A alpha-glucosidase inhibitor is?
Ans. b (Maglitol) (Ref. Harrison medicine 17th ed. Table 383-11; KD Tripathi, Pharmacology, 5th ed., 252)ORAL HYPOGLYCEMICS# Sulfonylureas : Tolbutamide, chlorpropamide, glibenclamide, glipizide, gliclazide, glimepiride# Biguanides : Phenformin and metformin.# Meglitinide analogues : Repaglinide, nateglinide# Thiazolidinediones : Rosiglitazone, pioglitazone.# Alpha-glucosidase inhibitor : maglitol, acarbose.GLUCOSE-LOWERING THERAPIES FOR TYPE 2 DIABETESClass of anti-diabetic and ExamplesMechanism of ActionAgent-Specific AdvantagesAgent-Specific DisadvantagesContraindications/ Relative ContraindicationsORALBiguanidesMetforminHepatic glucose production, weight loss, glucose, utilization, insulin resistanceWeight lossLactic acidosis, diarrhea, nauseaSerum creatinine >1.5 mg/dL (men) >1.4 mg/dL (women), CHF, radiographic contrast studies, seriously ill patients, acidosisalpha-Glucosidase inhibitorsAcarbose, Maglitol|Glucose absorptionReduce postprandial glycemiaGl flatulence, liver function testsRenal/liver diseaseDipeptidyl peptidase IV inhibitorsSitagliptinProlong endogenous GLP-1 actionDoes not cause hypoglycemia Reduce dose with renal diseaseInsulin secretagogues-- Sulfonylurea-first generation: Chlorpropamide, Tolazamide, Tolbutamide Sulfonylurea--second generation: Glimepiride, Glipizide, Glipizide (extended release), Glyburide, Glyburide (micronized)|Insulin secretionLower fasting blood glucoseHypoglycemia, weight gainRenal/ liver diseaseInsulin secretagogues-- nonsulfonylureasRepaglinideNateglinide| Insulin secretionShort onset of action, lowers postprandial glucoseHypoglycemiaRenal/ liver diseaseThiazolidinedionesRosiglitazone,Pioglitazone| Insulin resistance,| glucose utilizationLower insulin requirementsPeripheral edema, CHF, weight gain, fractures, macular edema; rosiglitazon may increase risk of MlCongestive heart failure, liver diseasePARENTERALInsulinShort-acting,subcutaneousLispro, AspartGlulisine, Regular| Glucose utilization and other anabolic actionsKnown safety profileInjection, weight gain, hypoglycemia Short-acting, inhaledInhaled regular insulinLong-actingNPH, Detemir,Glargine GLP-1 agonistExenatide| Insulin,| Glucagon, slow gastric emptyingWeight lossInjection, nausea, | risk of hypoglycemia with insulin secretagoguesRenal disease, agents that also slow GI motilityAmylin agonistPramlintideSlow gastric emptying, |GlucagonReduce postprandial glycemia, weight lossinjection, nausea, ?risk of hypogly- cemia with insulinAgents that also slow GI motilityMedical nutrition therapy and physical activityLow-calorie, low-fat diet, exercise| Insulin, resistance,| insulin secretionOther health benefitsCompliance difficult, long-term success low
Pioglitazone
Maglitol
Metformin
Nateglinide
Endocrinology