Non-Insulins

Question 1

Biguanides

Answer 1

Metformin (Glucophage) is the only drug in this classification

First choice to try for new Type 2
Used in combo w/diet & exercise, sometimes other drugs
ALERT: Lactic Acidosis & renal failure w/ Contrast Dye. Must stop metformin day of test and stay off for 48 hours after

Question 2

Sulfonylureas

Answer 2

2nd generation – Glipizide (glucatrol), glyburide (Diabeta), glimepiride (Amaryl)

increases secretion of insulin from pancreas.

Contraindications – Type 1 DM, active hypoglycemia, severe liver or renal disease, and pregnancy

Glipizide may be given with renal failure

Question 3

Glinides

Answer 3

repaglinide (Prandin), nateglinide (Starlix)

Mechanism of action – lower the blood glucose level by stimulating insulin release from the pancreatic beta cells (shorter duration of action than sulfonylureas and must be given with each meal)

Indications – type 2 DM; especially helpful with high postprandial blood glucose; can be given with metformin and thiazolidinediones, but never combined with a sulfonylureas

Question 4

Beta- blockers do what bad thing?

Answer 4

mask the S/Sx of hypoglycemia

Question 5

Thiazolinediones (GLItazones)

Answer 5

pioglitazone (Actos)

enhances the sensitivity of insulin receptors

type 2 DM, used with other oral antidiabetic agents – including insulin

Contraindications – children under 18 y/o, heart failure, pregnancy, liver/kidney disease

Question 6

Alpha-Glucosidase Inhibitors

Answer 6

acarbose (Precose), migitol (Glyset)

Only works if taken w/food, because it blocks an enzyme in the small intestine, which delays glucose absorption.

can be combo w/other drugs

problems are all GI related

Question 7

Dipeptidyl peptidase iv (dpp iv) inhibitors

Answer 7

sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina)

DPP-4 inhibitors work by blocking the action of DPP-4, an enzyme which destroys the hormone incretin. Incretins help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed.

Increases digoxin levels
Increased hypoglycemia if given with sulfonylurea/insulin

Question 8

Amylin agonists

Answer 8

pramlintide (Symlin) – only available as a SQ injection

slowing gastric emptying and promoting satiety, thereby preventing post-prandial spikes in blood glucose levels.

if given at the same time as preprandial short or rapid acting insulin, the insulin dose must be decreased by 50%

Question 9

incretin mimetics

Answer 9

exenatide (Byetta); liraglutide (Victoza); dulaglutide (Trulicity); albiglutide (Tanzeum)

stimulate insulin secretion, reduce postprandial glucagon production, slows gastric emptying, increases satiety

can’t be given with insulin

Question 10

Sodium Glucose Cotransorter inhibitors (SGLT2)

Answer 10

canagliflozin (Invokana); dapagliflozin (Farxiga); empagliflozin (Jardiance)

urinary excretion of glucose. These drugs block glucose reabsorption by the kidneys to increase glucosuria.

Question 11

Glucose – Elevating Drugs

Answer 11

Glucagon (GlucoGen) – IM/IV/SQ, also available as buccal tablets and semisolid gels that is designed for rapid absorption

nausea and vomiting

Contraindications – hypersensitivity, pheochromocytoma