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