DM drugs Flashcards
(31 cards)
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adverse effects of metformin ?
gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20%
reduced vitamin B12 absorption - rarely a clinical problem
lactic acidosis with severe liver disease or renal failure
indication to start someone on metformin ?
DM diagnosis
whose blood glucose measure (fasting plasma glucose or HbA1c) shows they are still progressing towards type 2 diabetes, despite their participation in an intensive lifestyle-change programme’
HB1AC targets for DM
HbA1c target
Lifestyle = 48 mmol/mol (6.5%)
Lifestyle + metformin (500mg OD) 48 mmol/mol (6.5%)
at what HB1AC level should we add a second drug ?
should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)
due to contrast nephropathy; metformin should be discontinued when?
on the day of the procedure and for 48 hours thereafter
o reduce the incidence of gastrointestinal side-effects of metformin what do clinicians do ?
metformin titrated up slowly
in what condition are lactic acidosis in metformin exacerbated ?
taken during a period where there is tissue hypoxia:
recent myocardial infarction,
sepsis,
acute kidney injury
and severe dehydration
DM medications causing weight gain.
Sulfonylureas - Gliclazide
side effects of agliflozins , sodium-glucose co-transporter-2 (SGLT2)- inhibitor group
weight loss = via the excretion of glucose by the kidneys.
fournier’s gangrene
Can increase the risk for necrotising fasciitis
SGLT-2 inhibitors reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule = can cause normoglycemic ketoacidosis
= unexplained raised anion gap acidosis and normal blood sugar level who is on one of these medications
Glucagon-like peptide-1 (GLP1)-agonist group are administered ?
subcutaneously
advantage of Glucagon-like peptide-1 (GLP1)-agonist such as Exenatide and liraglutide
help with weight loss.
Liraglutide has the added benefit of being given only once a day.
benefit of Dipeptidyl-peptidase 4 (DPP4 inhibitors) , gliptin?
do not cause weight gain.
no increased incidence of hypoglycaemia
route for DPP-4
oral
function of gliptin (DPP-4 inhibitor) ?
increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown
incretin
stimulate insulin release
and inhibit glucagon release
function of metformin ?
activation of the AMP-activated protein kinase (AMPK)
increases peripheral insulin sensitivity
and decreased hepatic gluconeogenesis
function of sulfonyureas - gliclazide ?
augment pancreatic insulin secretion.
bind to an ATP-dependent K+(KATP) channel
Increased insulin secretion can lead to hypoglycaemia.
function of GLP mimetic ?
exeatide - increase pancreatic inulin release
slow gastric emptying
promote satiety
suppress glucagon
when should GLP-1 be administered
Exenatide must be given by subcutaneous injection within 60 minutes before the morning and evening meals. It should not be given after a meal.
Liraglutide is the other GLP-1 mimetic currently available. One the main advantages of liraglutide over exenatide is that it only needs to be given once a day.
Glucagon-like peptide-1 (GLP-1) mimetics combination together
sulfonylureyas - gliclazide
metformin
To continue GLP-1 mimetic NICE guidelines would like to achieve what parameters ?
> 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months
3% weight loss after 6 months to justify the ongoing prescription of GLP-1 mimetics.
