Glucose lowering agents

Question 1

biguanides

Answer 1

Metformin
activates AMP-kinase
decreases hepatic production

Question 2

Sulonylureas

Answer 2

Glyburide/glibenclamide
glipizide
gliclazide
glimepiride

closes K-ATP channels on beta cell plasma membranes
increases insulin secretion

Question 3

Meglitinides

Answer 3

repaglinide
Nateglinide

closes K-ATP channels on beta-cell plasma membranes
increases insulin secretion

Question 4

TZDs

Answer 4

pioglitazone
rosiglitazone

activates the nuclear transcription factor PPAR-gamma
increases insulin sensitivity

Question 5

alpha-glucosidase inhibitors

Answer 5

acarbose
miglitol

inhibits intestinal alpha-glucosidase
slows intestinal carbohydrate digestion/absorption

Question 6

DDP-4 inhibitors

Answer 6

sitagliptin
vildagliptin
saxagliptin
linagliptin
alogliptin

inhibits DPP-4 activity, increasing postprandial active incretin (GLP-1, GIP) concentrations

increases insulin secretion (glucose-dependent), decreases glucagon secretion (glucose-dependent)

Question 7

Bile acid sequestrants

Answer 7

colesevelam

binds bile acids in intestinal tract, increasing hepatic bile acid production
decreases hepatic glucose production (?)
increases incretin levels (?)

Question 8

dopamine-2 agonists

Answer 8

bromocriptine (quick-release)

activates dopaminergic receptors
modulates hypothalamic regulation of metabolism, increases insulin sensitivity

Question 9

SGLT2 inhibitors

Answer 9

canagliflozin
dapagliflozin
empagliflozin

inhibits SGLT2 in the proximal nephron

blocks glucose reabsorption by the kidney, increasing glucosuria

Question 10

GLP-1 receptor agonists

Answer 10

exanatide
exanatide extended release
liraglutide
albiglutide
lixisenatide
dulaglutide

activates GLP-1 receptors

increases insulin secretion (glucose-dependent)
decreases glucagon secretion (glucose-dependent)
slows gastric emptying
increases satiety

Question 11

amylin mimetics

Answer 11

pramlintide

activates amylin receptors

decreases glucagon secretion
slows gastric emptying
increases satiety

Question 12

insulins

Answer 12

rapid acting analogs:
lispro
aspart
glulisine
short acting:
human regular
intermediate acting:
Human NPH
Basal insulin analogs:
glargine
detemir
degludec

activates insulin receptors

increases glucose disposal
decreases hepatic glucose production