Diabetes: Medications Flashcards Preview

Year 3 Medicine Block > Diabetes: Medications > Flashcards

Flashcards in Diabetes: Medications Deck (35)
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1
Q

What class of drugs is metformin?

A

Biguanides

2
Q

What is mechanism of action of metformin?

A

Increases peripheral insulin sensitivity + enhances hepatic glucose uptake
= lowers blood glucose levels

3
Q

What is dosage of metformin?

A

The starting dose is generally 500mg once or twice daily, with a maximum dose of 2000mg (aka 2g) daily.
The dosing may vary based on the patient’s renal function and individual response to the drug.

4
Q

What are side effects of metformin?

A
  • Nausea
  • Vomiting
  • Abdominal discomfort
  • Diarrhoea
  • Lactic acidosis is a rare but serious adverse effect

can use modified release if pt experiencing these ADRs

5
Q

What are contraindications of metformin use?

A
  • Severe renal or hepatic impairment
  • Acute conditions that may affect kidney function, or cause significant risk of hypoxia or dehydration –> would be part of STOPP START
6
Q

What drug class is gliclazide?

A

Sulfonylureas

7
Q

What is mechanism of action of gliclazide?

A

Stimulate pancreatic beta cells so promote the release of insulin

8
Q

What is dosage of gliclazide?

A
  • starting dose is40-80mg daily.
  • max dose is 320mg daily
9
Q

What are side effects of gliclazide?

A
  • hypoglycaemia = as we are stimulating more insulin to be released –> so more glucose stored in cells = less in blood = low blood sugar
  • weight gain = as increases appetitie
  • nausea
  • diarrhoea
  • allergic reaction
10
Q

What are contraindications of gliclazide?

A
  • T1 DM
  • DKA
  • Severe renal or hepatic impairment
11
Q

What class of drug is pioglitazone?

A

Thiazolidinediones

12
Q

What is mechanism of action of pioglitazone?

A

Increase peripheral insulin sensitivity, so lower blood glucose levels.

13
Q

What is dosage of pioglitazone?

A
  • initial dose = 15-30mg OD
  • max dose = 45mg
14
Q

What are side effects of pioglitazone?

A
  • weight gain
  • fluid retention –> can lead to HF
  • increased risk of fractures
  • increased risk bladder cancer (but benefits outweigh this risk acc to CKS NICE). Need to assess this risk before starting treatment - ask about age, smoking, radiation / chemo exposure, haematuria.
  • visual impairments
  • numbness/ pins and needles

Note: why fluid retention? –> collecting duct of kidney seems to have higher reabsorption when on this drug.

15
Q

Contraindications for pioglitazone?

A
  • Heart failure ( having drug could worsen it)
  • Hepatic impairmetn
  • Bladder cancer or uninvestiagted macroscopic haematuria
16
Q

What class of drug is dapagliflozin?

A

SGLT2 inhibitor

17
Q

Mechanism of action of dapagliflozin?

A

Increase urinary glucose excretion so reduce levels of glucose in blood.

18
Q

Dosage of dapagliflozin?

A

10mg OD

19
Q

Side effects of dapagliflozin?

A
  • genital fungal infections
  • UTIs
  • euglycaemic DKA
  • Increased risk of LL amputation
SGLT2 = reduce blood glucose = reduce insulin secretion and increase glucagon = cause lipolysis = fatty acid B oxidation = ketones made
20
Q

Contraindications of dapagliflozin?

A
  • Severe renal impairment
  • ESRD
21
Q

What drug class is sitagliptin?

A

DPP4 inhibitor

22
Q

What is mechanism of action of sitagliptin?

A
  • Inhibit enzyme DPP4
  • This enzyme normally breaks down incretin hormones ( which stimulate insulin production)
  • If this breakdown is inhibited = increases insulin production
  • reduces glucagon hormone (starvation hormone)
23
Q

What is standard dose of sitagliptin?

A

100mg OD

24
Q

What are side effects of sitagliptin?

A
  • Nasopharyngitis
  • URTI
  • Headache
  • Pancreatitis
25
Q

Contraindications of sitagliptin use?

A
  • Pts with Hx of pancreatitis
  • dose needs to be adjusted in renal impairment
26
Q

What drug class is exenatide?

A

GLP1 analogue

27
Q

What is mechanism of action of exenatide?

A

Like GLP1, exenatide:
* stimulates insulin secretion
* reduces glucagon secretion
* delay gastric emptying
* reduce appetite

28
Q

What is dosage of exenatide?

A
  • 5mcg injected subcut BD
  • Can be increased to 10mcg BD
29
Q

What are side effects of exenatide?

A
  • GI disturbance
  • hypoglycaemia
  • pancreatitis
  • weight loss
30
Q

What are contraindications of exenatide?

A
  • In pts with Hx of pancreatitis
  • In pts with severe renal impairment
31
Q

What class of drug is Acarbose?

A

Intestinal alpha-glucosidase inhibitors

32
Q

What is mechanism of action of acarbose?

A

Delay digestion of carbs in the small intestine, so slow down absorption of glucose and reduce postprandial peaks of glucose

33
Q

Dosage of acarbose?

A
  • Starts at 50mg TDS
  • Increased to 100mg TDS
34
Q

What are side effects of acarbose?

A

GI disturbance
* abdo pain
* diarrhoea
* flatulance

35
Q

Contraindications for acarbose?

A
  • IBD
  • colonic ulceration
  • partial intestinal obstruction or predisposition to intestinal obstruction
  • severe hepatic impairment

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