Class Alpha glucosidase inhibitor

For this class - Aka. starch blockers

Drug Name Acarbose (Glucobay)

Pathophysiology of Drug - Slows down the absorption of carbohydrate in the small intestine. - Taken w/ first bite of each main meal - Most effective in lowering postprandial blood glucose - To reduce glucose production by liver - Enhances insulin sensitivity at the peripheral tissue level and improves glucose transport into the cell - Inhibits GI absorption of glucose - Also used to treat pre-diabetes - Esp for ppl are obese and have impaired fasting glucose - Enhances the incretin system - Stimulate release of insulin from pancreatic beta cells - Inhibits hepatic glucose production.

Benefits

Adverse Effects of Drug - Not effective against fasting hyperglycemia - Flatulence - Abdom. Pain - Diarrhea - Nausea, diarrhea - Potential lactic acidosis in renal or hepatic impairment - Has to be held at time before procedure and 48 hr after admin of IV contrast media - upper respiratory tract infection - sore throat - headache - diarrhea

Biguinides

can be used alone or w/ OHAs or insulin to treat type 2 DM

Metformin (Glucophage)

- No weight gain - Beneficial effects on plasma lipids - Does not cause hypoglycemia

DPP4 inhibitor

- Glucose-lowering drugs - glucose-dependent (respond to presence of glucose and result in insulin release only when needed) Meglitinides - When take drug 30 (nonsulphonylureas) min before meals, pancreatic insulin production increase during & after meal, mimicking normal blood glucose response to eating.

Stiagliptin (Januvia)

- b/c they are glucose dependent, they lower the potential for hypoglycemia - no weight gain

- Reduced potential for hypoglycemia - Safer to use for clients with irregular mealtimes (b/c they should not take it if not eating) - Less weight gain - Decrease potential of hypoglycemia Sulfonylureas - Increase beta cell Glyburide - More effective early in - Weight gain (Sulphonylureas OR insulin production (Diabeta) the course of type 2 DM - Hypoglycemia (so caution insulin from pancreases (but some pt have in dosage for older adults & secretagogues) decrease effects later ) pt w/ renal impairment) Thiazolidinediones - insulin sanitizer Rosiglitazone - Improves insulin sensitivity, transport, - No hypoglycemia when - Cant use it w/ insulin in - Most effective for pt (Avandia) and utilization at target tissues (muscle used alone b/c they dont Canada b/c adverse effects w/ insulin resistance and fat etc). increase insulin of edema and weight gain. - Inhibits hepatic glucose production production - 2ndary benefit of improved triglyceride, HDL, and BP Avandamet: its the combination of rosiglitazone and metformin. AE: nausea, diarrhea, edema, weight gain, potential lactic acidosis in renal or hepatic impairment. Other drugs affecting BG levels: B-adrenergic blockers can mask symptoms of hypoglycemia and prolong the hypoglycemic effects of insulin. Thiazide & loop diuretics can potentiate hyperglycemia by inducing potassium loss, although low-dose therapy w/ thiazide is considered safe

Repaglinide (GlucoNorm)

- Increase insulin production from the pancreas - More rapidly absorbed and eliminated