Antidiabetic agents Flashcards
Glucagon
Hyperglycemic agent - requires glycogen. IM, SC, IV, gradual onset
Tx: adults w/ stable DM, Bblocker OD, to relax GI (radio)
Adv: not for juveniles
Diaxozide
(Proglycem) Non-diuretic thiazide, vasodilator, hyperglycemic
Tx for insulinomas
Directly inhibits insulin secretion, dec glucose periph use, stim gluconeogenesis.
Adv: excessive hair growth (esp kids)
Tolbutamide (Orinase)
1st gen Sulfonylurea - block K+ch, depol: direct inc insulin release
Tx: DM, safer in elderly
Adv: hypoglycemia, GI, wt gain
CI: Sulfa allergy, renal/hepatic dz
Chlorpropamide (Diabenese)
1st gen Sulfonylurea - block K+ch, depol: direct inc insulin release
Tx: DM, disulfiram like effect (flushing)
Adv: hypoglycemia, GI, wt gain
CI: Sulfa allergy, renal/hepatic dz
Tolazamide (Tolinase)
1st gen Sulfonylurea - block K+ch, depol: direct inc insulin release
Tx: DM
Adv: hypoglycemia, GI, wt gain
CI: Sulfa allergy, renal/hepatic dz
Glyburide (Micronase)
2nd gen Sulfonylurea - block K+ch, depol: direct inc insulin release
Tx: DM, worst for hypoglycemia
Adv: hypoglycemia, GI, wt gain
CI: Sulfa allergy, renal/hepatic dz
Glipizide (Glucotrol)
2nd gen Sulfonylurea - block K+ch, depol: direct inc insulin release
Tx: DM, least hypoglycemic effect
Adv: hypoglycemia, GI, wt gain
CI: Sulfa allergy, renal/hepatic dz
Glimepiride (Amaryl)
2nd gen Sulfonylurea - block K+ch, depol: direct inc insulin release
Tx: DM
Adv: hypoglycemia, GI, wt gain
CI: Sulfa allergy, renal/hepatic dz
Repaglinide (Prandin)
Metglitinide- Tx: DM
block K+ch: mimics endo insulin pattern (dec postprandial glucose)
Not sulfa, short acting (preprandial dose), NO WT GAIN
Adv: slight hypoglycemia
CI: Not for combo w/ sulfas, liver dz, preg cat C
Nateglinide (Starlix)
Metglitinide- Tx: DM
block K+ch: mimics endo insulin pattern (dec postprandial glucose)
Not sulfa, short acting (preprandial dose), NO WT GAIN
Adv: slight hypoglycemia
CI: Not for combo w/ sulfas, liver dz, preg cat C
Metformin (Glucophage)
Biguanide -Tx: DM, dec glucose levels (not by releasing insulin)
Safe >10yo, no wt gain, dec macrovasc events, no hypoglycemia
Adv: lactic acidosis (renal/hep, alcolo, CHF, COPD), DIARRHEA
CI: preg/breast feeding
Pioglitazone (Actos)
Glitazone/Thiazolidinediones “insulin sensitizer” Post-receptor insulin mimetic (nuclear PPAR-y ligand), wks/mos for onset, no insulin release
Lowers insulin resistance, dec development of T2DM
Adv: wt gain, edema (inc risk of heart dz)
CI: hepatic dz, CHF, preg cat C
Rosiglitazone (Avandia)
Glitazone/Thiazolidinediones “insulin sensitizer” Post-receptor insulin mimetic (nuclear PPAR-y ligand), wks/mos for onset, no insulin release
Lowers insulin resistance, dec development of T2DM
Adv: wt gain, edema (inc risk of heart dz)
CI: hepatic dz, CHF, preg cat C
Acarbose (Precose)
a-glucosidase inhibitor (SI enterocytes)-
delays carb digestion, diet aid in T1-2DM
dec postprandial glucose, no wt gain
Adv: FLATULENCE
CI: breastfeed, GI dz, renal/hepatic dz
Miglitol (Glyset)
a-glucosidase inhibitor (SI enterocytes)-
delays carb digestion, diet aid in T1-2DM
dec postprandial glucose, no wt gain
Adv: FLATULENCE
CI: breastfeed, GI dz, renal/hepatic dz
Exenatide (Byetta)
GLP-1 agonist resistant to DPP-IV, SubQ 2x/day
Tx: dec postprandial gluc, inc Bcell, wt loss, no hypoglycemia
Adv: GI, HS, pancreatitis, pancreas/thyroid CA
CI: slow GI, renal sz, preg/breastfeed, thyroid Ca
Liraglutide (Victoza)
GLP-1 agonist resistant to DPP-IV, SubQ 1x/day
Tx: dec postprandial gluc, inc Bcell, wt loss, no hypoglycemia
Adv: GI, HS, pancreatitis, thyroid CA
CI: slow GI, renal sz, preg/breastfeed, thyroid Ca
Dulaglutide (Trulicity)
GLP-1 agonist resistant to DPP-IV, SubQ 1x/wk
Tx: dec postprandial gluc, inc Bcell, wt loss, no hypoglycemia
Adv: GI, HS, pancreatitis, pancreas/thyroid CA
CI: slow GI, renal sz, preg/breastfeed, thyroid Ca
Sitagliptin (Januvia)
DPP-IV inhibitor- more incretin effect (inc gluc dependent insulin sec)
Oral, dec postprandial/fasting gluc, no wt gain
Adv: HS, pancrea-titis/Ca
CI: slow GI, renal dz, preg/breastfeed cat C
Saxagliptin (Onglyza)
DPP-IV inhibitor- more incretin effect (inc gluc dependent insulin sec)
Oral, dec postprandial/fasting gluc, no wt gain
Adv: HS, pancrea-titis/Ca
CI: slow GI, renal dz, preg/breastfeed cat C
Linagliptin (Tradjenta)
DPP-IV inhibitor- more incretin effect (inc gluc dependent insulin sec)
Oral, dec postprandial/fasting gluc, no wt gain
Adv: HS, pancrea-titis/Ca
CI: slow GI, renal dz, preg/breastfeed cat C
Alogliptan (Nesina)
DPP-IV inhibitor- more incretin effect (inc gluc dependent insulin sec)
Oral, dec postprandial/fasting gluc, no wt gain
Adv: HS, pancrea-titis/Ca
CI: slow GI, renal dz, preg/breastfeed cat C
Pramlintide (Symlin)
Centrally acting DM1-2 tx, amylin analog, Adjunct w/ insulin, SubQ
Wt loss (appetite dec), dec postprandial glucose
Adv: GI, injection site lipodystrophy
CI: slow GI, preg/breastfeed
Bromocriptine (Cycloset)
DA agonist- DM specific, inc suppression of gluconeogenesis, oral
dec FFA/TG-dec CV endpoint pd. Take <2hrs waking, CYP3A4
Adv: N, weak, dizzy, GI (mild)
CI: CYP3A4 interact, ergot all, syncope/hypotension, dec lactation
