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Metformin
- Biguanide to treat DM type 2
- Improves glucose tolerance
- -activates AMP kinase
- -decreases gluconeogenesis
- -stimulates direct tissue glycolysis
- -decrease plasma glucagon
- -decrease GI glucose absorption
- Reduces microvascular complications
- No weight gain
- Adv Rxns: lactic acidosis, GI distress, decrease B12 absorption
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Sulfonylureas
- Treat DM type 2
- MOA: lowers threshold of beta cells by blocking SUR1 K+ receptors, which causes depolarization and insulin release
- Adv Rxns: Hypoglycemia, weight gain, GI distress, SIADH
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Meglitinides
- Nateglinide, Rapeglinide
- Treat DM type 2
- MOA: lowers threshold of islet beta cells by blocking SUR1 K+ receptors, which causes depolarization and insulin release
- Faster onset and shorter duration than Sulfonylureas
- Can be given to pts with sulfa allergies
- Tox: Renal disease, increased transaminases
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Thiazolidinediones
- Rosiglitazone, Pioglitazone
- Treat DM type 2
- Insulin sensitizer in peripheral tissues via PPAR gamma receptor (alters gene production in glucose metabolism)
- Decreases gluconeogenesis
- Increases glucose uptake in skeletal muscle
- Tox: elevated liver enzymes, edema, HEART FAILURE
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Incretin Mimetics
- Exanitide
- Treat DM type 2
- GLP-1 analogue: Increases insulin secretion
- Tox: hypoglycemia, GI distress, decreased appetite, pancreatitis (rare)
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Sitagliptin
- DPP-4 Inhibitor (DPP-4 is the enzyme that breaks down incretin)
- Treat DM type 2
- Add-on therapy with Metformin and Sulfonylureas
- Tox: GI distress, nasopharyngitis, hypoglycemia
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Alpha-Glucosidase Inhibitors
- Acarbose, Miglitol
- Results in delayed carb digestion from GI and therefore decreases glucose absorbed
- Tox: Abd pain, diarrhea, flatulence
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