Oral Antidiabetic Drugs Flashcards

Oral Antidiabetic Drugs Overview

• Oral antidiabetic drugs are primarily used for managing type 2 diabetes.
• Effectiveness is enhanced when combined with lifestyle and behavioral changes.

Metformin (Glucophage)

• Class: Biguanides
• First-line treatment for type 2 diabetes; also effective for Polycystic Ovarian Syndrome.
• Mechanism of Action:
  • Reduces glucose production in the liver.
  • Decreases intestinal glucose absorption.
  • Increases tissue glucose uptake.
  • Does not stimulate insulin secretion from the pancreas.
• Does not cause hypoglycemia or weight gain.
• Common adverse effects include abdominal bleeding, nausea, cramping, diarrhea, and lactic acidosis.
• Contraindications: Renal disease/dysfunction, alcoholism, liver failure, heart failure.
• Interactions:
  • Avoid IV contrast 48 hours before and after use to prevent renal failure.
  • Diuretics and corticosteroids may cause hyperglycemia.

Glipizide (Glucotrol)

• Class: Sulfonylureas
• Second-generation medication that stimulates insulin secretion from the pancreas, increasing insulin levels.
• Requires the presence of beta cell function to be effective.
• Common adverse effects: Hypoglycemia, weight gain, nausea, heartburn.
• Contraindications: Hypoglycemia and cross-allergy to sulfonamide antibiotics.

Repaglinide (Prandin)

• Class: Glinides
• Used primarily to control postprandial blood glucose levels.
• Mechanism: Increases insulin secretion from the pancreas with a short duration; must be administered with each meal.
• Adverse effects include hypoglycemia and weight gain.

Pioglitazone (Actos)

• Class: Glitazones
• Mechanism: Decreases insulin resistance and increases glucose uptake in muscles while inhibiting glucose production in the liver.
• Effect onset is slow; may take months to reach full therapeutic action.
• Used for patients who cannot tolerate or have failed other medications like Metformin or Sulfonylureas.
• Adverse effects include peripheral edema, weight gain, hepatotoxicity, and increased LDL/triglyceride levels.
• Contraindication: Heart failure.
• Interactions: Gemfibrozil increases hypoglycemic effects by inhibiting drug metabolism.

Acarbose (Precose)

• Class: Alpha-Glucosidase Inhibitor
• Mechanism: Reversibly inhibits alpha-glucosidase to delay glucose absorption, should be taken with the first bite of a meal.
• Common adverse effects: Flatulence, diarrhea, abdominal pain, hepatotoxicity.
• Contraindications include inflammatory bowel disease, malabsorption syndromes, and intestinal obstruction.

Pramlintide (Symlin)

• Class: Amylin Mimetics
• Mechanism: Slows gastric emptying, suppresses glucagon secretion, and reduces hepatic glucose output; helps regulate appetite and satiety.
• Effective for both type 1 and type 2 diabetes.
• Adverse effect: Nausea.
• Contraindicated in patients with gastrointestinal motility problems.
• Interactions with insulin (increases hypoglycemia risk) and oral medications (delays absorption).

General Considerations

• All medications require careful monitoring for effectiveness and potential side effects.
• Lifestyle modifications remain crucial in managing diabetes effectively.