| Drug class |
Types |
Action |
Clinical use |
Toxicities |
| Biguanides: |
Metformin |
Exact mechanism is unknown. Decrease gluconeogensis, increase glycolysis, decrease glucose. (insulin sensitizer) |
Oral hypoglycemic. (type 1,2) |
Lactic acidosis |
| Glitazones: |
Pioglitazone, Rosiglitazone |
Increase response to insulin by causing release of adiponectins |
monotherapy in type 2 |
Weight gain, edema. Hepatoxicity, CV toxicity |
| Alpha-glucosidase inhibitors |
Acarbose, Miglitol |
Inhibit intestinal brush-border alpha glucosidases. |
Type 1, 2 |
GI disturbances |
| Mimemtics |
Pramlintide |
decreased glucagon |
type 2 |
hypoglycemia, nausea, diarrhea |
| GLP-1 |
Exenatide |
increased insulin, decreased glucagon |
Type 2 |
Nausea, vomiting; pancreatitis |
| Orlistat |
|
Alters fat metabolism by inhibitng pancreatic lipases |
long-term obesity management (in conjunction with modified diet) |
Steatorrhea, GI discomfort, reduced absorption of fat-soluble vitamins, headache |
| Sibutramine |
|
sympathomimetic serotonin and NE reuptake inhibitor |
short-term, long-term obesity management |
HTN, tachycardia |
| Propylthiouracil, methimazole |
|
Inhibit organifiation and coupling of thyroid hormone synthesis. Decreased conversion of T4, T3 |
Hyperthyroidism |
Skin rash, agranulocytosis (rare), aplastic anemia |
| GH |
|
GH deficiency, Turner's syndrome |
|
|
| Somatostatin |
|
Acromegaly, carcinoid, gastrinoma, glucagonoma |
|
|
| Oxytocin |
|
stimulates labor, uterine contractions, milk let-down, controls uterine hemorrhage |
|
|
| ADH |
|
Pituitary (central, nephrogenic) DI |
|
|
| Levothyroxine, triiodothyronine |
|
Thyroxine replacement |
Hypothyroidism, myxedema |
Tachycardia, heat intolerance, tremors, arrythmias |
| Glucocorticoids |
Hydrocortisone, prednisone, triamcinolone, dexamethasone, beclomethasone |
decrease the production leukotrienes, PGE by inhibiting phospholipase A2 and expression COX-2 |
Addison's disease, inflammation, immune suppression, asthma |
Iatrogenic Cushing's synrome- buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, bruisability, OA, adrenocortical atrophy, peptic ulcers, diabetes (chronic) |
| Demeclocycline |
|
ADH antagonist (member of tetracycline) |
Diabetes insipidus, SIADH |
Photosensitivity, abnormalities of bone and teeth |
| Insulin: short, medium long acting |
Short acting: Lispro, Aspart, regular; intermediate: NPH, Long-acting: glargine, determir |
Bind insulin receptor; Liver: glycogenolysis, muscle: glycogenolysis, protein synthesis, K uptake, Fats: TG storage |
Type 1, 2. hyperkalemia, stress induced hyperglycemia |
Hypoglycemia, hypersensitivity |
| Sulfonylurea: 1st and 2nd generation |
1st generation: Tolbutamide, Chlorpropamide; Second generation: Glyburid, Glimepiride, Glipizide |
Close K channel in B cell membrane, so cell depolarizes --> triggering of insulin release |
Stimulates release of endogenous insulin in type 2. Require some islet function (no DM 1) |
Bad for people with sulfa allergiesFirst generation: disulfiram-like effects; 2nd: hypoglycemia |
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