antidiabetic drugs 2 Flashcards
(57 cards)
how does acarbose work
delays digestion and absorption or starch and sucrose
small but significant effect in lowering BG
how to take acarbose tabs
chew with first mouthful of food or swallow while with a little liquid immediately before food
common SE of acarbose include GI disorders. would you recommend antacids?
they are unlikely to be beneficial in treatment of SE
acarbose may enhance hypo effects of insulin and SUs. to counteract hypo, pt should carry
glucose with them
3-4 heaped teaspoonfuls of sugar dissolved in water is not effective for hypo because acarbose interferes with sucrose absorption
how do the gliptins work
DDP4 inhibitor so increases insulin secretion and lowers glucagon secretion
pt on alogliptin, metformin, omeprazole.
they present to pharmacy for some indigestion tabs and pain killers. upon questioning they tell you they have persistent, severe abdominal pain. what do you do
DDP4 inhibitors - pancreatitis!! discontinue if symptoms occur and seek medical advice
caution for all DDP4 inhibitors (1)
Hx pancreatitis
Alogliptin dose adjustment in RI
reduce dose to 12.5mg OD if CrCl 30-50ml/min
sitagliptin dose adjustment in RI
50mg OD if eGFR 30-45
25mg OD if eGFR <30
before starting treatment with saxagliptin, vildagliptin or alogliptin check
LFTs and RFTs
vildagliptin: LFT 3 monthly during first year, periodically thereafter
saxa: renal function periodically
alog: renal function periodically
Avoid these 2 DDP4 inhibitors in HF
avoid vildagliptin if severe heart failure; avoid alogliptin if moderate-to-severe heart failure.
what effect will alcohol consumption have on pt who takes just metformin
Alcohol (excessive consumption) potentially increases the risk of lactic acidosis when given with Metformin. Manufacturer advises avoid excessive alcohol consumption.
NOT HYPO BC METFORMIN CANNOT CAUSE HYPO
clarithromcyin and pioglitazone
Clarithromycin might cause hypoglycaemia when given with Pioglitazone. Manufacturer advises monitor blood glucose.
pioglitazone and this antiplatelet interact
Clopidogrel increases the exposure to Pioglitazone. Manufacturer advises monitor blood glucose and adjust dose.
pioglitazone and this fibrate interact
Gemfibrozil increases the exposure to Pioglitazone. Manufacturer advises monitor blood glucose and adjust dose.
which GLP1 agonist has proven CV benefit
liraglutide
how do GLP1 agonists work
binidng to the activator increases insulin secretion, supressed glucagon secretion and slows gastric emptying
what is the MHRA advice about re glp1 agonists
reports of DKA when concomitant insulin was rapidly reduced or discontinued
if a pt has severe abdominal pain with GLP1 agonists this could be
acute pancreatitis
important advice to give to pt who are taking GLP1 agonists re dehydration
potential risk of dehydration in relation to GI SE
ensure u avoid fluid depletion, stay hydrated
MHRA advice about ozempic (semglutide)
Vigilance required due to potentially harmful falsified products
Suspected falsified preparations should be quarantined and reported to the Yellow Card scheme.
contraindications to semaglutide when used for T2D
DKA
Main 2 contraindications to most GLP1-R agonists
ketoacidosis
severe GI disease
Exenatide SC injection using IR medicine - what is the dosage frequency
BD!
Dose to be taken within 1 hour before 2 main meals ( at least 6h apart)
