Anti-hyperglycemic Agents

Question 1

Biguanides

Answer 1

Metformin

Phenformin

Decrease hepatic glucose production while increasing peripheral utilization

No effect on pancreatic beta cells

CI: CKD stage 3B, 4, 5

Question 2

Sulfonylureas

Answer 2

Glipizide

Glyburide

Glimepiride

Stimulate pancreatic beta cell insulin release

SE: Hypoglycemia MC, GI upset, weight gain

Question 3

Meglitinides

Answer 3

Repaglinide

Nateglinide

Stimulate pancreatic beta cell insulin release

SE: mild hypoglycemia, weight gain

Question 4

Alpha-glucosidase inhibitors

Answer 4

Acarbose

Miglitol

Delay intestinal glucose absorption

SE: Hepatitis with increased LFTs

Question 5

Thiazolidinediones

Answer 5

Proglitazone (Actos)

Rosiglitazone (Avandia)

Increase peripheral receptor insulin sensitivity for adipose and muscle

No effect on pancreatic beta cells

SE: Fluid retention/edema, CV toxicity (Avandia)

Question 6

Glucagon-like peptide 1 (GLP-1)

Answer 6

Byetta

Victoza

Mimic incretin to lower sugars; increased insulin secretion; decrease glucagon secretion w/ delayed gastric emptying

CI: history of gastroparesis; CrCl <30

Weight loss

Question 7

DPP-4 Inhibitors

Answer 7

Januvia

Tradjenta

Inhibit degradation of GLP-1

SE: pancreatitis, renal failure, GI sx

Question 8

SGLT-2 Inhibitor

Answer 8

Canagliflozin

Dapagliflozin

Increase urinary glucose excretion

SE: thirst, nausea, abdominal pain, UTIs