Diabetes Meds — Master Study Deck (by Class)

A complete set of vocabulary flashcards covering the classes, mechanisms, dosing profiles, safety concerns, and clinical pearls of type 2 diabetes medications based on the lecture notes.

Biguanides

A medication class (represented by metformin) that decreases hepatic glucose output; typically used as first-line therapy due to longstanding evidence, high efficacy and safety, affordable cost, lack of hypoglycemia or weight gain, and cardiovascular risk reduction.

Metformin Contraindications and Cutoffs

Clinical criteria requiring discontinuation or avoidance of metformin: GFR < 30, not starting a new prescription if GFR < 45, liver disease, binge drinking, age > 80, IV dye study, and congestive heart failure (CHF) requiring medications.

Metformin Formulations and Dosing Definition: - Immediate-Release & Liquid Formulations :

• Glucophage/Metformin (tablets) (taken BID with meals)& Riomet (liquid): 500–2550 mg/day 500–2550mg/day

  • Extended-Release (XR) Formulations (taken once daily with dinner):

• Glucophage XR & Glumetza (1xdaily with dinner): 500–2000 mg/day500–2000mg/day

• Fortamet: 500–2550 mg/day500–2550mg/day

Sulfonylureas

A class of insulin secretagogues (glyburide, glipizide, glimepiride) dubbed 'squirters' that stimulate pancreatic beta cells to release insulin; effective for glucose toxicity and lowers A1C by 1–2%, but carries risks of hypoglycemia and weight gain with no CV benefit.

Sulfonylureas Formulations and Dosing

glyburide/diabeta 1.25-20mg, Glynase PresTabs 0.75- 12 mg once or twice a day. Glipizide/Glucotrol 2.5- 40 mg, Glucotrol XL: 2.5- 20 mg. Glimepiride/Amaryl 1- 8 mg daily. Once or Twice a day before meals.

glyburide/diabeta

is noted as being the most likely within its class to cause hypoglycemia.

Meglitinides

Fast-acting insulin secretagogues (repaglinide and nateglinide) taken right before meals to stimulate mealtime insulin secretion and target post-prandial hyperglycemia; doses are skipped if meals are skipped, making them useful for irregular meal schedules. Similar mechanism to sulfonylureas but with a short-acting duration

Repaglinide vs. Nateglinide Metabolism

Pharmacokinetic distinction between meglitinides: repaglinide (Prandin, 0.5–4 mg) is metabolized by the liver, whereas nateglinide (Starlix, 60–120 mg) is eliminated by the kidneys.

Thiazolidinediones (TZDs)

A drug class represented by pioglitazone (Actos, 15–45 mg once daily) that decreases insulin resistance by making muscle and adipose cells more insulin-sensitive and lowering free fatty acids; takes 6 weeks for maximum effect and can be considered for T2D with MASLD/MASH. Recommeded after a stroke and/or to treat steatosis

Pioglitazone Safety Warnings

Specific safety risks of pioglitazone (Actos), including fluid retention leading to a strict contraindication in congestive heart failure (CHF), as well as an associated risk of bladder cancer. Increases future risk. Monitor for edema

Alpha-Glucosidase Inhibitors

Medications such as acarbose (Precose 25-100mg/meals) and miglitol (Glyset 300mg/max dose/d) delay carbohydrate absorption in the gastrointestinal tract to target postprandial glucose; they have minimal systemic absorption, are weight neutral, and commonly cause GI side effects like gas, bloating, and diarrhea. Lower A1C 0.5-1%.

DPP-4 Inhibitors

Oral incretin enhancers (sitagliptin/Januvia, sitagliptin/Zitluo=25-100 Mg/d, linagliptin/Tradjenta=5 Mg/d=liminated via feces, alogliptin/Nesina=6.25-25mg/d, saxagliptin=2.5-5mg) that inhibit the enzyme that degrades native GLP-1, thereby increasing glucose-dependent insulin release and suppressing glucagon levels without causing hypoglycemia or weight gain.

linagliptin /Tradjenta

A DPP-4 inhibitor dosed at 5 mg once daily that requires no renal dose adjustment because it is eliminated primarily through the feces.

