Diabetes Medications (non-insulin)

Question 1

Biguanides

Answer 1

Metformin
750 mg to 2g daily
divided into 2-3 doses

Question 2

Sulfonyureas

Answer 2

Glimipiride (Amaryl)
Glyburide (Diabeta, Micronase)
Glipizide (Glucotrol; Glucotrol XL)
Micronized Glyburide (Glynase)

Question 3

GLP-1 agonists

Answer 3

Exenatide (Bydureon, Byetta) 5 mcg BID (up to 10 mcg BID)
Liraglutide (Victoza) 0.6 mg QD for 1 week then increase to 1.2mg QD; may go to 1.8 mg QD
Dulaglutide (Trulicity) 0.75 mg once weekly; increase to 1.5 once weekly

Question 4

SGLT-2 inhibitors

Answer 4

Canagliflozin (Invokana) (Not in pt w/ CVD) 100 mg QD
Empagliflozin (Jardiance) 10mg QD
Dapagliflozin (Farxiga) 5 mg QD

Question 5

DPP-4 inhibitors

Answer 5

Sitagliptin (Januvia)
Saxaglipton (Onglyza)
Linagliptin (Tradjenta)

Question 6

Thiazolidinediones (TZDs)

Answer 6

Pioglitazone (Actos)

Rosiglitazone (Avandia)

Question 7

Meglitinides

Answer 7

Repaglinide (Prandin)

Nateglinide (Starlix) [derivative]

Question 8

Alpha-glucosidase inhibitors

Answer 8

Acarbose (Precose)

Miglitol (Glyset)

Question 9

Mechanism of Action? Biguanides

Answer 9

Works on:
Intestine - increases anaerobic glucose metabolism
Liver - decreases gluconeogenesis, glycogenolysis, & fatty acid oxidation
Skeletal muscle - increase insulin-mediated glucose updake, increase glycogenesis, decrease fatty acid oxidation

Question 10

Mechanism of Action? Sulfonyureas

Answer 10

Stimulate insulin secretion from pancreatic beta-cell plasma membrane and decrease in hepatic clearance of insulin; blocking the inflow of K+ through the ATP-dependent channel

Question 11

Mechanism of Action? GLP-1 agonists

Answer 11

Slow glucose absorption from the gut; increase insulin secretion from the pancreas; slows gastric emptying

Question 12

Mechanism of Action? SGLT-2 inhibitors

Answer 12

Prevent reabsorption of glucose in proximal renal tubule and facilitate excretion in urine

Question 13

Mechanism of Action? DPP-4 inhibitors

Answer 13

Increase incretin levels (GLP-1 and GIP) which inhibit glucagon release, increasing insulin secretion, decreasing gastric emptying

Question 14

Mechanism of Action? Thiazolidinediones (TZDs)

Answer 14

Bind to peroxisome proliferator-activated receptor gamma in adipocytes to promote adiposenesis and fatty acid uptake (in peripheral fat)

Question 15

Mechanism of Action? Meglitinides

Answer 15

Non-sulfonylurea secretagogue that binds ATP-dependent K+ channel on the cell membrane of pancreatic beta cells

Question 16

Mechanism of Action? Alpha-glucosidase inhibitors

Answer 16

blocks pancreatic alpha-amylase and inhibits membrane-bound alpha-glucosidase; reduces ate of digestion of carbohydrates