Oral Antidiabetics on the NCLEX
Metformin, sulfonylureas, SGLT2 inhibitors, GLP-1 agonists, DPP-4 inhibitors, class by class.
Multiple classes of oral diabetes meds with different mechanisms. The NCLEX tests metformin lactic acidosis, sulfonylurea hypoglycemia, and SGLT2/GLP-1 cardio-renal benefits.
Metformin (biguanide)
First-line T2DM. Decreases hepatic glucose production. Lactic acidosis risk, hold for contrast studies (48h before and after) and in renal impairment (CrCl <30). GI side effects common; titrate slowly. Doesn't cause hypoglycemia alone.
Sulfonylureas (-ide)
Glipizide, glyburide, glimepiride. Stimulate pancreatic insulin release. Hypoglycemia risk. Avoid glyburide in elderly (longer half-life, prolonged hypoglycemia).
SGLT2 inhibitors (-flozin)
Empagliflozin, dapagliflozin, canagliflozin. Block glucose reabsorption in kidney. Cardio-renal benefits (HF, CKD). Side effects: UTI, genital infections, euglycemic DKA.
GLP-1 agonists
Semaglutide (Ozempic, Wegovy), liraglutide, dulaglutide, tirzepatide. SQ injection (oral semaglutide exists). Weight loss benefit. Cardio benefits. Side effects: nausea, pancreatitis risk.
DPP-4 inhibitors (-gliptin)
Sitagliptin, linagliptin. Modest A1c reduction. Generally well-tolerated. Pancreatitis risk.
Frequently asked
Metformin and contrast?
Hold 48 hours before and after iodinated contrast. Resume after renal function confirmed stable.
Best class for HF?
SGLT2 inhibitors, proven mortality benefit in HFrEF and HFpEF.
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