Biguanides – MOA
(Metformin)
- Lowers the amount of glucose released from the liver
- Helps the body absorb and use more glucose
Biguanides – Examples
Metformin
Biguanides – Weight Change
None
Biguanides – Side Effects
- Diarrhea
- Flatulence
- Lactic Acidosis
Biguanides Notes
- Reduction Vitamin B12
- Infrequent hypoglycemia if the patient not well nourished
- Hold Metformin for 48 hours after contrast imaging interventions
Sulfonylureas – MOA
- Helps pancreas release more insulin
Sulfonylureas – Examples
**GL.....
Glipizide (Glucotrol, Glucotrol XL)
Glimepiride (Amaryl)
Glyburide (Micronase, DiaBeta)
Glyburide, microionized (Glynase PresTabs)
Tolbutamide(Orinase)
Sulfonylureas – Weight Change
GAIN
Sulfonylureas – Side Effects
- HYPOGLYCEMIA
- nausea
- dizziness
Important Facts with Sulfonyureas: contraindications, Insulin pairing, Beers List
- Sulfa allergies
- Do not pair with insulin bc can cause hypoglycemia
- Glyburide & Glimepiride on Beers List (Medications inappropriate for older patients)
- Decreases A1c by 1-2 %
Metaglides MOA
- stimulate release of insulin from pancreatic beta cells = lower blood glucose
Metaglides Examples
Repaglinide (Prandin)
Nateglinide (Starlix)
Metaglinides Weight Change
Gain
Metaglinides Side Effects
- Hypoglycemia
DPP4 Inhibitors – MOA
(Dipeptidyl peptidase-4 inhibitor)
- Helps body use incretins ––> (hormones that make the pancreas release more insulin and stop liver from making extra glucose)
- increase incretin levels (GLP-1 and GIP), which stop glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels
DPP4 Inhibitors – Examples
(Dipeptidyl peptidase-4 inhibitor)
--Gliptans
- Alo gliptin (Nesina)
- Sita gliptin (Januvia)
- Saxa gliptin (Onglyza)
- Lina gliptin (Trajenta)
DPP4 Inhibitors – Weight Change
(Dipeptidyl peptidase-4 inhibitor)
None
DPP4 Inhibitors – Side Effects
- Pancreatitis
- Nose/Sinus Congestion
DPP4 Contraindications
Do not use with GLP-1
SGLT2 Inhibitors – MOA
- Helps glucose leave the body via urine because the kidneys aren't able to absorb as much glucose back into the blood
SGLT2 Inhibitors – Examples
-- Flozin
- Canagli flozin (Invokana)
- Dapagli folozin (Farxiga)
- Empagli flozin (Jardiance)
SGLT2 Inhibitors – Weight Change
LOSE
SGLT2 Inhibitors – Side Effects
- Yeast Infections/UTIs
- Hypoglycemia
- Low blood pressure
- DKA
GLP1 Agonists – MOA
- Helps make more insulin when blood glucose rises
- Slows emptying of food from the stomach
- Helps you feel full with meals and decreases your appetite
GLP1 Agonists – Examples
"–tide" given via INJECTION
Dulaglu tide (Trulicity)
Liraglu tide (Victoza)
Exena tide (Byetta)
Albiglu tide (Tanzeum)
GLP1 Agonists – Weight Change
LOSE
GLP1 Agonists – Side Effects
- Increases risk for pancreatitis
Thiazolidinediones – MOA
- Helps muscles and fat use up insulin better (reduce peripheral insulin resistance)
Thiazolidinediones – Examples
-–glitazone
Pio glitazone (Actos)
Rosiglitazone (Avandia)
Thiazolidinediones – Weight Change
GAIN
Thiazolidinediones – Side Effects
- Peripheral Edema – can worsen CHF
- Increases risk of osteoporosis/breaking bone
- Increase risk with bladder cancer (Pioglitazone)
Thiazolinediones
- Reduces A1c up to 1-2 %
Alpha Glucosidase Inhibitor MOA
- Inhibits the gut enzymes that normally break down starches to release glucose
Alpha Glucosidase Examples
Acarbose
Alpha Glucoseidas Side Effects
- Diarrhea