Diabetes - Oral antidiabetic meds Flashcards Preview

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Flashcards in Diabetes - Oral antidiabetic meds Deck (45)
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1

1st choice in T2DM for overweight patients

metformin

2

advantages of metformin 3

does not give hypos
lower incidence of weight gain
lower plasma insulin concentration (what does this even mean?)

3

metformin is used unlicesnsed to treat

polycystic ovaries - initiated by a specialist
reduces weight gain
normalises menstral cycle
improve hirsutism

4

mode of action of metformin

decreasing gluconeogenisis, increasing peripheral utilisation of glucose

- only acts in the presence of endogenous insulin therefore some residual pancreatic function is required

5

metformin is contraindicated in ............... 2

ketoacidosis
general aneasthsia (restart when renal funciton returns to baseline)

6

what test is metformin contraindicated in

iodine containing contrast media - can cause renal failure. This increases metformins risk of producing lactic acidosis

7

Main s/e of metformin

GI effects - slow increases in dose can improve tolerability

8

caution metformin in egfr under

45

9

target hba1c for diabetes

48-59
for those at risk of arterial disease less than 48

10

how long does hba1c measure the average of

2-3 months

11

1 drug class and two drugs PO that cause hypos

sufonylureas
nateglinide
repaglinide

12

when should pt with diebetes get an ACEi

nephropathy causing albuminurea or establish microalbuminurea
even if BP is normal

13

pt with diabetes are particularly suceptable to developping what electrolyte imbalance and therefore shouldnt recieve ACEi and ARB together

hypokalaemia

14

what effect can ACEi have on glycaemic control

when is this more likely (2)

potential the hypogylcaemic effect of insulin and PO diabetes meds

more likely in first weeks of treatment and in renal impairment

15

what are the treatments for painful diabetic neuropathy
1st-4th line

1st initially paracetamol or NSAIDs
2nd duloxetine
3rd amitryptiline or nortryptiline
4th pregabalin
combination therapy of the above

16

are opioids useful for diabetic neuropathy pain

can be but usually initiated by a specilist (usually morphine, oxycodone or tramadol used. Tramadol may be tried while waiting for specialist referal)

17

what can we treat autonomic nephropathy diabeteic diarrhoea with?

tetracycline
codeine

18

treatments for neuuropathic postrural hypertension

increase salt intake
fludrocortisone
but this may cause uncomfortable oedema

19

glucosary sweating can be treated with

antimuscurinics

20

neuropathic oedema can be treated with

ephidrine

21

what causes DKA

too high glucose levels and not enough insulin
as a result body burns fatty acids for energy producing ketones

22

what is included in the treatment of DKA

glucose (once blood levels under 14 to avoid hypos)
fluids (inclu K - clear ketones, correct hypotension & electrolytes)
soluble insulin

23

How long should lifestyle be tried before using an oral antidiabetic drug

3 months

24

when adding insulin into an oral therapy when is it given

at night (long acting or isophane)

25

2 major complications of adding insulin into oral therapy

weight gain and hypo

26

pregnancy appropriate oral antidiabetic drugs

metformin
glibencamide (for genstational diabetes) - only after 11 weeks

27

when are sulfonyureas considered

in patients who are not overweight and in whom metformin is contraindicated

28

which sufonylureas are and aren't apprpriate in the elderly

glibencamide - long acting, not ok
gliclazide/tolbutamide - short acting so ok

29

Problem with acarbose

flatulance

30

What can we treat in type 1 with acarbose

postprandial hyperglycaemia