Oral Antidiabetic Agents
Common Oral antidiabetic medicines (hypoglycemic agents) :
MCQs on this topic are in the end.
1. Sulfonylureas:
- Stimulate beta cells to produce insulin;
- Second-generation sulfonylureas: glipiZIDE , glyBURIDE, glimepiride
Glipizide is taken as a 2.5 mg to 10 mg tablet, single dose or in two divided doses, 30 minutes before breakfast.
Glimepiride is available as a 1, 2, and 4 mg tablet, taken once a day with breakfast or twice a day with meals. For patients at increased risk for hypoglycemia, such as older patients or those with a chronic kidney disease, the initial dose could be as low as 0.5 mg daily.
Glyburide is available as a 1.25, 2.5, and 5mg tablet, taken as a single dose or two divided doses.
2. Biguanides:
- Reduce the rate of endogenous glucose production by liver.
- Increase the use of glucose by muscle and fat cells.
- Metformin
Metformin is the first drug of choice in patients with type 2 diabetes mellitus. It is given orally in 500 to 1000 mg tablets twice a day.
3. Thiazolidinediones:
- Improve insulin sensitivity, thus improving peripheral glucose uptake
- Rosiglitazone, pioglitazone
Pioglitazone is given as 15, 30, or 45 mg tablet daily. Rosiglitazone, when rarely used, is given as 2, 4 and 8 mg daily.
4. Meglitinides:
- Stimulate quick release of insulin by beta cells
- Repaglinide, Nateglinide
Repaglinide is available as a 0.5, 1, or 2 mg tablet, taken orally as two to three divided doses in a day
5. Alpha-glucosidase inhibitors:
- Block digestion of ingested carbohydrates and slow absorption of glucose
- Acarbose, Miglitol
6. Dipeptidyl peptidase 4 (DPP-4) inhibitor:
- Prevents breakdown of glucagon-like peptide-1 (GLP-1) which reduces blood glucose levels in the body
- Sitagliptin, saxagliptin
7. Synthetic analog of human amylin:
- Decreases gastric emptying
- Pramlintide
8. Incretin mimetic:
- Stimulates insulin production in type 2 diabetes
- Exenatide, liraglutide
- Injectable medications for type 2 diabetes
9. Combination:
- GlyBURIDE/metformin
- Sitagliptin/metformin
- Pioglitazone/metformin
Common Questions on Oral Hypoglycemic Agents
Question 1 : A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority?
-
Send blood to the laboratory for analysis
-
Administer the prescribed insulin
-
Administer oxygen per nasal cannula
-
Administer 50% dextrose IV per protocol
Question 2 : The healthcare provider is teaching a group of students about the characteristics of type 1 diabetes mellitus. Which of the following describe the underlying cause of the disease?
-
Increased hepatic glycogenesis
-
Cellular resistance to insulin
-
Destruction of pancreatic beta cells
-
Atrophy of pancreatic alpha cells
Question 3 : A diabetic patient has been prescribed an alpha-1 glucosidase inhibitor. When teaching the patient about the medication, which of the following information will the healthcare provider include?
-
"Call us immediately if you experience tremors or palpitations.”
-
“Take one tablet daily first thing in the morning.”
-
“Take this medication with the first bite of each meal.”
-
“You should select foods low in protein when taking this medication.”
Question 4 : What Hyperglycemic medication increases blood glucose with in 5 - 20 minutes?
-
Glucagon
-
Glucovance
-
Glybride
-
Glimepride
-
Glipizide
Question 5 : What stimulates rapid and short lived release of insulin from the pancreas
-
Meglitinides
-
Thiazolidinediones
-
Biguanides
-
Alpha- Glucosidase
-
Sulfonylureas
Question 6 : What classification of OAD (Oral Anti-diabetic) medication delays the absorbtion of carbohydrates from the GI TRACT?
-
Biguanides
-
Thiazolidinediones
-
Alpha- Glucosidase
-
Meglitinides
-
Sulfonylureas
Question 7 : What Oral Antidiabetic stimulates beta cells to secrete more insulin and increase receptor sites in the tissue?
-
Biguanides
-
Thiazolidinediones
-
Alpha- Glucosidase
-
Meglitinides
-
Sulfonylureas
Question 8 : What increased glucose uptake in muscle, decreases glucose production in the liver?
-
Meglitinides
-
Thiazolidinediones
-
Sulfonylureas
-
Glucagon
Answers
Question 1 : Correct Answer : 4. Administer 50% dextrose IV per protocol.
- The body responds to hypoglycemia by mounting a sympathetic response, causing tachycardia, diaphoresis, and pallor. The patient may become unresponsive as the glucose supply to the brain decreases.
Question 2 : Correct Answer : 3. Destruction of pancreatic beta cells
- The major feature of type 1 diabetes mellitus is an absence of endogenous insulin.
- Insulin is produced by beta cells in the pancreas.
- The beta cells in a patient with type 1 diabetes mellitus are destroyed, so the patient has no endogenous insulin.
Question 3 : Correct Answer : 3. "Take this medication with the first bite of each meal.”
- Glucosidase is a hormone that breaks down glucose so it can be absorbed.
- Glucosidase inhibitors act in the gut and have a rapid onset.
- The patient should be instructed to take the medication with the first bite of food at each main meal. Glucosidase inhibitors do not cause hypoglycemia on their own.
Question 4: Correct Answer : 1. Glucagon
Question 5 : Correct Answer : 1. Meglitinides
Question 6 : Correct Answer : 3. Alpha- Glucosidase
Question 7 : Correct Answer : 5. Sulfonylureas
Question 8 : Correct Answer : 2. Thiazolidinediones
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