Oral Glycemic Agents

Question 1

Biguanides

Answer 1

Metformin -

Inhibits gluconeogenesis and glycogenolysis in the liver and decreases peripheral insulin resistance
Does NOT cause hypoglycemia
R/o lactic acidosis - increases with renal and liver disease
D/C 48H before surgery

Question 2

Alpha-Glucosidase Inhibitors

Answer 2

Acarbose, Migitol

Active in small intestine - results in delay of glucose absorption
Should be given before a meal
Does NOT cause hypoglycemia

Question 3

Thiazolidinediones

Answer 3

Rosiglitazone, Pioglitazone

Decrease peripheral insulin resistance and increase hepatic glucose hypoglycemia
Does NOT cause hypoglycemia
CONTRAINDICATED in liver failure, expand ECF causes edema and increase risk of CHF

Question 4

Sulfonylureas

Answer 4

Glyburide, Glipizide, Glimepride

Stimulate insulin secretion from pancreatic beta cells
Closes K (ATP) channels, inhibits myocardial preconditioning, increases morbidity in high risk patients
AVOID if SULFA allergy
Usually initial treatment for DM2
Most common side effect: hypoglycemia

Question 5

Meglitinides

Answer 5

Repaglinide, Nateglinide

Stimulate insulin secretion from pancreatic beta cells
Risk of hypoglycemia

Question 6

Glucagon-like Peptide-1 receptor Agonist

Answer 6

Exenatide, Liraglutide

Increases insulin release from beta cells
Decreases glucagon release from alpha cells
Prolongs gastric emptying
Risk of hypoglycemia

Question 7

Dipeptidyl-Peptidase-4 Inhibitors

Answer 7

-liptin suffix

Increases insulin release
Decreases glucagon release
Risk of hypoglycemia

Question 8

Amylin Agonist

Answer 8

Pramlintide

Inhibits glucagon release from alpha cells
Reduce gastric emptying
Risk of hypoglycemia when used WITH insulin
Can cause N/V