Diabetic Meds (Oral Hypoglycemics)

Question 1

Glucophage

Answer 1

Trade Name(s): Metformin

Class: Antidiabetics (Biguanides)

Indication: Management of DM Type 2; may be used with diet, insulin, and sulfonylureas

Action: ↓hepatic glucose production and intestinal glucose absorption; ↑insulin sensitivity

Side Effects: N/V/D, abdominal bloating

Adverse Effects: Lactic acidosis

Question 2

Glipizide
Glyburide
Glimepiride

Answer 2

Trade Name(s): Glucotrol (Glipizide), Diabeta (Glyburide), Amaryl (Glimepiride)

Class: Antidiabetics (Sulfonylureas)

Indication: Management of DM Type 2 as an adjunct treatment to diet and exercise

Action: ↓BG by stimulating the release of insulin from the pancreas; ↑insulin sensitivity at receptor sites

Side Effects: Photosensitivity, hypoglycemia

Adverse Effects: Aplastic anemia

Question 3

Pioglitazone

Answer 3

Trade Name(s): Actos

Class: Antidiabetics (Thiazolidinediones)

Indication: Management of DM Type 2 as an adjunct treatment to diet and exercise; may be used with metformin, sulfonylureas, and insulin

Action: ↑sensitivity to insulin by acting as an agonist at receptor sites involved with insulin responsiveness and subsequent glucose production/utilization

Side Effects: Edema, ↑liver enzymes

Adverse Effects: HF, edema, bladder cancer

Question 4

Acarbose

Answer 4

Trade Name(s): Precose

Class: Antidiabetics (Alpha-Glucosidase inhibitors)

Indication: Management of DM Type 2 as an adjunct treatment to diet and exercise; may be used with insulin or other hypoglycemics

Action: ↓BG levels in DM, especially postprandial hyperglycemia (after meals)

Side Effects: Abd px, D, flatulence, ↑liver enzymes

Adverse Effects: N/A

Question 5

Repaglinide

Answer 5

Trade Name(s): Prandin

Class: Antidiabetics (Meglitinides)

Indication: Management of DM Type 2 as an adjunct treatment to diet and exercise; may be used with metformin and pioglitazone

Action: Stimulates the release of insulin from pancreatic β cells: closes K⁺ channels→ opening of Ca²⁺ channels in β cells → release of insulin

Side Effects: Dizziness

Adverse Effects: Hypoglycemia

Question 6

Nateglinide

Answer 6

Trade Name(s): Starlix

Class: Antidiabetics (Meglitinides [D-Phenylalanine Derivatives])

Indication: Improvement of glycemic control with DM Type 2 (with diet and exercise)

Action: Stimulates the release of insulin from pancreatic β cells: closes K⁺ channels→ opening of Ca²⁺ channels in β cells → release of insulin

Side Effects: Dizziness

Adverse Effects: Hypoglycemia

Question 7

Sitagliptin

Answer 7

Trade Name(s): Januvia

Class: Antidiabetics (Enzyme Inhibitors [DDP-4 Inhibitors])

Indication: Management of DM Type 2 as an adjunct treatment to diet and exercise

Action: Inhibits enzyme DPP-4 → slows inactivation of incretin hormones, which are released by intestines throughout the day and involved in glucose homeostasis

Side Effects: N/A

Adverse Effects: Steven-Johnsons Syndrome, pancreatitis, rhabdomyolysis, hypersensitivity reactions (anaphylaxis, angioedema)

Question 8

Colesevelam

Answer 8

Trade Name(s): Welchol

Class: Lipid-Lowering Agents (Bile Acid Sequestrants)

Indication: Adjunct treatment to diet and exercise for ↓LDL with primary hyperlipidemia (can be combined with statins); adjunct treatment to diet and exercise to improve glycemic control with DM Type 2

Action: Binds bile acids in GI tract, resulting in ↑cholesterol clearance; unknown ↓glucose mechanism

Side Effects: Constipation, dyspepsia

Adverse Effects: N/A

Question 9

Exenatide

Answer 9

Trade Name(s): Bydureon, Byetta

Class: Antidiabetics (Incretin Mimetics Agents [GLP-1 Receptor Agonists])

Indication: Management of DM Type 2 as an adjunct treatment to diet and exercise

Action: Mimics action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucose-lowering

Side Effects: Nausea, vomiting, diarrhea

Adverse Effects: Thyroid c-cell tumors, pancreatitis, thrombocytopenia