Anti-Diabetic Medications Other Than Insulin

Front 1

non-insulin medications for DM

3 main categories

Back 1

1-oral for DM -II

2-injectable for DM II

3-injectable for DM I

Front 2

oral medications for DM II

categories # 7

Back 2

1-Biguanide = metformin

2-insulin secretagogous

((SFU / non-SFU))

3-DPP-IV

4-TZDs = pioglitazone

5-a-glucosidase inhibitors

6-bile acid sequestrant

7-dopamine receptors agonist

Front 3

biguainide

Back 3

metformin

Front 4

SFUs secretagogues

(4)

Gly/i

Back 4

(Glyb)uride / (gli)penclimide
(Glip)izde
(Glim)epride
(Glic)lazide

Front 5

non-SFUs secretagogues
(3)

glinide

Back 5

Nate(glinide)
Repa(glinide)
Miti(glinide)

Front 6

a-glucosidase inhibitors

Back 6

acarbose
voglibose
miglitol

Front 7

thia-zolidin-diones

zone

Back 7

pio-glita-zone

Front 8

DPP-4

Di-peptidyl peptidase-4 inhibitors

gliptin

Back 8

sita-gliptin
saxa-gliptin
vilda-gliptin
lina-gliptin

Front 9

bile acid sequestrant

Back 9

cole-seve-lam

Front 10

dopamine receptor agonist

Back 10

bromocriptine mesylate

Front 11

2-injectable for DM II

Back 11

GLP agonist

Hint 11

Liraglutide

exenatide

Front 12

2-injectable for DM II + I

Back 12

amylin analog

Hint 12

pramlinitide

Front 13

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Back 13

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Hint 13

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Front 14

Biguanide

example

Back 14

metformin

Front 15

metformin

doses forms / tab

Back 15

500

850

1000

Front 16

metformin

dose / day

Back 16

start by 500-850 once

increase every days - wks

Hint 16

start

500 X2

850 X1

Front 17

meformin extended release

Back 17

Glucophage XR

500 X1 then increase up to 2000/d

Front 18

metformin

max dose

Back 18

max 2000 mg / day

? 200 - 2550

Front 19

metformin

mechanism of action

Back 19

1-inhibits hepatic glucose output

2-decrease GI glucose absorption

2-stimulate periphral glucose uptake/ sensitivity

Front 20

metformin

advantages

Back 20

wt loss

no hypoglycemia

Front 21

metformin

administration

Back 21

with food

Front 22

metformin

side effects

Back 22

1-GI

2-lactic acidosis

3-asthenia /weakness

Front 23

metformin

contraindications

Back 23

1-CHF

2-M.acidosis

3-DKA

4-cr > 1.5 male / > 1.4 fem

5-contrast within 48 hrs before / after

6-lactation

7-shock

Front 24

metformin

when to D/C during hospitalization

Back 24

-trauma

-fever

-stress

-avoid with alcohol

-infection

Front 25

metformin

pregnancy

Back 25

B

Front 26

metformin

uses /

Back 26

montherapy / 1st line

as combination

Front 27

meformin

brand names

Back 27

-glucopahge

-Diamet

-formit

-metforal

-Mystro

Hint 27

Front 28

metformin combination available

Back 28

meformin + Glmepride

metformin + glibenclimide

metformin + vildagliptin

metformin + sitagliptin

metformin + saxaglibtin

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metformin + pioglitazone

Front 29

metformin + glimepride

Back 29

amaryl M

500 / 2

Front 30

metformin + glibenclimide

Back 30

Glucovance

500 / 2.5

500 / 5

Front 31

metformin + vildagliptin

Back 31

Galvusmet

1000 / 50

850 / 50

Front 32

metformin + sitagliptin

Back 32

janumet

500 / 50

1000 / 50

1000 / 100 (ER)

Front 33

metformin + saxaglibtin

Back 33

kombiglyza XR

500 / 5

1000 / 2.5

1000 / 5

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1111

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Front 38

DDP-IV ???

Back 38

dipeptidyl peptidase 4 inhib

=gliptins

Front 39

DDP-IV

mechanism of action

Back 39

1-L-cells in intestine

2-L-cells secreates the enzyme DPP-IV

3-DPP4 breaks down GLP

4-GLP is an (incretin) that secraeted from L-cells

5-GLP act ti inhibit glucagon and stimulate insulin

Hint 39

GLP = incretin

Front 40

GLP ??

Back 40

Glucagon-like-peptide

is an incretin

Front 41

incretin ??

Back 41

group of gastrointestinal hormones that stimulate a decrease in blood glucose levels by :

1-inhibiting glucagon

2-stimulating insulin

Front 42

incretin examples ??

Back 42

only 2 :

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1-GLP : glucagon-like-peptide

2-GIP :gastric inhibitory peptide

Front 43

DPP- IV

??

