Drugs used in Diabetes Dr Sally Hudson. BIGUANIDES reduce output of glucose from the liver and...
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Transcript of Drugs used in Diabetes Dr Sally Hudson. BIGUANIDES reduce output of glucose from the liver and...
Drugs used in Diabetes
Dr Sally Hudson
BIGUANIDESreduce output of glucose from the liver and enhances uptake and use of glucose by
muscle cells
Example ADVANTAGES DISADVANTAGES COST Caution
Metformin500mg/850mg/1g
ORALWeight reductionNo hypo’sUKPDS evidenceHba1c 1.5%
Nausea, vomiting abdo. Pain, diarrhoea,anorexia/loss apetiteRisk lactic acidosisAvoid eGRF<30
CHEAP Renal failureHepatic failure and alcoholism as increase risk of lactic acidosis
Metformin M/R500mg,750mg,1g
ORALOnce dailyWeight reductionNo hypo’s
Still GI side effects Less than standard formulationRisk lactic acidosis
Moderate Renal failure
SULPHONYLUREASstimulate insulin release from the pancreas.
Example ADVANTAGES DISADVANTAGES COST Caution
GLICLAZIDE80MG
RAPID ONSET ACTIONORALHba1c
HYPO’SWEIGHT GAINGI SIDE EFFECTSLIVER FUNCTION
CHEAP ELDERLY DRIVERS
GLICLAZIDE m/R30MG
ONCE DAILYORAL
Postprandial glucose regulatorsPostprandial glucose regulators stimulate a rapid, short duration release of insulin
from the pancreas. This helps to restore the normal physiological insulin response to meals.
ExampleExample
Example ADVANTAGES DISADVANTAGES COST Caution
Repaglinide500mcg 30min before mealsUp to 4mg as single dose
Reduce post prandial BGReduce Hba1c up to 2%Suitable patient erratic lifestyle or hypo’s on sulphonylureas
Weight gainhypoglycaemia
cheap Renal impairment hepatic impairment
THIAZOLINDIONES(GLITAZONES)Thiazolidinediones reduce insulin resistance in adipose, skeletal, and hepatic tissues
by increasing transcription of insulin sensitive genes in these cells.
Example ADVANTAGES DISADVANTAGES COST Caution
PIOGLITAZONE15MG.30MG,45MG
ONCE DAILYORALIMPROVED LIPID PROFILE 0.5-1.5% Hba1c
WEIGHT GAINFracture riskRisk heart failureAnaemiamaculopathy
EXPENSIVE Ci HEARTFAILURE
DPP-4 INHIBITORSblock the action of DPP-4 which increases the availability of GLP-1.
Example ADVANTAGES DISADVANTAGES
COST Caution
SITAGLIPTIN(januvia)
WEIGHT NEUTRALONCE DAILY 100mgORALImproves fasting glucoseImproves B cell function(Triple therapy licence metformin,gliclazide,glitazone) Mono therapy licence if unable to take metformin.
GI SIDE EFFECTSNASOPHARYNGITIS
EXPENSIVE Adverse effects pancreatitis
Vildagliptin(galvus)Saxagliptin(onglyza)
INCRETIN MIMETICSBeta cells: Enhances glucose-dependent insulin secretion
Stomach: Helps slow gastric emptyingLiver: ↓ Glucagon which reduces hepatic glucose output
Alpha cells: ↓ Postprandial glucagon secretionPromotes satiety and reduces appetite.
Example ADVANTAGES DISADVANTAGES COST Caution
EXENATIDE LOW HYPO RISKWEIGHT LOSS
INJECTEDTWICE DAILYNAUSEA BLOATING
EXPENSIVE PANCREATITISSevere renal impairment
LIRAGLUTIDE ONCE DAILYLOW HYPO RISKWEIGHT LOSSBP REDUCTION
INJECTEDNAUSEA BLOATING
EXPENSIVE PANCREATITITSMEDULLARY THYROID CASevere renal impairment
INSULINExample ADVANTAGES DISADVANTAGES COST Caution
LONG ACTING ANALOGUESLANTUS AND LEVEMIR
EffectiveTailored regime
HYPO RISKWEIGHT GAINLantus cancer risk
moderate HGV/PSV DRIVERS
Short actingHumalognovorapid
Reduces postprandial glucoseRapidUse as part of basal bolus
Weight gainHypo’s
moderate
MixedHumalog mix 25Novomix 30
Only twice daily Less flexibleHypo’s
moderate
Erectile impotencePDE5 inhibitors
Name Dose duration Caution CI SE
SildenafilViagra
25-100mgSingle dose1 hour before intercourseTake on empty stomach
Onset action 25 min delayed if taking foodDuration action 4-5 hours
CVDAnatomical deformation penisPredisposition to priapism
Not in patients on nitrates.Within 4 hours of alpha blockesr
IndigestionHeadache facial flushing
TadalafilCialis
10mg-20mg at least 30min before max-20mg in 24 hours
Onset action 16-45 minDuration 36 hours
Not in patients on nitrates.Alpha blockers
IndigestionHeadache
Vardenafillevitra
5-20mg 25-60 min beforeCan eat/drink
Onset action 25 min. Delayed by fatty meal.Duration 4-5 hours
Not in patients on nitrates.Alpha blockers
Headache facial flushing