Oral Hypoglycemic Drugs
-
Upload
quentin-lott -
Category
Documents
-
view
222 -
download
41
description
Transcript of Oral Hypoglycemic Drugs
Oral Hypoglycemic Drugs
Heider SH. AL-QassamMSc.PH. & TH.
Chronic systemic disease characterized by metabolic abnormalities
Disorder of carbohydrate metabolism
Results from inadequate production of insulin
Diabetes Mellitus
Characterized by glucosuria and hyperglycemia
Two forms—Type 1 and Type 2Type 1—patient's βcells are
destroyed this willcause absolute insulin deficiency
Type 2ــــ patient secretes insufficient amounts of insulin and insulin receptors are resistant to existent circulating insulin
Diabetes Mellitus
Oral Hypoglycemic Drugs
I. Insulin Secretagogu
es
Sulfonylureas
Meglitinide analogs
II. Insulin Sensitizers
Biguanides
glitazones
III.α-Glucosidase Inhibitors
IV.Dipeptidyl Peptidase-IV
Inhibitors
V.Incretin Mimetics
(mechanism of action) :A.Increase release of insulinB.Decrease production of glucose in the liverC.Increase the number of insulin receptorsD.Effective only if have functioning beta cellsE.Primary side effect is hypoglycemia and weight gainF.These drugs include glibenclamide, glipizide, and glimepiride .
I.Sulfonylureas
Nateglinide and repaglinide are nonsulfonylureas that lower blood sugar by stimulating pancreatic secretion of insulin
In contrast to the sulfonylureas, the meglitinides have a rapid onset and a short duration of action
They are categorized as postprandial glucose regulators
Monotherapy or in combination with metformin Should be taken 1 to 30 minutes before a meal Side effects hypoglycemia and weight gian caution in patients with hepatic impairment
II.Meglitinides
(mechanism of action): increases the use of glucose by muscle and fat cells, decreases hepatic glucose production, and decreases intestinal absorption of glucose
Does not cause hypoglycemia May be used alone or in combination Side effects include GIT disturbance and
lactic acidosis Contraindicated in liver or renal impairment.
Can result in lactic acidosis. This group include metformin
III.Biguanides
(mechanism of action):Decrease insulin resistance. Through binding with PPAR lead to regulation adipocyte production and secretion of fatty acids as well as glucose metabolism, resulting in increased insulin sensitivity in adipose tissue, liver, and skeletal muscle
Side effects include weight gain, headache and anemia
Contraindicated in patients with liver disease and acute MI
May be used as monotherapy or in combination with insulin, metformin or a sulfonylurea
These drugs include Pioglitazone and rosiglitazone
IV.Glitazones
Include acarbose and miglitol (mechanism of action): inhibit alpha-
glucosidase enzymes (maltase, amylase, sucrase) in GI tract. Delays absorption of complex CHO and simple sugars
Can be combined therapy with sulfonylurea
Contraindicated in malabsorption, severe renal impairment
Side effects include bloating and diarrhea
Alpha glucosidase Inhibitors
Exenatide is an incretin mimetic with a polypeptide homologous to GLP-1
It is improves glucose-dependent insulin secretion ,slows gastric emptying time, decreases food intake, decreases glucagon secretion, and promotes βcell proliferation
It must be administered subcutaneously Side effects include nausea, vomiting, and
diarrhea
Incretin Mimetics
Sitagliptin is an orally active dipeptidyl peptidase-IV inhibitor used for the treatment of patients with Type 2 diabetes
(Mechanism of action) inhibits the enzyme DPP-IV, which is responsible
for the inactivation of incretin hormones, such as glucagon-like peptide-1 (GLP-1).
Prolonging the activity of incretin hormones results in increased insulin release in response to meals
Adverse effects include nasopharyngitis and headache
newOral Agents: Dipeptidyl Peptidase-IV Inhibitors
Thank you