T2DM therapeutics Flashcards Preview

Endocrinology > T2DM therapeutics > Flashcards

Flashcards in T2DM therapeutics Deck (12):
1

Metformin adverse effects

GI side effects:
Anorexia, nausea, vomiting, diarrhoea, abdo pain, taste disturbance
GI side effects in up to 25%; only 5% cannot tolerate the drug

Interference with vitamin B12 and folic acid absorption (anaemia is rare)

Lactic acidosis
- 1 case per 100,000 treated patients
- Can be fatal

Liver failure

Rash

2

Lactic acidosis and Metformin

Lactic acidosis:
Rarely causes it de novo, but caution in patients at high pre-existing risk eg acute heart failure, sepsis, acute MI, respiratory failure, hypotension for any cause

3

Metformin and Renal toxicity

Avoid or stop if eGFR 150μmol/l
Half dose if eGFR 30-45 ml/min
Temporarily withhold if IV contrast being used eg. Angiography, CT scan

4

Metformin and liver toxicity

Discontinue if advanced cirrhosis/liver failure
Discontinue if risk of lactic acidosis eg encephalopathy, alcohol excess
May be beneficial in Non-alcoholic fatty liver disease (NAFLD)

5

Gliclazide

Sulphonylurea
40mg od -160mg bd

6

Glibenclamide

Sulphinylurea 5mg - 15mg od

7

Glimepiride

1mg-6mg od

8

Sulphonylurea adverse effects

Hypoglycaemia
Greatest risk with older agents eg chlorpropramide and glibenclamide
Particular care in elderly/frail, alcohol excess, liver disease

Weight gain
Only 1st line use in underweight T2DM, or 2nd line as add-on to metformin, or in those intolerant to metformin

GI upset, headache

Rarely hypersensitivity, blood dyscrasias and liver dysfunction

Avoid in severe renal or hepatic failure

9

Which type of drug might cause hypersensitivty and blood dyscrasias and liver dysfunction?

Sulphonylureas

10

PPARy agonists?

Thiazolidinediones --> pioglitazone 15-45 mg od

11

TZD bad side effects :(

RISK OF HIP FRACTURE

Weight Effect: load of shite but interesting
Increase almost inevitable
Due to increase in subcutaneous (but not visceral) fat and fluid retention

Heart Failure
Fluid retention results in near doubling of risk of admission with heart failure (risk still low in non-elderly without pre-existing HF)

12

SGLT2 inhibitor

Dapagliflozin
-acts on the incretin pathway