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Anti-diabetic drugs Cheat Sheet (DRAFT) by

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This is a draft cheat sheet. It is a work in progress and is not finished yet.

Insulin secret­agogues

Sulfon­ylureas & meglit­inides
DPP-4 inhibitors
MOA: block ATP-de­pendent K+ channels
Sitagl­iptin "januvia"
SU
MOA: inhibit DPP4 enzyme (cytop­lasmic recept­or)­--> no incretin (GLP1) degred­ati­on-­-> Increase in GLP1 stimulates insulin secretion.
1 gen: Tolbutamide-chlorpropamide.
long acting SU so long hypogl­ycemic episodes.
Only eliminated renallly; risk to renally compro­mised patients.
2 gen: Glicla­zid­e-g­lyb­uride "glibenclamide"
Shorter acting SU with pendant lipohilic gp larger or aromatic. Undergo enterh­epatic circul­ation and eliminated in urine & bile.
3 gen: Glimepiride
Completely metabo­lized by oxidation of pendant methyl substi­tuent into methoxy metabo­lites (mostly in feces) & COOH metabo­lites (mostly in urine).
Meglit­ini­des­/gl­iti­nides
D-phen­yla­lan­ine­-Re­pag­lin­ide­-Na­teg­linide
 

Insulin sensit­izers

Biguanides
Thiazo­lid­ine­diones (TZD)
Metformin
Rosiglitazone-Pioglitazone
MOA: reduces liver glucose release and increases glucose uptake into tissue (decreases BG level).
MOA: activate the nuclear receptors (PPAR-y) which causes transc­ription of genes stimul­ating lipid uptake & adipog­enesis.
Best described as anti-h­ype­rgl­ycemic agent because it doesn't cause hypogl­ycemia.
1st line for T2D with normal kidney function (Ineffe­ctive without insulin).

Alpha-­glu­cos­idase inhibitors

Voglibose
MOA: Delay digestion and carb absorp­tion.
SE: flatul­ence, bloating, abdominal cramping
Adjuvant therapy.