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Classes (6)
- Insulin Secretagogues (sulfonylureas & meglitanides)
- Thiazolidinediones (TZD's)
- Biguanide
- aplha-Glucosidase Inhibitors
- DPP-IV Inhibitors
- Hormone mimetics
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Sulfonylurea drugs (3)
- Glyburide
- Glipizide
- Glimipride
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Sulfonylurea MOA
- Bind to ATP-sensitive K channel receptors, causing depolarization of cell.
- Ca ion influx through voltage-gated channels causes secretion of insulin
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Meglitanide MOA
- Interact with ATP-sensitive K channel on pancreatic Beta cells
- Depolarization of the cell opens Ca channels, Ca influx and insulin secretion
- (similar to sulfonylurea)
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Sulfonylurea ADR
Tachyphylaxis
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Insulin Secretagogue ADR's (sulfonylurea & meglitanides)
- Hypoglycemia due to promotion of insulin secretion
- Weight gain due to insulin secretion
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Thiazolidinedione (TZD) Drugs (2)
- Rosiglitazone
- Pioglitazone
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TZD MOA
Improves insulin sensitivity in adipose, skeletal muscle and liver
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Selected TZD ADR's (2)
- Cardiotoxicity (Avandia)
- Hepatotoxicity
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Biguanide Drug (1)
Metformin
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Biguanide MOA (3)
- Decreased hepatic gluconeogenesis
- Decreases intestinal absorption of glucose
- Improves insulin sensitivity by increasing peripheral glucose uptake and utilization
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Selected Biguanide ADR's (4)
- Lactic acidosis (black box warning)
- Renally eliminated, contraindicated w/renal issues
- Contraindicated for those that may become hypoxic (COPD)
- Diarrhea (>50%)
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alpha-Glucosidase Inhibitor Drugs (2)
- Acarbose (Precose)
- Miglitol (Glyset)
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alpha-Glucosidase MOA (2)
- Delay digestion and absorption of carbohydrates into absorbable monosaccharides by competetively inhibiting alpha-glucosidase enxzymes in the intesting
- Cause a slower rise in post-prandial blood glucose, requiring reduced insulin response (insulin sparing agents)
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Selected alpha-Glucosidase Inhibitor ADR's (3)
- Flatulance
- Diarrhea
- Abdominal pain
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DPP-IV Inhibitor Drugs (3)
- Linagliptin
- Sitagliptin
- Saxagliptin
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DPP-IV inhibitor MOA (3)
- Increase glucose-dependent insulin secretion
- Decrease Glucagon levels
- Slow gastir emptying by preventing degredation on incretin hormones by DPP-IV
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Hormone Mimetic Drugs (3)
- Exenatide
- Liraglutide
- Pramlintide
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Hormone Mimetic MOA (4)
- Increase glucose-dependent insulin secretion
- Decrease glucagon levels
- Slow gastric emptying
- Decrease appetite
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Selected Hormone Mimetic ADR's (3)
- Exanatide - weight loss and nausea
- Liraglutide - nausea and risk of thyroid cancer
- Pramlintide - nausea and hypoglycemia
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