DPP-4 Inhibitor Safety Cautions

Class and agent-specific risks including high cost (~$650/month), severe joint pain, an increased risk of heart failure specifically associated with alogliptin and saxagliptin, and the recommendation to avoid co-administration with GLP-1 receptor agonists.

SGLT2 Inhibitors

A class known as 'glucoretics' (dapagliflozin/farxiga (5-10mg/d-once), empagliflozin/Jardiance(10-25mg/d-once), canagliflozin/invokana(100-300mg once/d), ertugliflozin/steglatro (5-15mg/d-once), bexagliflozin(20mg/d-once) that lowers glucose by decreasing renal glucose reabsorption in the proximal tubule; proven to lower CV risk (dapa, empa, cana) and preferred in heart failure and kidney disease, approved for peds 10+. First line of therapy for HF, CKD, CVD before or with metformin

SGLT2 Inhibitor Adverse Risks

Adverse effects linked to SGLT2 inhibitors: genitourinary (GU) infections, volume depletion, hypotension, and euglycemic diabetic ketoacidosis (DKA); may be used in renal failure provided GFR ≥ 20. Limited lowering BG effect with GFR <45

GLP-1 Receptor Agonists

A drug class (exenatide 2d injection, 5 and 10 mcg; liraglutide/Victoza 1xd injection 0.6, 1.2,1.8mg; semaglutide/Ozempic:0.25, 05,1.0, 2.0mg Tx for CkD/Wegovy Tx for mash; dulaglutide/Trulicity, 1wk injection: 0.75,1.5,3.0, 4.5mg) that mimics native GLP-1 to increase insulin, decrease glucagon, slow gastric emptying, and enhance satiety, providing strong cardiovascular benefits and significant weight loss.

GLP-1 RA Contraindications and Risks

Clinical safety considerations for GLP-1 receptor agonists, which require avoidance in patients with a history of medullary thyroid carcinoma (MTC) or MEN-2, and carry cautions for pancreatitis, biliary disease, and gastrointestinal side effects.

Tirzepatide (Mounjaro/Zepbound=sleep apnea)

A dual GLP-1 and GIP receptor agonist that produces the strongest weight-loss effect (~13%) of its group, dosed weekly up to 15 mg, and requiring backup contraception for 4 weeks if used alongside oral contraceptives.

GLP-1 Receptor Agonists

A drug class that mimics native GLP-1 to increase glucose-dependent insulin release, decrease glucagon, delay gastric emptying, and promote satiety, providing significant weight loss and cardiovascular benefits.

• Available Agents & Formulations:

  • Semaglutide: Available in both subcutaneous injection and oral tablet forms:

  • Subcutaneous Injections: Ozempic ($0.25\text{–}2.0\,\text{mg}$ once weekly, also indicated for CKD risk reduction) and Wegovy (up to $2.4\,\text{mg}$ once weekly for weight loss and up to 7.2 for MASH).

  • Oral Tablets: Ozempic (1.5 -9mg) & Rybelsus ($3\text{–}14\,\text{mg}$ once daily).

  • Exenatide (Byetta): Subcutaneous injection ($5\text{–}10\,\mu\text{g}$ BID).

  • Liraglutide (Victoza / Saxenda): Subcutaneous injection ($0.6\text{–}1.8\,\text{mg}$ once daily for diabetes; $3.0\,\text{mg}$ once daily for weight loss).

  • Dulaglutide (Trulicity): Subcutaneous injection ($0.75\text{–}4.5\,\text{mg}$ once weekly).

Approved for peds 10-17

mounjaro,liraglutide/victoza, duluglatide/trulicity are GLP-1 receptor agonists that have been authorized for use in pediatric patients aged 10 to 17 years for managing type 2 diabetes.

Approved for peds 12-17

wegovy