Patho/Pharm - Antidiabetic Agents (Study cards) Test 3

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Patho/Pharm - Antidiabetic Agents (Study cards) Test 3
2012-04-14 15:58:22
Patho Pharm Antidiabetic Agents Test study cards

Patho/Pharm - Antidiabetic Agents (Study Cards) Test 3
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  1. Treatment for DM:
    Type 1:

    insulin therapy

    Type 2:
    lifestyle changes
    oral drug therapy
    insulin when above no longer provies glycemic control
  2. Types of antidiabetic drugs:
    Oral hypoglycemic agents
    Goal: normal or correct BG levels
  3. Oral Antidiabetic Drugs:
    used for type 2
    lifestyle changes: diet, exerices, smoking cessation,

    oral antidiabetic drugs may NOT be effective unless the patient makes behavioral or lifestyle changes
  4. Indications:
    used alone or in combination with other dugs and/or diet and lifestyle changes to lower blood glucose levels in patients with type 2
  5. Oral Antidiabetic Drugs:
    -Most used

    First generation:
    -Diabinase (chlorpropamide)
    -Tonilase (tolazamide)
    -Orinase (tolbutamide)

    Second generation:Amaryl (glimepiride)
    -Glucotrol (glipizide)
    -Diabeta (glyburide)

    -Repaglinide (Prandin)
    -Nateglinide (Starlix)

    -Metformin (Glucophage)

    -Pioglitazone (Actos)
    -Rosiglitazone (Avandia)
    -Also known as “glitazones”

    Alpha-glucosidase inhibitors:
    Acarbose (Precose)
    Miglitol (Glyset)
  6. Mechanism of action
    -Stimulate insulin secretion from beta cells of pancreas
    -Beta cell function must be present for these drugs to -work
    -Improve sensitivity to insulin in tissues
    -Result: Lower blood glucose levels
    -First-generation drugs not frequently used

    -Action similar to sulfonylureas
    -Increase insulin secretion from pancreas *most effective within one hour of taking

    -Decrease production of glucose
    -Increase uptake of glucose by tissues
    -Does NOT increase insulin secretion from pancreas (does not cause hypoglycemia)

    -Decrease insulin resistance
    -Are known as “insulin sensitizing drugs”
    -Increase glucose uptake and use in skeletal muscle
    -Inhibit glucose and triglyceride production in liver

    Alpha-glucosidase inhibitors:
    -Reversibly inhibit the enzyme “alpha-glucosidase” in small intestine
    -Result: Delayed absorption of glucose
    -Must be taken with meals to prevent excessive postprandial (post meals) blood glucose elevations (with the “first bite” of a meal)
  7. Sulfonylureas -- 2nd generation: Glipizide (Glucotrol), Glimepiride (Amaryl):
    Onset of action: 1- 1 1/2 hours
    Peak: 1-3 hours
    Half life: 2 -4 hours
    Duration: 10-24 hour

    Meglitinide (Prandin):
    Onset of action : 30 minutes
    Peak: 1- 1 ½ hours
    Duration: < 4 hours
    Half-life: 1 hour

    Biguanides (metformin):
    Onset of action:
    Peak: 1–3 hours
    Half-life: 1 ½ - 5 hours
    Duration: 6-20 hours

    Thiazolidinediones (pioglitazone, actos):
    Maximal reduction in blood glucose after 12 weeks
    Half-life: 3-7 hours
    Duration: 16-24 hours

    Alpha-glucosidase inhibitor:
    Peak: 1 hour
    Half –life: 2 hours
  8. Adverse Side Effects:
    -Hypoglycemia, hematologic effects, nausea, epigastric fullness, heartburn, many others

    -Headache, hypoglycemic effects, dizziness, weight gain, joint pain, URI or flu-like symptoms

    Biguanides (Metformin):
    -Primarily affects GI tract: abdominal bloating/fullness, nausea, cramping, diarrhea
    -May also cause metallic taste, reduced vitamin B12 levels (form of pernicious anemia)
    -Lactic acidosis is rare, but lethal if it occurs
    -Does NOT cause hypoglycemia

    -Moderate weight gain, edema, mild anemia
    -Hepatic toxicity – monitor ALT levels closely

    Alpha-glucosidase inhibitors:
    -Flatulence, diarrhea, abdominal pain
    -Do NOT cause hypoglycemia, hyperinsulinemia, or weight gain
  9. Interactions: (ppt only shows sulfonylureas)
    -Hypoglycemic effect increases when taken with alcohol, anabolic steroids, and many other drugs
    -Adrenergics, corticosteroids, & thiazides may reduce hypoglycemic effects
    -Allergic cross-sensitivity may occur with loop diuretics & sulfonamide antibiotics
    -May interact with alcohol
  10. Insulins:
    -Function as substitute for the endogenous form
    -Effects are same as normal endogenous insulin
    -Restores diabetic patient’s ability to:
    -Metabolize carbohydrates, fats & proteins
    -Store glucose in liver
    -Convert glycogen to fat stores
    -Derived from porcine or beef sources
    -Most are human-derived, using recombinant DNA technologies
    -GOAL: Tight glucose control
    -To reduce the incidence of long-term complications
  11. Human-Based Insulins:
    -Insulin aspart (Novolog)
    -Insulin lispro (Humalog)
    -Insulin glulisine (Apidra)
    -All may be given SC or via continuous SC infusion pump (NOT IV)
    ---Onset of action: 5 to 15 minute
    ---Peak: 1-2 hours
    ---Half Life: 80 minutes
    ---Duration : 3-5 hours
    ---Shorter duration

