Diabetic meds Flashcards
(32 cards)
What is the first line treatment for DM2?
Metformin
What are the 2 main side effects of Metformin to be aware of?
- Nausea, diarrhoea, abdo pain
* Lactic acidosis → rare side effect
What does Metformin not do?
It does not cause HYPOglycaemia
What are the major contraindications for Metformin?
- Renal disease
- Hepatic disease
Patients are predisposed to lactic acidosis as there is reduced drug elimination or reduced tissue oxygenation.
What drugs can metformin be paired with?
- Sulphonylureas
- Glitazones (Thiazodinediones)
- Insulin
What eGFR threshold should be adhered to in the administering of Metformin?
=/< 36L/min
What is the MOA of Metformin?
- Reduces hepatic glucose genisis
* Reduces insulin resistance in skeletal mescle
What is the MOA of sulphonylureas?
- They stimulate insulin production in B-cells
* They stimulate Ca2+ influx into the cell
What are major side effect of sulphonylureas?
- Hypoglycaemia!!! → excreted via urine so avoid in the elderly or renaly impaired
- Weight gain → Major concern for obese patients
- ~3% experience gastro upset
- allergic skin rash
- Bone marrow toxicity
What is a major contraindication for sulphonylureas?
Pregnancy/breastfeeding
When should you stop a sulphonylurea?
During and for a few days after an MI → reduced mortality
What drugs have major contraindications when used with a sulphonylurea?
• Several drugs augment the effects of sulphoylurea causing severe hypoglycaemia →
- NSAIDs
- coumarins
- Antibiotics :Sulphomamides, trimethoprim, cloramphenicol
- imidazole antifungal drugs
When would you not use a sulphonamide?
in late stage DM2 or in DM1 → They need functional B-cells
How does repaglinide differ to a normal sulphonylurea?
- Less potent + faster acting with shorter duration → Less risk of hypoglycaemia
- Less weight gain
What is the MOA of glitazones?
Better glucose absorbtion in fat
What are the major side effects of glitazones?
- Hepatotoxicity → LFTS
- Weight gain + fluid retention
- Hypoglycaemia
- Fractures
What is the major contraindication of Glitazones?
Pregnancy/breastfeeding
When treating DM2, where do glitazones come in?
they replace either Metformin of sulphonylurea
What would be indications for the use of repaglinide?
- Poor medication compliance
* irregular mealtimes
When would you use a GLP1?
as an alternative to insulin
What is the what is the major side effect of GLP1’s?
Weight loss
What medication should be given to a patient with a mutation in the HNF -1 alpha gene and poor compliance?
gliclazide
What is the effect of metformin on someone suffering from polycystic ovary syndrome?
- It increases periferal insulin sensitivity.
* sometimes used in conjunction with clomifene
What is the management of diabetic ketoneacidosis?
- fluid replacement: most patients with DKA are deplete around 5-8 litres. Isotonic saline is used initially.
- insulin: an intravenous infusion should be started at 0.1 unit/kg/hour.
- Once blood glucose is < 15 mmol/l an infusion of 5% dextrose should be started
- correction of hypokalaemia
