Diabetes Medications: A Complete PTCB Review
Review all major diabetes drug classes including metformin, sulfonylureas, GLP-1 agonists, SGLT2 inhibitors, and insulin for the PTCE exam.
Diabetes Drug Classes for the PTCE
Diabetes is one of the most common chronic conditions, and its medications span multiple drug classes with different mechanisms. The PTCE expects you to know the major classes, representative drugs, mechanisms of action, and key counseling points.
Biguanides
Metformin (Glucophage) is the first-line drug for type 2 diabetes. It decreases hepatic glucose production and increases insulin sensitivity. Key points: Does not cause hypoglycemia when used alone. GI side effects (nausea, diarrhea) are common initially. Rare but serious risk of lactic acidosis. Hold before contrast dye procedures. Contraindicated in severe renal impairment.
Sulfonylureas
Examples: glipizide (Glucotrol), glyburide (DiaBeta), glimepiride (Amaryl). Mechanism: Stimulate insulin release from the pancreas. Key risk: hypoglycemia, especially in elderly and renal impairment. Glyburide has the highest hypoglycemia risk. Take 30 minutes before meals.
GLP-1 Receptor Agonists
Examples: semaglutide (Ozempic, Rybelsus), liraglutide (Victoza), dulaglutide (Trulicity), exenatide (Byetta, Bydureon). Mechanism: Mimic incretin hormones to increase insulin secretion and slow gastric emptying. Benefits: Weight loss, cardiovascular benefit. Side effects: Nausea, vomiting. Black box warning for medullary thyroid carcinoma risk. Most are subcutaneous injections; Rybelsus is an oral formulation taken on an empty stomach with a sip of water.
SGLT2 Inhibitors (-gliflozin)
Examples: empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana). Mechanism: Block glucose reabsorption in the kidneys, causing glucosuria. Benefits: Weight loss, cardiovascular and renal benefits. Risks: UTIs, genital yeast infections, diabetic ketoacidosis (rare), dehydration.
DPP-4 Inhibitors (-gliptin)
Examples: sitagliptin (Januvia), linagliptin (Tradjenta), saxagliptin (Onglyza). Mechanism: Inhibit DPP-4 enzyme, prolonging incretin action. Generally well tolerated. Weight neutral. Low hypoglycemia risk.
Diabetes pharmacology is high-yield for the PTCE. Review with PTCB flashcards organized by drug class.
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