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Antidiabetic agents for Type II (a- Glucosidase Inhibitors (MOA: (Delayed…
Antidiabetic agents for Type II
Secretagouge
Sulfonylureas
Second Gen
Short acting
Glipizide
Long acting
Glibencamide (Glyburide USA)
Glimepride
First Gen
Intermediate acting
Acetohexamine
Long acting
Chloropropamide
Short acting
Tolbutamide
x2.5 CV mortality
Low specificity
Delayed time of onset
Long duration of action
Side effects
= Not used frequently
MOA:
Release Insulin from B Cells
Reduction of serum glucagon
Potentiation of insulin action on target cells
Adverse Effects:
Hyperinsulinemia
Hypoglycemia
Weight gain
Pharmacokinetics:
Plasma proteins - Liver - Kidneys
Glinides
MOA:
Stimulate Insulin production by Beta cells
Repaglinide
Nateglinide
Hypoglycemia
is most common side effect
Rapid onset
Shorter duration
than Sulfonylureas
Insulin sensitizers
Biguanides
Reduce gluconeogenesis
Increase glucose uptake in skeletal muscles
Reduce LDL & VLDL
Reduce carbs absorption
OBESE PEOPLE
METFORMIN
Usually given with Sulfonylureas to combine effect
Adverse Effects:
Lactic acidosis
Hypoglycemia (rarely alone)
GI disturbances (diarrhea etc.)
Long term use => Vit B absorption
Thiazolidinediones
(Glitazones)
Activate the nuclear PPAR gamma
Pioglitazone
Rosiglitazone
Adverse Effects:
Fata hepatotoxicity (Troglitazone)
Pioglitazone & Rosiglitazone => Weight gain + Fluid retention + CV problems
Oral contraceptives levels decreased
Troglitazone :red_cross:
Work by improving insulin target cell response/ decrease insulin resistance
a- Glucosidase Inhibitors
Acarbose
Miglitol
MOA:
Delayed absorption of glucose in GIT
Result in lower postprandial blood glucose
No effect on insulin section/ action
Very safe / absorbed systematically
Side Effects:
Diarrhea
Flatulence
Incretin Memetics
Incretins => Group of gastric hormone => insulin up
Insulin section up
Control apetite
Decrease postprandial glucagon secretion
Decrease gastric emptying
Exenatide
Administered Sc (1 per week)
Dipeptidyl peptidase IV inhibitors
MOA:
Increase insulin release by inhibiting DPP IV that inhibit incretin that is important in the release of insulin and decrease glucagon
Sitagliptin
Saxagliptin