Back 43

is the enzyme that inhibits incretin and breaks them

Front 44

DPP-IV

side effects

Back 44

-pancreatitis مهم مهم مهم / نادر

-angioedema

-Steven Johnson synd

Front 45

DPP-IV

Examples #4

Back 45

1-sitagliptin = jinuvea

2-saxagliptin = Ongelyza

3-linagliptin

4-vildaglibtin =

Front 46

Sitagliptin

generic name

Back 46

JANUVIA

Front 47

Sitagliptin

administration

Back 47

once daily

Front 48

Sitagliptin

dose

Back 48

100 mg

Front 49

Sitagliptin

renal impairment

Back 49

renal elimenation

if GFR < 50

dose 50 mg

Front 50

Saxagliptin

generic name

Back 50

Onglyza

Hint 50

Front 51

Saxagliptin

dose

Back 51

once daily

2.5 mg

5 mg

Front 52

Saxagliptin

renal imparment

Back 52

renal elimination

2.5 mg / day

Front 53

Saxagliptin

side effects

Back 53

urticaria

angioedema

Front 54

Vildagliptin

generic name

Back 54

Galvus

Front 55

Vildagliptin

dose

Back 55

once daily

50

100 mg

Front 56

Vildagliptin

renal impairment

Back 56

not approved

Front 57

linagliptin

dose

Back 57

once daily

5 mg

Front 58

linagliptin

renal imparment

Back 58

fecal excreation

no adjustment

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Front 65

a-glucosidase inhibitors

mechanism of action

Back 65

acts by inhibition of :

-polusaccharides

-disacchardides

breakdown to glucose so decreasing postprandial hyperglycemia

Front 66

a-glucosidase inhibitors

administration

Back 66

with meals

Front 67

a-glucosidase inhibitors

examples

Back 67

1-Acarbose

2-Miglitol

Front 68

a-glucosidase inhibitors

dose / initial

max

Back 68

300 mg / day

Front 69

a-glucosidase inhibitors

main side effect

Back 69

GI 25 - 50 %

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bloating

cramps

diarrhea

flatulance

Front 70

a-glucosidase inhibitors

HbA1c reduction

Back 70

modest

0.4 - 0.7 %

Front 71

a-glucosidase inhibitors

risk of hypoglycemia

Back 71

no

Front 72

a-glucosidase inhibitors

acarbose

Back 72

1

Front 73

a-glucosidase inhibitors

acarbose

specific side effect

Back 73

elevated liver enzymes

Front 74

a-glucosidase inhibitors

if hypoglycemia while in regimen

Back 74

treat with glucose not sucrose

Front 75

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Front 80

TZDs ??

Back 80

thia-zolidine-diones

Front 81

TZDs

thia-zolidine-diones

mechanism of action??

Back 81

increased insulin sensitivity in :

-,uscles

-adipose

-liver

Front 82

TZDs

thia-zolidine-diones

examples

Back 82

only one :

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Pioglitazone

Front 83

TZDs

thia-zolidine-diones

pioglitazone

brand name

Back 83

Actos

Front 84

TZDs

thia-zolidine-diones

pioglitazone

use

Back 84

as single agent

in combination

in pt early in DM , still have endogenous insulin

Front 85

TZDs

thia-zolidine-diones

pioglitazone

frequency of use

Back 85

once daily

Front 86

TZDs

thia-zolidine-diones

pioglitazone

dose

Back 86

15 - 30 mg daily

up to 45 /day

Front 87

TZDs

thia-zolidine-diones

pioglitazone

max dose

Back 87

45 mg daily

30 mg daily if used with insulin

Front 88

TZDs

thia-zolidine-diones

pioglitazone

contraindications

Back 88

combromized heart function NYHA III-IV

every pt must be assessed regarding cardiac function

active bladder CA

Front 89

TZDs

thia-zolidine-diones

pioglitazone

side effects

Back 89

- edema / CHF

-hepatotoxicity - rare

-bladder CA ?? still

-subclinical BM suppression

(((with possible pancytopenia due to volume expansion))

-inhib. osteoblast : risk of fx in females

-ovulation in women with anovulatory cycles

-interactions / cyto-p450

Front 90

TZDs

thia-zolidine-diones

pioglitazone

risk factors for precipitating heart failure

Back 90

-previous CHF

-IHD

-HTN

-long-standing DM

-left vent. hypertropthy

-pre-existing edema

-edema after TZDs therapy

-insulin therapy

-aging

-renal failure

-aortic stenosis

-mitral valve disease

Front 91

actos

u have to monitor >>>>

Back 91

liver enzemes

Front 92

actos and bladder CA ??

