diabetes pharmacology

  1. acarbose and miglitol
    • alpha glucosidase inhibitors 
    • inhibits upper GI enzymes that convert polysaccharide carbohydrates into monosaccharides
    • slows absorption of glucose
    • decreases post-meal hyperglycemia
    • doesn't affect insulin secretion: no hypoglycemia
    • side effects: flatulence and diarrhea
  2. glipizide, glimepiride, glyburide
    • sulfonylureas
    • insulin seretagogues
    • intermediate or long-acting - given once or twice a day
    • lead to glucose-independent insulin secretion: should be taken with food
  3. repaglinide, nateglinide
    • meglitinides
    • insulin seretagogues
    • act by regulating ATP-dependent K+ channels in pancreatic beta cells, but use different receptors than sulfonylureas
    • short acting - given before each meal
    • lead to glucode-independent insulin secretion: should be taken with food
  4. exenatide, liraglutide
    • GLP-1 agonist
    • glucode-dependent insulin secretion = no gypoglycemia
    • enhances insulin secretion but still relies on glucose to cause cell depolarization
    • slows gastric emptying (nausea)
    • weight loss (~5 lb) because of nausea and slowed gastric emptying
    • adverse effects: nausea, pancreatitis in some cases
  5. sitagliptin, saxagliptin, linagliptin
    • DPP-IV inhibitor
    • glucode
    • glucose-dependent insulin secretion = no gypoglycemia
    • makes endogenous GLP-1 last longer
  6. metformin
    • biguanide
    • reduces endogenous glucose production by inhibiting gluconeogenesis
    • does not affect insulin sensitivity in muscle or adipose tissue
    • does not lead to increased insulin levels
    • adverse effects: nausea, abdominal pain, bloating, diarrhea, possibly lactic acidosis
  7. pioglitazone
    • thiazolidinediones
    • PPAR γ agonist
    • lowers blood glucose by enhancing effects on insulin
    • lower plasma FFA = enhance fat storage
    • do not lead to increased insulin secretion = not assoc. with hypoglycemia
    • adverse effects: weight gain, fluid retention (contraindicated in CHF)
  8. canagliflozin
    • SGLT-2 inhibitor
    • non-insulin mediated decrease in glucose
    • no hypoglycemia
    • decrease in blood pressure
    • decrease in weight (~5 lbs)
    • adverse effects: vulvovaginal candidiasis, UTI, risk of ketoacidosis
  9. glargine, detemir, NPH
    long acting insulin: mimics basal insulin
  10. regular, aspart, lispro, glulisine
    short acting insulin: mimics food insulin
Card Set
diabetes pharmacology
MOHD3 lecture 103, MOHD Keystone