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Cards (34)
What is the primary biguanide medication mentioned?
Metformin
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Why should the dosage of metformin be increased gradually?
To
minimize
the
risk
of
GI
side
effects
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How much should the metformin dosage be increased weekly?
By
500
mg
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When should metformin be taken to reduce side effects?
With
food
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What caution should be taken when prescribing metformin?
Cautions
in
renal
impairment
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What is a common transient side effect of metformin?
Diarrhea
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Name two other common side effects of metformin.
Anorexia
and
nausea
&
vomiting
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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
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What are examples of sulphonylureas?
Glibenclamide
,
gliclazide
,
glimepiride
,
glipizide
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How much does sulphonylureas decrease HbA1c?
By
1-2%
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When are sulphonylureas considered first line treatment?
If
metformin
is intolerant
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What are the advantages and disadvantages of sulphonylureas?
Advantages:
Good evidence base
Inexpensive
Disadvantages:
Weight gain
Increased risk of
hypoglycaemia
(
1 in 100
)
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What is an example of a thiazolidinedione?
Pioglitazone
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How much does thiazolidinediones decrease HbA1c?
By
1%
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Why are thiazolidinediones useful in renal failure?
As a substitute for
metformin
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What is the risk of hypoglycaemia with thiazolidinediones?
Low risk
of
hypoglycaemia
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What side effect do thiazolidinediones cause?
Weight gain
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In which patients are thiazolidinediones contraindicated?
Heart
failure
,
fractures,
haematuria
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What are Dipeptidylpeptidase-4 inhibitors commonly known as?
Gliptins
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How do gliptins affect weight?
They do not appear to
cause
weight
gain
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How long does it take for gliptins to exert their effect?
It
takes
time
to
exert
effect
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How do gliptins compare to sulphonylureas regarding hypoglycaemia?
Less
incidence
of
hypoglycaemia
than
sulphonylureas
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What is the approximate decrease in HbA1c from gliptins?
Approximately
0.7%
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What are examples of SGLT2 inhibitors?
Dapagliflozin
,
canagliflozin
,
empagliflozin
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How much does SGLT2 inhibitors decrease HbA1c?
By
5
mmol
/
mol
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What are the benefits of SGLT2 inhibitors?
Weight
loss
and
BP
reduction
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What is a side effect of SGLT2 inhibitors?
Polyuria
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What infections are associated with SGLT2 inhibitors?
Genital
infections
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What is a caution for SGLT2 inhibitors?
Care with
hypovolaemia
/
loop diuretics
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What is the age limit for SGLT2 inhibitors?
Cannot be given to >
85
years
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When cannot SGLT2 inhibitors be used based on eGFR?
If eGFR <
45
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What are examples of meglitinides?
Repaglinide
,
nateglinide
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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
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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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