Diabetes Medications: Classes and Effects

• Comprehensive list of medications is categorized for clarity.
• Medications are broken down by class, mechanism, indications, contraindications, adverse effects, and monitoring requirements.

Biguanide/Metformin

• Increases insulin sensitivity, reduces hepatic glucose production, and increases peripheral glucose uptake.
• Indicated for type 2 diabetes mellitus.
• Should not be used in patients with renal impairment, metabolic acidosis, severe infection, or dehydration.
• Adverse effects include gastrointestinal upset and lactic acidosis.
• Monitor renal function (serum creatinine), liver function, and vitamin B12 levels.

Alpha-glucosidase Inhibitors (Acarbose, Miglitol)

• Inhibits intestinal enzymes to delay glucose absorption.
• Treats type 2 diabetes mellitus.
• Contraindicated in inflammatory bowel disease, chronic intestinal diseases, and renal impairment.
• Adverse effects: flatulence, diarrhea, and abdominal pain.
• Monitor blood glucose levels and liver function.

Sulfonylureas (1st and 2nd Generation)

• Stimulates insulin release from pancreatic β-cells.
• Indicated for type 2 diabetes mellitus.
• Should not be used in type 1 diabetes, diabetic ketoacidosis, or sulfa allergy.
• Can cause hypoglycemia and weight gain.
• Blood glucose levels should be monitored.

Thiazolidinediones (Pioglitazone, Rosiglitazone)

• Increases insulin sensitivity by activating PPAR-γ receptors.
• Indicated for type 2 diabetes mellitus.
• Should not be used in heart failure or active liver disease.
• Adverse effects include edema, weight gain, risk of fractures, and heart failure.
• Liver function, heart function, and weight should be monitored.

Dipeptidyl Peptidase-4 Inhibitors (Sitagliptin, Saxagliptin)

• Inhibits DPP-4, prolonging incretin hormone action to increase insulin release.
• Indicated for type 2 diabetes mellitus.
• Contraindicated in renal impairment (dose adjustment required).
• Potential adverse effects: headache, upper respiratory tract infections, and rare pancreatitis.
• Monitor renal function.

Meglitinides (Repaglinide, Nateglinide)

• Stimulates insulin release from pancreatic β-cells.
• Indicated for type 2 diabetes mellitus.
• Should not be used in type 1 diabetes or diabetic ketoacidosis.
• Can cause hypoglycemia and weight gain.
• Blood glucose levels should be monitored.

Levothyroxine

• Synthetic thyroid hormone, replacing deficient thyroid hormone.
• Indicated for hypothyroidism.
• Contraindicated in hyperthyroidism and acute myocardial infarction.
• Adverse effects: palpitations, weight loss, anxiety, and insomnia (in excess).
• Monitor thyroid function (TSH, Free T4) and heart rate.

Antacids (Aluminum Hydroxide, Magnesium Hydroxide, Calcium Carbonate, Sodium Bicarbonate, Magaldrate Combo)

• Neutralizes gastric acid.
• Indicated for gastroesophageal reflux disease (GERD) and peptic ulcer disease.
• Contraindicated in renal failure (in some cases).
• Adverse effects: constipation (aluminum), diarrhea (magnesium), and hypercalcemia (calcium).
• Electrolyte levels should be monitored.

Misoprostol

• Prostaglandin analog increasing mucous production and reduces acid secretion.
• Indicated for preventing NSAID-induced gastric ulcers and for labor induction.
• Contraindicated in pregnancy (causes abortion).
• Adverse effects: diarrhea, abdominal cramps, and uterine rupture.
• Monitor pregnancy status and GI symptoms.

Omeprazole

• Is a proton pump inhibitor (PPI) that inhibits gastric acid secretion.
• Used for GERD and peptic ulcers.
• Should not be used in hypersensitivity to omeprazole.
• Adverse effects include headache, diarrhea, and risk of C. difficile infection with long-term use.
• GI symptoms, calcium, and vitamin B12 levels should be monitored with long-term use.

Donepezil/Aricept

• Acetylcholinesterase inhibitor, increasing acetylcholine levels in the brain.
• Indicated for Alzheimer’s disease.
• Should not be used in hypersensitivity to donepezil.
• Adverse effects: Nausea, diarrhea, bradycardia.
• Monitor cognitive function and heart rate.

Levodopa/Carbidopa

• Levodopa converts to dopamine, carbidopa prevents its breakdown before reaching the brain.
• Indicated for Parkinson’s disease.
• Should not be used in narrow-angle glaucoma, recent MAOI use.
• Adverse effects: Dyskinesias, nausea, orthostatic hypotension.
• Motor symptoms and blood pressure should be monitored.

Levodopa

• Converts to dopamine in the brain, increasing dopamine levels.
• Indicated for Parkinson’s disease.
• Should not be used in narrow-angle glaucoma, recent MAOI use.
• Adverse effects: Dyskinesias, nausea, orthostatic hypotension.
• Motor symptoms and blood pressure should be monitored.

