Rav Endcr Dm Medications

Front 1

best initial tx

Back 1

metformin
not sulfonurea( they increase insulin release from pancreas thereby driving the glucose and lead to obesity

Front 2

how metformin work

Back 2

block gluconeogenesis and increased tissue sensitivity to insulin
reduce intestinal glucose ansorbtion

# 1 choice for obese patients be aware of lactic acidosis

Front 3

when metform is contrind

Back 3

in P with renal disfunction because it can accumulate and cause metabolic acidosis and in elderly
COPD
CHF
alcohol abuse
hepatic disease
be aware of lactic acidosis especially if serum Cr .1.4 in fem and >1.5 in male

Front 4

sulfonylureas

Back 4

tolbutamide
chlorpropamide
glyburide
glipizide glimepiride
stimulate insuline secretionfrom beta cells in pacreas, expect drop of HgA1C on 2 %

#1 choice for BMI <30
asymp or mild DM without pregancy ( contrindicated)
if Hb A1C>7-- add acarbose orthiasalidine ( increase Gi abcrobt of glucose) or insuline
insulin is need when hyperglycemia is out if control even in insulin resistance

most offet ass with hypo glycemia

Front 5

thiasolinidiones

Back 5

improve the insulin resistance and pancreatic beta cells function
m

Front 6

thiasolinidiones what may precipitate

Back 6

acute CHF exacerbation especially in those with underlying CHF and bone loss

Front 7

rapid acting secretagogues--

Back 7

nateglydine
repaglydine
very short life can cause immediate release of insulin
they do not add any therap effect to sulfonurea

Front 8

increatins

Back 8

exenatide- synthetic analog exendine 4? polypeptide that mimics incretin and promote insulin secretion ....

they are part of mechanism when oral glucose
normally produce a rise in insulin adn decrease glucagon level

GLP1- SQ administration BID
reduces gastric emptying, causing early satiety and help in weight loss

stimulate insuline secretion
inhibit glucagon secretion
they decrease DM type 2

Front 9

increatins adv effe

Back 9

nausea in 30 %
may cause pancreatitis

Front 10

dipeptydil peptidase 4 ingibitors

Back 10

sitagliptin inhibit the enzyme dipeptudile peptidas 4.. который ингибирует increatin
increatin>>>incres insulin release and reduc gluycagon secretion

Front 11

alfa glucosidase inhibitors

Back 11

acarbose , miglitol (-) enzyme that digest complex carbohydrates
block glucose absorb in the bowek
they add a 50 % of decrease in Hb A1C
they cause flatus
diarrea
abd pain

Front 12

pramlintide

Back 12

synthetic analog of the polypeptide pancreatic hormone amylin with slows gastric emptying, suppress glucagon and regulate appetite