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    Cards (34)

    • What is the primary biguanide medication mentioned?
      Metformin
    • Why should the dosage of metformin be increased gradually?
      To minimize the risk of GI side effects
    • How much should the metformin dosage be increased weekly?
      By 500 mg
    • When should metformin be taken to reduce side effects?
      With food
    • What caution should be taken when prescribing metformin?
      Cautions in renal impairment
    • What is a common transient side effect of metformin?
      Diarrhea
    • Name two other common side effects of metformin.
      Anorexia and nausea & vomiting
    • What are the advantages of metformin?
      • Reduced HbA1c by 1-2%
      • Not associated with weight gain
      • Not associated with hypoglycemia when given alone
      • Beneficial effects on lipid profile
      • No blood glucose monitoring required
      • Good evidence base
      • Not expensive
    • What are examples of sulphonylureas?
      Glibenclamide, gliclazide, glimepiride, glipizide
    • How much does sulphonylureas decrease HbA1c?
      By 1-2%
    • When are sulphonylureas considered first line treatment?
      If metformin is intolerant
    • What are the advantages and disadvantages of sulphonylureas?
      Advantages:
      • Good evidence base
      • Inexpensive

      Disadvantages:
      • Weight gain
      • Increased risk of hypoglycaemia (1 in 100)
    • What is an example of a thiazolidinedione?
      Pioglitazone
    • How much does thiazolidinediones decrease HbA1c?
      By 1%
    • Why are thiazolidinediones useful in renal failure?
      As a substitute for metformin
    • What is the risk of hypoglycaemia with thiazolidinediones?
      Low risk of hypoglycaemia
    • What side effect do thiazolidinediones cause?
      Weight gain
    • In which patients are thiazolidinediones contraindicated?
      Heart failure, fractures, haematuria
    • What are Dipeptidylpeptidase-4 inhibitors commonly known as?
      Gliptins
    • How do gliptins affect weight?
      They do not appear to cause weight gain
    • How long does it take for gliptins to exert their effect?
      It takes time to exert effect
    • How do gliptins compare to sulphonylureas regarding hypoglycaemia?
      Less incidence of hypoglycaemia than sulphonylureas
    • What is the approximate decrease in HbA1c from gliptins?
      Approximately 0.7%
    • What are examples of SGLT2 inhibitors?
      Dapagliflozin, canagliflozin, empagliflozin
    • How much does SGLT2 inhibitors decrease HbA1c?
      By 5 mmol/mol
    • What are the benefits of SGLT2 inhibitors?
      Weight loss and BP reduction
    • What is a side effect of SGLT2 inhibitors?
      Polyuria
    • What infections are associated with SGLT2 inhibitors?
      Genital infections
    • What is a caution for SGLT2 inhibitors?
      Care with hypovolaemia / loop diuretics
    • What is the age limit for SGLT2 inhibitors?
      Cannot be given to >85 years
    • When cannot SGLT2 inhibitors be used based on eGFR?
      If eGFR < 45
    • What are examples of meglitinides?
      Repaglinide, nateglinide
    • What are the advantages and disadvantages of meglitinides?
      Advantages:
      • Used as mono or with metformin

      Disadvantages:
      • Weight gain
      • Increased risk of hypoglycaemia (less than SU)
      • Expensive
    • What is the place of GLP-1 in therapy?
      3rd line with:
      • Metformin and SU or TZD if:
      • BMI > 35 kg/m²
      • HbA1c > 58 mmol/mol
      • Diagnosis < 10 years
      OR
      • BMI < 35 kg/m² and can't tolerate insulin
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