Amantadine

• Increases dopamine release and inhibits dopamine reuptake.
• Indicated for Parkinson’s disease and influenza A prophylaxis.
• Should not be used in severe renal impairment.
• Adverse effects: Confusion, dizziness, livedo reticularis (skin rash).
• Monitor renal function and mental status.

Galantamine

• Acetylcholinesterase inhibitor, increasing acetylcholine in the brain.
• Indicated for Alzheimer’s disease.
• Should not be used in hypersensitivity to galantamine.
• Adverse effects: Nausea, diarrhea, bradycardia.
• Monitor cognitive function and heart rate.

Rivastigmine

• Acetylcholinesterase inhibitor, increasing acetylcholine in the brain.
• Indicated for Alzheimer’s disease and Parkinson’s disease dementia.
• Should not be used in hypersensitivity to rivastigmine.
• Adverse effects: Nausea, diarrhea, bradycardia.
• Monitor cognitive function and heart rate.

Memantine

• NMDA receptor antagonist, reduces glutamate excitotoxicity.
• Indicated for moderate to severe Alzheimer’s disease.
• Should not be used in hypersensitivity to memantine.
• Adverse effects: Dizziness, confusion, headache.
• Monitor cognitive function and renal function.

Carbamazepine

• Inhibits voltage-gated sodium channels, stabilizing neuronal membranes.
• Indicated for epilepsy, bipolar disorder, trigeminal neuralgia.
• Should not be used in bone marrow suppression, hypersensitivity to carbamazepine.
• Adverse effects: Drowsiness, dizziness, hyponatremia.
• Monitor CBC, liver function, and sodium levels.

Valproate

• Inhibits voltage-gated sodium channels, increases GABA activity.
• Indicated for epilepsy, bipolar disorder.
• Should not be used in hepatic disease and urea cycle disorders.
• Adverse effects: Hepatotoxicity, pancreatitis, tremor.
• Monitor liver function, CBC, and serum valproate levels.

Phenytoin

• Inhibits voltage-gated sodium channels, stabilizing neuronal membranes.
• Indicated for epilepsy and status epilepticus.
• Should not be used in hypersensitivity to phenytoin and bradycardia.
• Adverse effects: Gingival hyperplasia, ataxia, and rash.
• Monitor serum phenytoin levels and liver function.

Laxative Classes

• Bulk-forming (e.g., Psyllium): absorbs water into the stool, making it easier to pass, indicated for constipation, contraindicated in intestinal obstruction, adverse effects include bloating and abdominal cramping, monitor bowel movement frequency.
• Surfactant (e.g., Docusate): increases water absorption in the stool, indicated for constipation, contraindicated in intestinal obstruction, adverse effects include abdominal cramping and diarrhea, monitor bowel movement frequency.
• Stimulant (e.g., Bisacodyl, Senna): stimulates peristalsis and water secretion into the intestines, indicated for acute constipation, contraindicated in intestinal obstruction and abdominal pain, adverse effects include abdominal cramping and diarrhea, monitor bowel movement frequency.
• Osmotic (e.g., Lactulose, PEG): draws water into the bowel, increasing stool water content, indicated for constipation and hepatic encephalopathy, contraindicated in intestinal obstruction, adverse effects include bloating and diarrhea, monitor bowel movement frequency and electrolytes.

Oxybutynin

• Is anticholinergic, inhibiting bladder muscle contractions.
• Indicated for overactive bladder.
• Should not be used in glaucoma and urinary retention.
• Adverse effects: dry mouth, constipation, dizziness.
• Monitor urinary symptoms and mental status.

Ethinyl Estradiol/Norethindrone

• Combination of estrogen and progestin, inhibits ovulation.
• Indicated for contraception and menstrual regulation.
• Should not be used in history of blood clots and breast cancer.
• Adverse effects: Nausea, weight gain, mood changes.
• Monitor blood pressure and menstrual cycle.

Norethindrone (Mini-Pills)

• Progestin-only contraception, prevents ovulation.
• Indicated for contraception.
• Should not be used in history of blood clots and liver disease.
• Adverse effects: Spotting, headache, mood changes.
• Monitor blood pressure and menstrual cycle.

Sildenafil

• Phosphodiesterase-5 inhibitor, increasing blood flow to the penis.
• Indicated for erectile dysfunction, and pulmonary hypertension.
• Should not be used with nitrates.
• Adverse effects: Headache, flushing, visual disturbances.
• Monitor blood pressure and cardiac symptoms.

Finasteride

• 5-alpha-reductase inhibitor, reduces dihydrotestosterone levels.
• Indicated for benign prostatic hyperplasia and male pattern baldness.
• Contraindicated in pregnancy (teratogenic).
• Adverse effects: Decreased libido and erectile dysfunction.
• Monitor prostate-specific antigen (PSA) levels.