9 Oral Medications for Type II Diabetes

What are the 8 types of oral medications for type 2 diabetes?

1.Sulfonylureas

2.Meglitinides

3.Biguanide (Metformin)

4.Thiazolidinediones (Glitazones)

5.Alpha-glucosidase inhibitors

6.Gliptins (DPP-4 inhibitors)

7.SGLT-2 inhibitors

8.GLP-1 receptor agonists

Fill in the Blanks: General MOAs of Oral Medications for Type II Diabetes

• Inhibition of BLANK production (glycogenolysis)

• Increase in insulin BLANK (tissues)

  • i.e. decreases insulin resistance

• Stimulation of insulin BLANK (pancreas)

• Delayed BLANK absorption (gut)

• Enhancement or mimicking BLANK hormones

• Suppression post-prandial (meal) release of BLANK

• Inhibition of SGLT-2 in the BLANK

  • [redacted] do not reabsorbed glucose which are then excreted

glucose, sensitivity, secretion, carb, incretin, glucagon, kidneys

What is an example drug of Sulfonylurea, the oldest class of oral anti-hypoglycemics?

glipizide (Glucotrol)

What is the MOA of Glipizide (Glucotrol)?

• prior to meals, 1-2 times a day.

stimulates insulin secretion (pancreas) & increases insulin sensitivity of tissues

What are the Adverse Effects/Interactions/Alerts of Glipizide (Glucotrol)?

Hypoglycemia (especially in hepatic or renal impairment)

No alcohol (flushing, palpitations, N/V)

• Beta-blockers (can mask shakiness in hypoglycemia)

• Don’t use in pregnancy/lactation

Is Glipizide (Glucotrol) ok to use for women during pregnancy/lactation?

No

What is an example drug of Meglitinides?

repaglinide (Prandin)

What is the MOA of Repaglinide (Prandin)?

• 3 times a day before meals

Stimulates insulin secretion (pancreas), similar to sulfonylureas

True or False: A pt is recommended to take Glipizide (Glucotrol) and Repaglinide (Prandin) at the same time to best treat type 2 diabetes.

False

What are the Adverse Effects/Interactions/Alerts of Repaglinide (Prandin)?

Hypoglycemia (especially in hepatic or renal impairment)

• Some DDIs that increase or decrease the drug’s effect

  • Alcohol decreases effect

Which oral medication is a first-line therapy for type 2 diabetics (maybe prediabetes)?

Biguanide

What is an example drug of Biguanide?

metformin (Glucophage)

What is the MOA of Metformin (Glucophage)?

• With meals, 1-2 times a day

Decreases glucose absorption (gut)

Inhibits glucose production (liver)

Increases insulin sensitivity (tissues)

What are the Adverse Effects/Interactions/Alerts of Metformin (Glucophage)?

GI effects (take with food)

• B12 deficiency (monitor)

• Toxicity: lactic acidosis (rare, no alcohol while taking)

• Excreted by kidneys (renal dosing or d/c med)

True or False: a pt should be taught to take no alcohol when on Metformin (Glucophage).

True

What is an example drug of TZDs? (aka Thiazolidinediones/Glitazones)

pioglitazone (Actos)

What is the MOA of Pioglitazone (Actos)?

• •T ½  is 16-24 hrs

Increases insulin sensitivity (tissues)

Inhibits glucose production

What are the Adverse Effects/Interactions/Alerts of Pioglitazone (Actos)?

Fluid retention: caution in CHF

Drug interactions: gemfibrozil and ketoconazole (CYP inhibitor)

• Risk of bladder cancer

• Risk of fractures in women (educate)

• Potential to induce ovulation, reduced OCP (oral contraceptives) effectiveness

• Possibly hepatotoxic (monitor LFTs)

• Lipid levels may increase

What is an example drug of Alpha-glucosidase Inhibitor?

acarbose (Precose)

What is the MOA of Acarbose (Precose)?

• start of meals, 3x a day

• Delays carb absorption (gut)

What are the Adverse Effects/Interactions/Alerts of Acarbose (Precose)?

Frequent GI distress (gas, bloating, cramping, diarrhea, & borborygmus)

• Decreased iron absorption (monitor for anemia)

• Possible liver dysfunction (monitor LFTs)

• Hypoglycemia (only if given with insulin or sulfonylurea)

• Cant be treated w/ Sucrose (OJ wont work)

What is an example drug of Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (gliptins)?

sitagliptin (Januvia)

What is the MOA of Sitagliptin (Januvia)?

• PO, comes in combo with metformin

Enhances incretin hormones

• Stimulates insulin secretion (pancreas)

• Suppresses post-prandial release of glucagon

What are the Adverse Effects/Interactions/Alerts of Sitagliptin (Januvia)?

Pancreatitis (rare) (most common)

• Severe & persistent upper abdominal pain

• Vomiting

• Very rare upper respiratory problems

• Rare allergic reactions (skin)

What is an example drug of Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors?

canagliflozin (Jardiance)

What is the MOA of Canagliflozin (Jardiance)?

• Half-life = 12 hours → once daily dosing

• Inhibits SGLT-2 in the kidneys

• Increases urinary glucose excretion

• Glucosuria → caloric loss → modest weight loss

Canagliflozin (Jardiance) has been shown to prevent CV events, and is even able to treat what?

HF

What are the Adverse Effects/Interactions/Alerts of Canagliflozin (Jardiance)?

Increased urination (dehydration, hypotension) (remember cuz they pee out the glucose)

• UTIs / fungal infections / Genital necrotizing infections (good hygiene)

What is an example drug of Incretin Mimetics: Glucagon-like Peptide 1 (GLP-1)?

exenatide (Byetta pen)

What is the MOA of Exenatide (Byetta pen)?

• 1-2x day

mimics incretin hormones:

• Stimulates insulin secretion (pancreas)

• Suppresses post-prandial release of glucagon

• Slows gastric emptying (wait 1 hour for oral meds)

• Suppresses appetite (promotes weight loss)

What are the Adverse Effects/Interactions/Alerts of Exenatide (Byetta pen)?

• GI effects (reflux, N/V, diarrhea) (from slower gastric emptying)

• Hypoglycemia (when given with sulfonylurea)

• Rare pancreatitis

• Rare renal impairment