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Drug Mechanism of action Side effects contraindications Expected HbA1c

reduction
Biguanides  Inhibits hepatic gluconeogenesis - GI upset (abdo Contraindicated in elderly 0.8-2.0 %
- Metformin  ↑ glycolysis discomfort, bloating, (>80), renal insufficiency,
-glucophage  ↑peripheral tissues sensitivity to insulin ↑ glucose diarrhea) hepatic and heart failure
uptake - lactic acidosis
 Useful in obese T2DM patients and improves fasting -anorexia
and post prandial hyperglycemia -WEIGHT LOSS
- B12 deficiency

Sulfonylureas  Stimulates insulin release from pancreatic β cells by -HYPOGLYCEMIA Do not combine with 1.5-2.5%
-glicazide causing K+ channel closure  depolarization  Ca2+ -weight gain insulin
-glipzide mediated insulin release (↑Ca2+ influx  insulin Adjust dose in patient
release) with impaired kidney
 Use in non-obese T2DM function
Thiazolidinedione  ↑peripheral tissue sensitivity to insulin -fluid retention Contraindicated in patient 0.6-1.5%
(glitazones)  ↑insulin sensitivity of adipose tissue and muscle by -weight gain with heart failure
-rosiglitazone activating the PPARγ receptor  regulation of -CVS risk
pioglitazone glucose metabolism and free fatty acid storage -Bladder cancer
-bone loss
-hepatotoxicity
-DDP-4 inhibitors(-  Inhibits degradation of endogenous -nasopharyngitis Absolute CI: T1DM, DKA 0.7%
liptins) antihyperglycemic incretin hormones stimulate -headache Relative CI: adjust dose in
-sitagliptin insulin secretion, inhibit glucagon release and delay -weight neutral renal impairement
-linagliptin gastric emptying -pancreatitis
-Steven Johnson
SGLT-2 inhibitors  Enhances urinary glucose excretion by inhibiting -UTI Severe renal impairment 0.7-1.0%
(-flozins) glucose reabsorption in the proximal renal tubule -genital infection ESRD
-dapagliflozin -weight loss Patients on dialysis
-low BP
Alpha glucosidase  ↓ carbohydrate GI absorption by inhibiting brush -flatulence CI in inflammatory bowel 0.6%
inhibitors border α-glucosidase -diarrhea disease and severe liver
-acarbose -HYPOGLYCEMIA dysfunction

Glucagon-like  Binds to GLP-1 receptor to promote insulin release N/V, diarrhea CI: T1DM,DKA, Acute 1.0%
peptide (GLP)-1  Slows gastric emptying, suppresses inappropriate Dizziness, headache pancreatitis
analogue [incretin] elevated glucagon levels Muscle weakness Gastroparesis, ESRD, h/o
-Exenatide  Causes β cells regeneration and differentiatin in vitro pancreatitis medullary thyroid cancer
-liraglutide