Oral antidiabetic agents Flashcards
First generation sulfonylurneas
chlorpropamide (Diabinese)
second generation sulfonylurneas
glyburide (DiaBeta, Micronase, Glynase Press Tab)
alpha glycosidase inhibitors
acarbose (Precose)
Biguanide
metformin (Precose)
Dipeptidyl petidase- 4 inhibitors (DDP-4 inhibitor)
sitagliptin (Januvia)
Human amylin
pramlintide acetate (Symlin)
Incretin mimetic
exenatide (Byetta)
Meglitinides
repaglinide (Prandin)
Thiazolidinediones (TZD’s)
rosiglitazone (Avandia)
Actions of sulfonylureas
stimulate insulin release from the beta cells in the pancreas. Increases the number of insulin receptors.
Indications of sulfonylureas
Effective ONLY in patients with functioning beta cells (cannot give to a type I diabetic). May loose effectiveness as the patient disease progresses.
Adverse effects of sulfonylureas
hypoglycemia and GI symptoms
Contraindications of sulfonylureas
sulfa allergies, type I DM and pregnancy with caution in lactation
drug-drug interactions of sulfonylureas
meds that acidify the urine (output is decreased) and beta blockers mask the S&S of hypoglycemia.
Chlorpropamide special info
Is associated with increased cardiovascular disease and has a long half life that put elderly at high risk for hypoglycemia.
glyburide special info
does not interact with as may protein bound drugs and has a shorter duration.
Alpha glucosidase inhibitor adverse effects
GI effects (gas & diarrhea) and hypoglycemia that should be treated with glucose tablets (not sucrose)
actions of alpha glucosidase inhibitors
Inhibits the enzyme responsible for breaking down complex carbs.
Biguanide actions of
works by decreasing liver glucose production and increasing insulin sensitivity.
DDP-4 inhibitor (sitagliptin) acts on
prolonging the effects of insulin secretion, decreasing glucagon ans slows GI emptying
Rare side effects of DDP-4 inhibitor
nausea, cold like symptoms, pancreatitis that can be fatal
Actions of incretin mimetic (exenatide)
mimics effects of the GLP-1 (hormone in the GI track), thereby enhancing glucose dependent insulin secretion in the beta cells, decreases glucagon secretion and slows gastric emptying.
Special info for incretin mimetic
- Discovered in the saliva of Gila Monster.
- given by injection 1 hr prior to AM and PM meals
- DO NOT GIVE IF UNABLE TO EAT
Adverse effects of incretin mimetic
sour stomach, belching, N/V, diarrhea, heartburn, indigestion, (thus do not give it to pts with sever GI disease) Rare cases of pancreatitis.
Profs noted that this med is an injection than why would you not just use insulin.
Actions of human amylin
modulates gastric emptying after a meal to promote feeling of fullness. prevents postmeal rise in glucagon that elevates glucose levels.
Special info for human amylin
Injection SQ immediately prior to a major meal and can be used in combo with insulin or oral agents.
CANNOT BE USED IF PT IS UNABLE TO EAT, BECAUSE IT WORKS WITH GASTRIC EMPTYING
Actions of meglitindes
works like sulfonylureas but have a more rapid onset action and shorter duration thus less risk of hypoglycemia. Give 30 min before meal due to rapid onset.
Actions of Thiazolidinediones
increase the insulin sensitivity of skeletal muscle and adipose, thus increasing glucose uptake.
Special info for thiazolidinediones
- lot of bad side effects
- associated with weight gain and fluid retention; leading to poor outcomes for heart failure pts.
- increase bone fracture; osteoporosis would be a concern
- possible increase risk of stroke
