-
sulfonylureas
- secretagogues
- MOA: blocks ATP K+ channels in the pancreatic Beta-cells, results in Ca influx and release of preformed insulin, inhibits glucagon release
- USES: Type 2 DM
- AE: hypoglycemia, weight gain
-
tolbutamide
- insulin segretagogue
- safe in the elderly
- AE: hypoglycemia, weight gain
-
chlorpropamide
- insulin secretagogue
- MOA: potentiates the effect of ADH - dilutional hyponatremia - SAIDH - retains water
- USES: neurogenic diabetes insipidus
- AE: hypoglycemia, disulfiram- like reaction with alcohol
- long DOA (60hrs)
- CI: pts with renal and hepatic insufficiency
-
glyburide
- 2nd generation insulin secretagogue
- MOA: block ATP-K+ channels, increase Ca influx and insulin secretion
- USES: type 2 DM
- AE: highest incidence of hypoglycemia
- minimal transfer across placenta
-
glipizide
- 2nd generation insulin secretagogue
- MOA: block ATP-K+ channels, increase Ca influx and insulin secretion
- USES: preferred in elderly
- AE: less chances of hypoglycemia, weight gain
-
glimepiride
- 2nd generation insulin secretagogue
- MOA: block ATP-K+ channels, increase Ca influx and insulin secretion
- USES: type 2 DM
- AE: less chances of hypoglycemia
-
repaglinide
- meglinide
- MOA: stimulates insulin secretion by blocking ATP-sensitive K channels in the pancreatic beta cells
- USES: fast acting, limit to postprandial hyperglycemia
- AE: hypoglycemia
- rapid onset
-
metformin
- biguanide
- MOA: activation of AMP-stimulated protein kinase, decrease hepatic gluconeogenesis, decrease plasma glucagon, decrease glucose absorption from GIT, doesn't cause hypoglycemia or weight gain
- USES: type 2 DM, obese pts with insulin resistance
- AE: GI problems, lactic acidosis
-
rosiglitazone
- thiazolidinediones
- MOA: selective agonist of nucelar PPARgamma, increase insulin sensitivity by elevating AMP kinase, works on adipose tissue to reduce the flux of fatty acids into muscles
- USES: used in combo with other oral ant-diabetic drugs in type 2 DM
- AE: fluid retention, edema, angina, MI
- black box warning - CHF, liver disease
-
pioglitazone
- thiazolidinediones
- MOA: selective agonist of nucelar PPARgamma, increase insulin sensitivity by elevating AMP kinase, works on adipose tissue to reduce the flux of fatty acids into muscles
- USES: used in combo with other oral ant-diabetic drugs in type 2 DM
- AE: fluid retention, edema, angina, MI
- black box warning - CHF, liver disease
-
acarbose
- alpha-glucosidase inhibitor
- MOA: inhibits glucosidase (BB of intestinal cells and involved in the breakdown of starch and disaccharides into simple sugars), inhibits the postprandial digestion of starch and disaccharides in the GIT
- USES: type 2 DM
- AE: flatulence, diarrhea, ab pain
-
miglitol
- alpha-glucosidase inhibitor
- MOA: inhibits glucosidase (BB of intestinal cells and involved in the breakdown of starch and disaccharides into simple sugars), inhibits the postprandial digestion of starch and disaccharides in the GIT
- USES: type 2 DM
- AE: flatulence, diarrhea, ab pain
-
sitagliptin
- alpha glucosidase inhibitor
- MOA: inhibitor of dipeptidyl peptidase, increase circulating levels of GLP-1 and GIP
- USES: decrease postprandial glucose excursions by increasing glucose mediated insulin secretion and decrease glucagon levels
- AE: nasopharyngitis
-
exenatide
- incretin, not oral
- MOA: GLP-1 receptor agonist, increase insulin secretion when glucose levels are elevated, slows gastric emptying, decreases appetite
- USES: type 2 DM
- AE: N/V
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