FN: Diabetes Oral Hypoglycaemics Flashcards Preview

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Flashcards in FN: Diabetes Oral Hypoglycaemics Deck (25):
1

Metformin MOA

Biguanide
Insulin sensitizer
- reduced gluconeogenesis
- Increased peripheral glucose use
- reduced LDL and VLDL

2

Metformin Indications

Lactic acidosis
GI upset - anorexia - wt. loss

3

Metformin Contraindications

Caution in renal or hepatic impairment

Contrast media
General anesthesia
Recent MI

4

Metformin other

Renal excreted - reduced dose or avoid if reduced eGFR

Cannot cause hypos

5

Ploglitazone MOA

Thiazolidinedione
Peripheral insulin sensitizer
PPAR gamma ligand (nuclear receptor involved in glucose and lipid homeostasis)

6

Ploglitazone SE

Wt. gain
Fluid retention
Hepatoxicity
May exacerbate HF

7

Ploglitazone Contraindications

H/L
Insulin use
ACS

8

Ploglitazone other

Dont use with insulin
V. protein bound
Hepatic metabolism
Monitor LFTs

9

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide)

Sulfonylureas
Insulin secretagogues
Block hyperpolarising potassium channels on beta cells - depolarisation and insulin release

10

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide) interactions

effects increased by:
-sulphonamids
-trimethoprim
-NSAIDS
0 warfarin
- fibrates

11

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide) SE

Hypoglycaemia - can be prolonged
Wt. gain (increased appetite)
GI upset
Headache

12

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide) Contraindications

Severe L/R
Acute porphyria

13

Gliclazide (s)
Tolbutamide (s)
Glipizide (s)
Glibenclamide (l)
(chlorpropramide) Other

Renally excreted
V. albumin bound
Caution in elderly with reduced renal function
Avoid long-acting (glibenclamide) in elderly - use gliclazide or tolbutamide

14

Nateglinide
Repaglinide MOA

Meglitinides
Insulin secretagogues
Block hyperpolarising potassium channel

15

Nateglinide
Repaglinide SE

Hypoglycaemia

16

Nateglinide
Repaglinide Other

V. short acting - reduced risk of hypo
Give before meal

17

Sitagliptin
Vildagliptin MOA

Insulin secretagogues
Dipeptidylpeptidase - 4 inhibitor
DPP - 4 breaks down endogenous GLP-1

18

Sitagliptin
Vildagliptin SE

Hypoglycaemia
GI upset

19

Exenatide
Liraglutide MOA

Insulin secretagogues
GLP-1 analogue
Increases insulin secretion and sensitisation

20

Exenatide
Liraglutide SE

hypoglycaemia
GI upset

21

Exenatide
Liraglutide other

Admin by SC injection

22

Acarbose MOA

Intestinal alpha-glucosidase inhibitor
Delays carb absorption - reduced post-prandial blood glucose
Little effect on fasting glucose

23

Acarbose SE

Flatulence
Looe stools/diarrhoea
Abdo pain/bloating
Hepatoxicity (rare)

24

Acarbose contraindications

IBD
L

25

Acarbose Other

Monitor LFTs

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