UC 8024 Pharm Exam 4
Biguanides (Metformin)
First line agent for DMII
MOA: Decreases liver glucose production
ADE: diarrhea and abdominal pain
BBW: Lactic Acidosis - rare
Contra: Pts with renal impairment
Sulfonylureas
MOA: Increased endogenous insulin secretion (binding to pancreatic beta receptors to
trigger insulin release)
ADE: Hypoglycemia (combined w/ other agents), wt gain, rash (sulfa), HA, N/V,
photosensitivity
Caution: Renal/hepatic impairment
Thiazolidinediones (TZDs)
MOA: Increases muscle and adipose cell sensitivity to insulin & suppresses liver glucose
production
ADE: Wt gain, edema, hypoglycemia (if taken w/ insulin), possible increased fracture risk
(women),
BBW: CHF
Caution: hepatic impairment
Meglitinides
MOA: stimulate insulin secretion in presence of glucose
ADE: Hypoglycemia (if patient has abnormal eating schedule), wt gain, SJS,
Contra: with use of gemfibrozil
Caution: hepatic dysfunction
, Medications in class: Repaglinide (Prandin), Nateglinide (Starlix)
GLP-1 Agonists
MOA: increases glucose-mediated insulin release. suppresses glucagon secretion, delays
gastric emptying
ADE: wt. loss, GI symptoms, pancreatitis
Caution: renal dysfunction, severe gastroparesis
Medications in class: exenatide (Byetta), liraglutide (Victoza, Dulaglutide (Trulicity)
SGLT2 Inhibitors
MOA: Block renal glucose resorption - causes glucosuria
ADE: GU infections, Wt loss, polyuria, dehydration
Contra: severe renal impairment
**Fracture risk
***Dose-related increase in LDL
Alpha-glucosidase Inhibitors
MOA: blocks enzymes that digest starch in small bowel; causing decreased glucose
absorption
ADE: flatulence, abdominal discomfort
Hypoglycemia risk with secretagogue
Contra: pts with IBS or cirrhosis
Medications in this class: acarbose (Precose) and miglitol (Glyset)
DPP-4 Inhibitor
MOA: inhibits breakdown of glucagon-like peptide-1 secreted during meals
Oral medication: Increased glucose-mediated insulin release, delays gastric emptying
(promotes satiety)
ADE: Pancreatitis, NV, hypersensitivity (angioedema, anaphylaxis)
Caution: renal insufficiency
Biguanides (Metformin)
First line agent for DMII
MOA: Decreases liver glucose production
ADE: diarrhea and abdominal pain
BBW: Lactic Acidosis - rare
Contra: Pts with renal impairment
Sulfonylureas
MOA: Increased endogenous insulin secretion (binding to pancreatic beta receptors to
trigger insulin release)
ADE: Hypoglycemia (combined w/ other agents), wt gain, rash (sulfa), HA, N/V,
photosensitivity
Caution: Renal/hepatic impairment
Thiazolidinediones (TZDs)
MOA: Increases muscle and adipose cell sensitivity to insulin & suppresses liver glucose
production
ADE: Wt gain, edema, hypoglycemia (if taken w/ insulin), possible increased fracture risk
(women),
BBW: CHF
Caution: hepatic impairment
Meglitinides
MOA: stimulate insulin secretion in presence of glucose
ADE: Hypoglycemia (if patient has abnormal eating schedule), wt gain, SJS,
Contra: with use of gemfibrozil
Caution: hepatic dysfunction
, Medications in class: Repaglinide (Prandin), Nateglinide (Starlix)
GLP-1 Agonists
MOA: increases glucose-mediated insulin release. suppresses glucagon secretion, delays
gastric emptying
ADE: wt. loss, GI symptoms, pancreatitis
Caution: renal dysfunction, severe gastroparesis
Medications in class: exenatide (Byetta), liraglutide (Victoza, Dulaglutide (Trulicity)
SGLT2 Inhibitors
MOA: Block renal glucose resorption - causes glucosuria
ADE: GU infections, Wt loss, polyuria, dehydration
Contra: severe renal impairment
**Fracture risk
***Dose-related increase in LDL
Alpha-glucosidase Inhibitors
MOA: blocks enzymes that digest starch in small bowel; causing decreased glucose
absorption
ADE: flatulence, abdominal discomfort
Hypoglycemia risk with secretagogue
Contra: pts with IBS or cirrhosis
Medications in this class: acarbose (Precose) and miglitol (Glyset)
DPP-4 Inhibitor
MOA: inhibits breakdown of glucagon-like peptide-1 secreted during meals
Oral medication: Increased glucose-mediated insulin release, delays gastric emptying
(promotes satiety)
ADE: Pancreatitis, NV, hypersensitivity (angioedema, anaphylaxis)
Caution: renal insufficiency