    -Regular insulin (Humulin R, Novolin R)
    -Is the ONLY insulin product that can be given by IV bolus, continuous IV infusion
    ---Onset of action: 30 to 60 minutes
    ---Peak 2-5 hours
    ---Half life: unknown
    ---Duration: 6-10 hours

    -Isophane insulin suspension (also called NPH) (Humulin N, Novolin N)
    -Insulin zinc suspension (also called Lente) (Humulin L, Novolin L)
    -Both have a cloudy appearanceSlower in onset and more prolonged duration of action than endogenous insulin
    ---Onset of action: 1-2 hours
    ---Peak: 4-8 hours
    ---Half life : Unknown
    ---Duration: 10-18 hours

    -Glargine (Lantus)
    ----Dosed: once a day or twice a day
    ----Slowly absorbed
    ----Clear, colorless solution
    -Extended insulin zinc suspension (Ultralente, Humulin U)
    ----White, opaque solution

    Combination Insulin Products:
    -NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30)
    -NPH 50% and regular insulin 50% (Humulin 50/50)
    -Insulin lispro protamine suspension 75% and insulin lispro 25% (Humalog Mix 75/25)
    ---Onset of action: 1-2 hours
    ---Peak: none
    ---Half-life: unknown
    ---Duration: 24 hours
  12. Sliding-Scale Dosing
    -Sliding Scale short-acting (Lispro) or regular insulin doses adjusted according to blood glucose test results
    -Typically used in hospitalized diabetic patients, or in patients on TPN or enteral tube feedings
    -SC insulin is ordered in an amount that increases as the blood glucose increases
    2 units for glucose value: 141-199mg/dl
    4 units for glucose value 200-249 mg/dl
    6 units for glucose value 250-299mg/dl
    8 units for a glucose value of 300 mg/dl Greater than 300 call the physician
  13. Other Diabetic Drugs
    Amylin Mimetic: Pramlintide (Symlin)
    -Mimics the natural hormone amylin (important for glucose metabolism)
    -Slows gastric emptying
    -Suppressed glucagon secretion, reducing hepatic glucose output
    -Centrally modulates appetite & satiety
    -Used when other drugs have not achieved adequate glucose control

    Incretin Mimetic: Exenatide (Byetta)
    -Mimics the incretin hormones
    -Enhances glucose-driven insulin secretion from beta cells of pancreas
    -ONLY used for Type 2 diabetes
    -Given with injection pen device

    Inhaled insulin: Exubera
  14. Hypoglycemia
    -Abnormally low blood glucose level (below 50 mg/dl)
    -Mild cases treated with diet – higher intake of protein & lower intake of carbs (to prevent rebound postprandial hypoglycemia)
  15. Glucose-Elevating Drugs
    -Oral forms of concentrated glucose
    --Buccal tablets, semisolid gel
    -50% dextrose in water (D50W)
  16. Nursing Implications
    -Before giving any drugs that alter glucose levels, obtain & document:
    -Thorough history
    -Vital signs
    -Blood glucose level, HbA1c level
    -Potential complications & drug interactions
    -Before giving any drugs that alter glucose levels:
    -Assess the patient’s ability to consume food
    -Assess for nausea or vomiting
    -Hypoglycemia will be a problem if antidiabetic drugs are given & patient does not eat
    -If patient is NPO for a test or procedure, consult physician to clarify orders for antidiabetic drug therapy
    -Keep in mind that overall concerns for any diabetic patient increase when the patient:
    -Is under stress
    -Has an infection
    -Has an illness or trauma
    -Is pregnant or lactating
    -Thorough patient education is ESSENTIAL regarding:
    -Disease process
    -Diet and exercise recommendations
    -Self-administration of insulin or oral drugs
    -Potential complications
    -Insulin order and prepared dosages should be second-checked with another nurse
    -When insulin is ordered, ensure:
    -Correct route
    -Correct type of insulin
    -Correct Time and timing
    -Correct dosage : in Units!
    -Correct Patient

    -Check blood glucose level BEFORE giving insulin
    -Roll vials between hands instead of shaking them to mix suspensions
    -Ensure correct storage of insulins
    -ONLY insulin syringes, calibrated in units, should be used to measure & give insulin
    -When drawing up two types of insulin in one syringe, always withdraw the regular or rapid-acting insulin FIRST
    -Provide thorough patient education regarding self-administration of insulin injections, including timing of doses, monitoring blood glucoses, & rotating injection sites

    Oral antidiabetic drugs:
    -Always check blood glucose levels BEFORE giving
    -Usually given 30 minutes before meals
    -Alpha-glucosidase inhibitors are given with the first bite of each main meal
    -Metformin is taken with meals to reduce GI effects

    -Always assess for signs of hypoglycemia after giving an antidiabetic drug
    -If hypoglycemia occurs:
    -Give glucagon OR
    -Have patient eat glucose tablets or gel, corn syrup, honey, fruit juice, or non diet soft drink OR
    -Have patient eat small snack such as crackers of half a sandwich
    -Monitor blood glucose level AFTER treating per Protocol
    -Monitor for therapeutic response
    -Measure Hemoglobin A1c (HgbA1c) to monitor long-term compliance with diet and drug therapy
    -Watch for hypoglycemia & hyperglycemia – as the nurse, you need to be able to distinguish between each!!