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Diabetes drugs

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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  
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Glitazones:   Pioglitazone, Rosiglitazone   Increase response to insulin by causing release of adiponectins   monotherapy in type 2   Weight gain, edema. Hepatoxicity, CV toxicity  
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Alpha-glucosidase inhibitors   Acarbose, Miglitol   Inhibit intestinal brush-border alpha glucosidases.   Type 1, 2   GI disturbances  
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Mimemtics   Pramlintide   decreased glucagon   type 2   hypoglycemia, nausea, diarrhea  
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GLP-1   Exenatide   increased insulin, decreased glucagon   Type 2   Nausea, vomiting; pancreatitis  
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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  
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Sibutramine     sympathomimetic serotonin and NE reuptake inhibitor   short-term, long-term obesity management   HTN, tachycardia  
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Propylthiouracil, methimazole     Inhibit organifiation and coupling of thyroid hormone synthesis. Decreased conversion of T4, T3   Hyperthyroidism   Skin rash, agranulocytosis (rare), aplastic anemia  
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GH     GH deficiency, Turner's syndrome      
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Somatostatin     Acromegaly, carcinoid, gastrinoma, glucagonoma      
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Oxytocin     stimulates labor, uterine contractions, milk let-down, controls uterine hemorrhage      
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ADH     Pituitary (central, nephrogenic) DI      
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Levothyroxine, triiodothyronine     Thyroxine replacement   Hypothyroidism, myxedema   Tachycardia, heat intolerance, tremors, arrythmias  
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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)  
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Demeclocycline     ADH antagonist (member of tetracycline)   Diabetes insipidus, SIADH   Photosensitivity, abnormalities of bone and teeth  
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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  
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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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