Ward Round Notes

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Group Examples Mechanism Contrindications and side effects Other notes Biguinides Metformin Reduce hepatic glucose production Increases insulin sensitivity GI side effects are common Risk of lactic acidosis in acute illness or reduced GFR. CI in those with impaired hepatic function and hx of ETOH excess due to increased lactic acidosis risk. Sulfonylureas Gliclazide Glimepiride (long acting sulfonylurea) Glimbenclamide glipizide Increases insulin secretion from pancreatic B cells through closing ATP-sensitive potassium channels. Risk of hypoglycaemia Weight gain Meglitinides Repaglinide Nateglinide Works the same way as sulfonylurea – but shorter acting. Hypoglycaemia Dipeptidyl peptidase IV inhibitors (DPP4) Linagliptin Sitagliptin Saxagliptin Alogliptin Inhibit DPP-4 which breaks down incretins (GLP-1 and GIP) there