Back 92

still under-study

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Front 98

dopamin rec agonist

Back 98

bromocriptin

Front 99

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Front 103

Bile acid sequestrant

example

mech. of action

Back 103

Cole-Sevelam hydrochloride

Front 104

Cole-Sevelam hydrochloride

use

Back 104

as monotherapy

combination

Front 105

Cole-Sevelam hydrochloride

dose

Back 105

3 tabs X 2

((625 mg X2))

Front 106

Cole-Sevelam hydrochloride

administration

Back 106

empty stomach

not with other medications / not to interfere with their absorptions

Front 107

Cole-Sevelam hydrochloride

HbAic lowering effect

Back 107

0.4 - 0.8 %

Front 108

Cole-Sevelam hydrochloride

other benefit

Back 108

LDL lowering effect

can be used in pregnancy

can be used in renal + hepatic disease

Front 109

Cole-Sevelam hydrochloride

side effects

Back 109

constipation

Increases TG : triglecyrides

Front 110

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1

Back 112

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Hint 113

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Front 115

insulin secretagogus

SFU

mechanism of action

Back 115

- increasing insulin secreation by binding to specific receptor at B-cells

Front 116

SFUs

administration

Back 116

before meals by 30-60 min

never to fasting

Front 117

SFU

frequency of pills

Back 117

once ( esp. lomg acting)

twice daily

Front 118

SFUs

main side effects

Back 118

-hypoglycemia\\wt gain

Front 119

SFUs

examples #4

Back 119

1-Gli(b)enclimide = Daonil= Glibil

2-Gli(m)epride = Amaryl / Glemax

3-Gli(c)lazide = Dimicron

4-Gli(p)izide

Front 120

Glibenclamide

other name

Back 120

Glyburide

Front 121

Glibenclamide

trade name

Back 121

Daonil

Glibil

Front 122

Glibenclamide

dose

Back 122

1.25 - 20

5 mg X2

10 mg X2 max

Front 123

Glibenclamide

renal impairment

Back 123

avoid

also in elderly

high risk of hypoglycemia

Front 124

Glibenclimide + metformin

brand name

Back 124

Glucovance

Diamet

Hint 124

Front 125

11

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Front 126

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Hint 126

11

Front 127

Glipizide

Back 127

short action 2-3 X

once if ling acting

Front 128

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Front 130

Gli(M)epride

administration

Back 130

longest duration

once daily

Front 131

Gli(M)epride

brand name

Back 131

Amaryl

Glemax

Front 132

Gli(M)epride

doses

Back 132

1 mg >>>>> 8 mg

Front 133

Gli(M)epride + glucophage

brand

Back 133

Amaryl M

Front 134

11

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Front 135

11

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11

Front 136

Gli(c)lazide

brand name

Back 136

Di-mi(c)ron

dimicron

Front 137

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Hint 137

1111

Front 138

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Front 139

non-SFUs segreatagogus

examples ((-glinide grop))

Back 139

-meglitinide

-Repaglitinide

-nateglitinid

_________________________________-

X3 with meals

Front 140

meglitinide

??

Back 140

short acting secretagogus

5-20 X 3 (meals)

Front 141

Repaglitinide

Back 141

short action / half life

within 30 min before meals

0.5 - 4 mg X 3 (meals)

hypoglycemia / wt.gain

Front 142

Natiglinide

Back 142

D-phenylalanine derevatives

within 10 mino of meals

low hypoglycemia risk

to control postprandial hyperglycemia

18- - 320 X 3

Front 143

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1

Front 146

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1

Front 148

injectable drugs for Type 2 DM

Back 148

GLP agonist

Front 149

GLP agonist

mechanism

Back 149

similar to endogenous GLP 1 = incretin

resistant to degradation by DPP-IV enzyme

Front 150

GLP agonist

administration

Back 150

SC

Front 151

GLP agonist

advantages

Back 151

- improved satiety

-wt loss

Front 152

GLP agonist

examples

Back 152

Exenatide

Liraglutide

Front 153

GLP agonist

Exenatide

doses/admin

Back 153

-daily doses (X3 meals)

-weekly dose

Front 154

GLP agonist

Exenatide

daily dose

Back 154

5 - 10 micg X3

Front 155

GLP agonist

Exenatide

weekly dose

Back 155

2 mg / wk

Front 156

GLP agonist

Exenatide

side effects

Back 156

-pancreatitis

-renal impairment

Front 157

GLP agonist

Exenatide

advantages

wt

HbA1c

Back 157

-wt loss = 4 Kgg

-Hba1c 0.6 - 1.2 %

Front 158

GLP agonist

leraglutide

Back 158

SC

Once daily

0.6 ..... 1.2......1.6

Front 159

GLP agonist

leraglutide

side effects

Back 159

-nausea

-vomitting

-dizziness

-headach

Front 160

GLP agonist

leraglutide

possible side effects in animal models

Back 160

increased calcitonin and thyrois]d medullary cancer

Front 161

injectable medication for type 1+2

Back 161

Amylin analogues

Front 162

amylin analogue

mechanism

Back 162

blunting postprandial BG

Front 163

amylin analogue

example

Back 163

pram-lintide

SC

15 - 120 mic

before meals