Oral Hypoglycemic Agents Quick-Reference

Sulfonylureas examples

Glyburide, glipizide, and chlorpropamide.

Sulfonylureas first-line status

Used along with metformin for Type 2 Diabetes.

Sulfonylureas MOA

Increases pancreatic beta cell insulin secretion and decreases hepatic glucose production.

Sulfonylureas HbA1c reduction

Lowers HbA1c by 1% to 2%.

Sulfonylureas dosage efficacy

All agents are equally effective at equivalent doses.

Sulfonylureas administration timing

Take 30 to 40 minutes before food.

Sulfonylureas fasting rule

Never administer to a fasting patient.

Sulfonylureas contraindications

Type 1 diabetes, DKA, and sulfonamide cross-sensitivity.

Sulfonylureas standout ADR

Disulfiram-like reaction.

Metformin brand name

Glucophage.

Metformin first-line indications

Type 2 diabetes, gestational diabetes, PCOS, and antipsychotic weight gain.

Metformin MOA

Decreases hepatic glucose, decreases intestinal absorption, and increases insulin sensitivity.

Metformin lipid effects

Decreases LDL cholesterol and triglyceride levels.

Metformin renal contraindication

eGFR under 30 mL/min.

Metformin medical contraindications

Metabolic acidosis and diabetic ketoacidosis (DKA).

Metformin IV contrast rule

Hold 48 hours before and after IV iodinated contrast.

Metformin acute hold conditions

Hold during hypoxic states or surgery.

Metformin standout ADR

Lactic acidosis, especially with renal impairment.

Meglitinides examples

Repaglinide and nateglinide.

Meglitinides MOA

Closes ATP-sensitive potassium channels on beta cells.

Meglitinides insulin release type

Glucose-dependent insulin release.

Meglitinides administration timing

Rapid onset; take right before meals.

Meglitinides skipped meal rule

Skip the dose if a meal is skipped.

Meglitinides HbA1c reduction

Modest reduction of 0.6% to 1%.

Repaglinide administration timing

Take 30 minutes before meals.

Nateglinide administration timing

Take 10 minutes before meals.

Repaglinide drug contraindication

Gemfibrozil, which raises repaglinide levels.

Meglitinides standout ADR

Genitourinary infections.

TZDs examples

Pioglitazone and rosiglitazone.

TZDs MOA

Improves cellular insulin sensitivity without increasing insulin output.

TZDs insulin requirement

Requires the presence of insulin to work.

TZDs onset of action

Slow onset; up to 12 weeks for peak effect.

TZDs Black Box Warning

Risk of heart failure and cardiovascular events.

TZDs reproductive effect

Can resume ovulation in women.

TZDs contraception advice

Advise women to use non-oral contraception.

TZDs standout ADR

Precipitates or worsens heart failure.

Alpha-Glucosidase Inhibitors examples

Miglitol and acarbose.

Alpha-Glucosidase Inhibitors MOA

Delays carbohydrate digestion and absorption in the gut.

Alpha-Glucosidase Inhibitors clinical effect

Blunts the postprandial glucose spike.

Alpha-Glucosidase Inhibitors absorption

Less than 2% systemically absorbed.

Alpha-Glucosidase Inhibitors site of action

Acts locally within the gastrointestinal tract.

Alpha-Glucosidase Inhibitors HbA1c reduction

Modest reduction of approximately 1%.

Alpha-Glucosidase Inhibitors contraindications

IBD, GI obstruction, colonic ulceration, and cirrhosis.

Acarbose monitoring requirement

Monitor liver function tests (LFTs) due to elevated enzymes.

Alpha-Glucosidase Inhibitors standout ADR

Excessive flatulence from undigested carbohydrate fermentation.

Pramlintide brand name

Symlin.

Pramlintide MOA

Slows gastric emptying, decreases postprandial glucagon, and suppresses appetite.

Pramlintide indications

Adjunct to mealtime insulin in Type 1 or Type 2 Diabetes.

Pramlintide insulin dose adjustment

Reduce mealtime insulin dose by 50% before starting.

Pramlintide administration rule

Never mix with insulin; use separate injections only.