Anti-glycemic Agents

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Can you name the Anti-glycemic Agents?

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SE: No hypoglycemia
Glusine - Apidra (Avemtis) class
Onset: 1-2 hours
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.
Use: Human insulin is made by recombinant technology
Contraindications: Intestinal dz, cirrhosis, renal dz (creatinine > 2)
Miglitol class
Humalog Mix 50/50 class
Repalinide class
Nololin 70/30
SE: GI effects, increased transaminases (monitor). No hypoglycemia
Novolin R class
NPH Iletin III (Lilly) class
Nolvin N PenFill
Metformin and pioglitazone combo
Rosiglitazone and metformin combo
Acarbose 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.
MOA: Lowers postprandial glucose rise by delaying CHO absorption. Decreases glucose absorption secondary to decreased digestion of carbohydrates.
Onset 1-4 hours
Humulin 70/30
Sitagliptin (Januvia) class
Peak 6-8 hours
Use: First-line for most DM II, esp. obese.
Novolog Mix 70/30 PenFill class
Novolin N class
Apidra class
MOA: Binds to PPAR-gamma, a nuclear receptor regulating differentiation of cells (adipocytes, vascular tissue). Decreased plasma fatty acid levels, decreased central adiposity, res
Onset 15-30 minutes
Lispro - Humalog (Lilly) class
Use: DM II. Most effective in lean patients.
Humulin N (NPH) (Lilly) class
Detemir - Levemir class
Contraindications: Class III/IV CHF
Humalog Mix 75/25 class
Pioglitazone (Actos) class
Pioglitazone and glimepiride combo
Use: Onset and duration are rough within the range listed from person to person
MOA: GLP-1 agonist. Has all the properties of human GLP-1. 10 lb or greater wt loss in 1 yr
Duration 3 - 4 hours (4-5 hours)
SE: GI effects, occasional low B12, rare lactic acidosis, ovulation in PCO
MOA: Effective in long-duration DM, weight loss, no hypoglycemia, lowers insuling, TG, LDL
Peak: None
MOA: Lowers threshold for insulin release. Effective early; secondary failure common.
SE: Similar to sulfonureas but with less risk of prolonged hypoglycemia.
Peak 2 - 5 hours
Humulin L (Lente) (Lilly) class
Peak: 1 hour
Novolin R (Novo Nordisk) class
Rosiglitazone (Avandia) class
Metformin class
Humulin R (Lilly) class
Humalog 50/50 class
Sitagliptin and metformin combo
Nololin N (NPH) (Lilly) class
Glyburide (Micronase, Diabeta) class
Duration: 18-20 hours
P-kinetics: Eliminated by renal filtration
Duration ~14 hours
Duration 5-7 hours (6 - 8 hours)
Humulin Ultralente class
Nolovin R PenFill
Novolin R PenFill
P-kinetics: Injected SQ BID
SE: Increased plasma volume, edema, CHF, ovulation in PCO, mild anemia, rare liver toxicity, risk of fx in women. No hypoglycemia
Humalog class
Contraindications: Renal dz, liver dz, CHF, dehydration, shock, acidosis, alcoholism
Duration: 20-24 hours
SE: Nausea, other GI effects, rare reports of pancreatitis
Metformin and glipizide combo
Onset 30 minutes - 1 hour
Glargine - Lantus class
Novolog Mix 70/30 class
MOA: Similar to sulfonureas.
Metformin and glyburide combo
Avapro - Novalog (Novo Nordisk) class
Novolin 70/30 PenFill
Exenatide class
Use: Controls blood sugar surges at mealtime
Glimepiride (Amaryl) class
Humulin Br class
Novolin 70/30 class
Duration 18-24 hours (12-16 hours)
P-kinetics: 100 mg once daily
Novolog Mix 70/30 class
Use: Combines rapid-acting and intermediate-acting insulin. Controls blood sugar at mealtime and all day and night
Humalog 75/25 Mix class
MOA: Increases hepatic insulin sensitivity. Works through AMP dependent kinase, a mastor allosteric regulator of metabolism, that senses lack of energy substrates in cells.
Humulin 50/50
Novolog class
Regular Ileting II (Lilly) class
Glipizide (Glucotrol; Glucotrol XL) class
Humulin N class
SE: Hypoglycemia, weight gain, GI effects.
MOA: Decreases insulin resistance, increase muscle and adipose tissue glucose uptake, decreased hepatic glucose output.
Rosiglitazone and glimepiride combo
MOA: Decreases hepatic glucose production, decreases peripheral insulin resistance, increases glucose uptake, decrease gluconeogenesis, decreases fatty liver,
Use: Controls blood sugar between meals and during sleep
P-kinetics: Rapid absorption, short duration.

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