Prototypes

Sulfonylureas: glyburide (Diabeta)

t class: type 2 antidiabetic

p class: sulfonylurea

-stimulating beta cells of pancreas to excrete insulin

side effects: hypoglycemia, weight gain, GI issues, hematological issues, liver dysfunction

Biguanides: Metformin (Glucophage)

t class: type 2 antidiabetic

p class: biguanide

-decreasing glucose production in the liver, increasing insulin sensitivity

adverse effects: GI effects, metallic taste, lactic acidosis

Alpha-Glucosidase Inhibitors: acarbose (Precose)

t class: type 2 antidiabetic

p class: alpha-glucosidase inhibitor

-inhibiting this enzyme, acarbose slows down the digestion and absorption of carbohydrates, leading to a slower rise in blood glucose after meals

side effects: GI issues, hypoglycemia, and liver dysfunction

Thiazolidinediones: Rosiglitazone (Avandia)

t class: type 2 antidiabetic

p class: thiazolidineodiones

-binding to peroxisome proliferator-activated receptor gamma (PPAR-γ)

-doesn’t increase insulin secretion

-weight gain, edema, headache, muscle pains, upper respiratory tract infections

Meglitinides: Repaglinide (Prandin)

t class: type 2 antidiabetic

p class: meglitinide

-stimulating the pancreas to release insulin

-hypoglycemia, weight gain

Nateglinide (Starlix)

• Therapeutic Class: Antidiabetic (Type 2)

• Pharmacologic Class: Meglitinide

-releases insulin in response to a meal

• Brand Name: Starlix

• Adverse Side Effects:

  • Common: Hypoglycemia, weight gain, gastrointestinal symptoms (nausea, diarrhea), headache.

  • Serious: Severe hypoglycemia, liver dysfunction, allergic reactions, pancreatitis.

DPP-4 Inhibitors: Sitagliptin (Januvia)

• Therapeutic Class: Antidiabetic (Type 2)

• Pharmacologic Class: DPP-4 Inhibitor

  -These incretin hormones help regulate insulin release from the pancreas in response to food intake.

• Brand Name: Januvia

• Adverse Side Effects:

  • Common: Headache, upper respiratory infections, gastrointestinal symptoms (nausea, diarrhea).

  • Serious: Pancreatitis, severe allergic reactions, renal impairment, joint pain, liver enzyme abnormalities, and potential risk for heart failure.

GLP-1 Agonists: Semaglutide (Ozempic; Wegovy)

• Therapeutic Class: Antidiabetic (Ozempic), Anti-obesity agent (Wegovy)

• Pharmacologic Class: GLP-1 Receptor Agonist

• Generic Name: Semaglutide

• Brand Names: Ozempic (for Type 2 diabetes), Wegovy (for weight management)

• Adverse Side Effects:

  • Common: Nausea, vomiting, diarrhea, headache, abdominal discomfort.

  • Serious: Pancreatitis, thyroid C-cell tumors (risk in animals), kidney issues, severe hypoglycemia

-slows gastric emptying, increased insulin, promotes satiety

SGLT-2 inhibitors: Empagliflozin (Jardiance)

-new as of 2023 and is being used off-label for weight loss and hypertension

-glucose spills into the patient’s urine even though there is no diagnosis of DM

• Therapeutic Class: Antidiabetic, Heart Failure Medication

• Pharmacologic Class: SGLT-2 Inhibitor (Sodium-Glucose Cotransporter-2 Inhibitor)

• Mechanism of Action (MOA): Inhibits SGLT-2 in the kidneys, leading to increased glucose excretion in the urine, thereby lowering blood glucose levels. Additionally helps reduce blood pressure and benefits heart failure outcomes.

• Adverse Effects:

  • Common: Genital infections, urinary tract infections, dehydration, increased urination

  • Serious: Diabetic ketoacidosis, acute kidney injury, hypotension, lower limb amputations, hyperkalemia