
18
Q

What are the risk factors of diabetic ketoacidosis in a patient taking SGLT2 inhibitors?

A
  • Dehydration
  • Acute illness
  • Alcohol abuse
19
Q

What are the symptoms of fournier’s gangrene?

A

Genital area:

  • Severe pain
  • Tenderness
  • Erythema
20
Q

How would you manage lower limb amputation in a patient taking SGLT2 inhibitors (canagliflozin)?

A
  • Annual foot review
  • Manage foot complications
  • Stop if ulcers
21
Q

What is the first line insulin for type 2 diabetes?

A
  • NPH (isophane) OD/BD
  • HbA1c >75: NPH + short acting
  • Detemir/glargine: healthcare professional injects, recurrent symptomatic hypo, NHP BD w/ oral antidiabetics

PHAM01 (47 decks)

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