Anti-glycemic Agents

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Can you name the Anti-glycemic Agents?

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Duration: 20-24 hours
MOA: Increases hepatic insulin sensitivity. Works through AMP dependent kinase, a mastor allosteric regulator of metabolism, that senses lack of energy substrates in cells.
MOA: Decreases hepatic glucose production, decreases peripheral insulin resistance, increases glucose uptake, decrease gluconeogenesis, decreases fatty liver,
Humulin 50/50
MOA: Lowers postprandial glucose rise by delaying CHO absorption. Decreases glucose absorption secondary to decreased digestion of carbohydrates.
P-kinetics: Injected SQ BID
NPH Iletin III (Lilly) class
SE: GI effects, occasional low B12, rare lactic acidosis, ovulation in PCO
SE: GI effects, increased transaminases (monitor). No hypoglycemia
Metformin and glipizide combo
SE: Similar to sulfonureas but with less risk of prolonged hypoglycemia.
Humalog 50/50 class
Humalog 75/25 Mix class
P-kinetics: Rapid absorption, short duration.
Use: Controls blood sugar surges at mealtime
MOA: Decreases insulin resistance, increase muscle and adipose tissue glucose uptake, decreased hepatic glucose output.
Use: Combines rapid-acting and intermediate-acting insulin. Controls blood sugar at mealtime and all day and night
Humulin L (Lente) (Lilly) class
Detemir - Levemir class
Regular Ileting II (Lilly) class
Humulin 70/30
Novolin R PenFill
Use: Onset and duration are rough within the range listed from person to person
SE: Increased plasma volume, edema, CHF, ovulation in PCO, mild anemia, rare liver toxicity, risk of fx in women. No hypoglycemia
Metformin class
Metformin and glyburide combo
Acarbose class
Nolvin N PenFill
Glusine - Apidra (Avemtis) class
Contraindications: Intestinal dz, cirrhosis, renal dz (creatinine > 2)
Exenatide class
Use: Human insulin is made by recombinant technology
Rosiglitazone and glimepiride combo
Sitagliptin (Januvia) class
Use: Controls blood sugar between meals and during sleep
P-kinetics: 100 mg once daily
Duration 3 - 4 hours (4-5 hours)
Nololin 70/30
Pioglitazone (Actos) class
Use: First-line for most DM II, esp. obese.
Lispro - Humalog (Lilly) class
Peak 2 - 5 hours
Humalog Mix 50/50 class
Duration 5-7 hours (6 - 8 hours)
Humulin Br class
MOA: Bind to SU receptor on surface of beta cells, closing K+ATP channels -> to depolarization of cell membrane, allowing Ca++ to enter cell -> in insulin secretion.
Pioglitazone and glimepiride combo
Novolog Mix 70/30 class
Avapro - Novalog (Novo Nordisk) class
Rosiglitazone (Avandia) class
Onset 15-30 minutes
MOA: Inhibit enzymatic degradation of incretin hormones. Unlike most PO meds for DM, does not promote wt gain, there may even be slight wt loss.
Repalinide class
Novolin R class
Peak: None
Humulin Ultralente class
Glimepiride (Amaryl) class
Nolovin R PenFill
Onset 1-4 hours
Novolin R (Novo Nordisk) class
Humulin N class
Metformin and pioglitazone combo
SE: No hypoglycemia
Novolin 70/30 class
Onset: 1-2 hours
Novolog Mix 70/30 class
Novolin 70/30 PenFill
Contraindications: Class III/IV CHF
Humalog Mix 75/25 class
Novolin N class
Peak 6-8 hours
MOA: GLP-1 agonist. Has all the properties of human GLP-1. 10 lb or greater wt loss in 1 yr
Humulin R (Lilly) class
Apidra class
Humalog class
SE: Nausea, other GI effects, rare reports of pancreatitis
MOA: Effective in long-duration DM, weight loss, no hypoglycemia, lowers insuling, TG, LDL
Contraindications: Renal dz, liver dz, CHF, dehydration, shock, acidosis, alcoholism
Nololin N (NPH) (Lilly) class
Onset 30 minutes - 1 hour
Glyburide (Micronase, Diabeta) class
Duration: 18-20 hours
Novolog Mix 70/30 PenFill class
Use: DM II. Most effective in lean patients.
Duration ~14 hours
Rosiglitazone and metformin combo
Glipizide (Glucotrol; Glucotrol XL) class
SE: Hypoglycemia, weight gain, GI effects.
MOA: Similar to sulfonureas.
Peak: 1 hour
MOA: Binds to PPAR-gamma, a nuclear receptor regulating differentiation of cells (adipocytes, vascular tissue). Decreased plasma fatty acid levels, decreased central adiposity, res
Humulin N (NPH) (Lilly) class
Novolog class
Glargine - Lantus class
Duration 18-24 hours (12-16 hours)
P-kinetics: Eliminated by renal filtration
MOA: Lowers threshold for insulin release. Effective early; secondary failure common.
Miglitol class
Sitagliptin and metformin combo

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