81
H N i Ti t
Table 5.1 Thu c đi u tr đái tháo đư ng
TABLE 5.1 Antidiabetic Agents
For a full description of diabetes mellitus (DM) management and which drugs to use first line, please follow the website link
provided for NICE guidelines in Appendix 2
Class of
antidiabetic
agent
Example
Mechanism of action
Biguanides
Metformin
- Peripheral insulin sensitivity
- Glucose uptake into and use
by skeletal muscle
¯ Hepatic gluconeogenesis
¯ Intestinal glucose absorption
Uses
Type 2 DM
(first
choice in
overweight
patients)
Polycystic
ovarian
syndrome
Side-effects
Gastrointestinal
tract (GIT)
disturbance,
e.g.diarrhoea
Nausea
Vomiting
Lactic acidosis
Contraindications
Renal failure
Cardiac failure
Respiratory failure
Hepatic failure
(The above increase
the risk of developing
lactic acidosis)
Drug interactions
Contrast agents
Angiotensin converting
enzyme (ACE)
inhibitors
Alcohol
Nonsteroidal anti-
inflammatory drugs
(NSAIDs)
Steroids
Sulphonylureas
Glipizide
Block potassium channels on the
pancreatic beta cells, thus
stimulating insulin release
Block potassium channels on
the pancreatic beta cells, thus
stimulating insulin release
Type 2 DM
Type 2 DM
Type 2 DM
Type 2 DM
Type 2 DM
GIT disturbance
Hypoglycaemia
Weight gain
Renal failure
Hepatic failure
Porphyria
Pregnancy
Breastfeeding
ACE inhibitors
Alcohol
NSAIDs
Steroids
Meglitinides
(glinides)
Repaglinide
Weight gain
Hypoglycaemia
Hepatic failure
Pregnancy
Breastfeeding
Ciclosporin
Trimethoprim
Clarithromycin
Thiazolidinediones
(glitazones)
TZD
Pioglitazone
Kích ho t th th sao chép
trên nhân t bào (PPAR)
Tăng cân
H đư ng huy t
Đ c v i gan
Nguy cơ gãy xương
Type 1 DM
B nh gan
Suy tim
Ung thư bàng quang
Rifampicin
Paclitaxel
Type 2 DM
c ch Alpha-
glucosidase
Acarbose
c ch men alpha-glucosidase
R i lo n tiêu hóa,
vd. tiêu ch y
B nh viêm ru t
(IBD)
T c ru t
Xơ gan
Orlistat
Pancreatin
Incretins
Exenatide
Đ ng phân c a glucagon-like
peptide (GLP)-1
R i lo n tiêu hóa,
vd. tiêu ch y
Viêm t y c p
U thư tuy n giáp
H i ch ng tân sinh
đa tuy n n i ti t typ
2 (MEN2)
Bexarotene
Saxagliptin
c ch dipeptidyl peptidase
(DPP)-4
R i lo n tiêu hóa,
vd. tiêu ch y
Nhi m trùng hô
h p và ti t ni u
Đ c v i gan
Phù ngo i vi
Ti n s quá m n n ng Thiazolidinedione
Đ ng phân amylin Pramlintide
Đ ng phân c a amylin
Type 1 DM
Type 2 DM
H đư ng huy t
tr m tr ng
Li t d dày
Nh y c m v i
pramlintide
Acarbose
Ti p trang sau
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