Medications for Diabetes Mellitus (Chapter 49)
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Sulfonylureas: Mechanism of Action
To increase insulin production from the pancreas. Therefore, hypoglycemia is the major side effect with sulfonylureas.
What medications fall into the sulfonylureas class?
- glipizide (Glucotrol, Glucotrol XL)
- glyburide (Micronase, DiaBeta, Glynase PresTab)
- glimepiride (Amaryl)
Meglitinides: Mechanism of Action
Increase insulin production from the pancreas. However, unlike sulfonylureas, they are less likely to cause hypoglycemia. When taken before meals, pancreatic insulin production increases during and after the meal, mimicking the normal blood glucose response to eating (should be taken 30 minutes prior to eating).
What medications fall into the Meglitinides class?
- repaglinide (Prandin)
- nateglinide (Starlix)
Biguanide: Mechanism of Action
Reduces glucose production by the liver. It also enhances insulin sensitivity at the tissue level and improves glucose transport into the cells.
What medications fall into the biguanide class?
metformin ( Glucophage, Glucophage XR, Riomet, Fortamet, Glumetza)
What should nurses be aware of when they are administering biguanides to their diabetic patients?
Do not use in patients with kidney disease, liver disease, or heart failure.
Do not use in people who drink excessive amounts of alcohol
_____ is the first-choice drug for most people with type 2 diabetes mellitus.
a-Glucosidase Inhibitors: Mechanism of Action
Also known as Starch Blockers. Work by slowing down the absorption of carbohydrates in the small intestine. Taken with the first bite of each meal, they are the most effective in lowering post-prandial blood glucose. Effectiveness of these medications is measured by checking 2-hour postprandial glucose levels.
Thiazolidinediones: Mechanism of Action
Sometimes referred to as "insulin sensitizers". They are the most effective for the people who have insulin resistance. They improve insulin sensitivity, transport, and utilization at target tissues. Because they do not increase insulin production, they will not cause hypoglycemia when used alone.
What should the nurse be aware of when administering rosiglitazone (Avandia), a Thiazolidinedione?
- Increased risk of myocardial infarction and stroke
- Do not use in patients with heart failure
Dipeptidyl Peptidase-4 (DPP-4) Inhibitor: Mechanism of Action
Endogenous dipeptyl peptidase-4 normally inactivates the incretin hormones that increase insulin synthesis and decrease glucose production. DPP-4 Inhibitors slow the inactivation of incretin hormones. Since the DPP-4 inhibitors are glucose dependent, they lower the potential for hypoglycemia.
Incretin Mimetic: Mechanism of Action
Simulates one of the incretin hormones (Glucagon-like-peptide-1) found to be decreased in people with type 2 diabetes. Stimulates the release of insulin from the pancreatic B-Cells. 1) Suppression from the pancreatic B-cells, which reduces glucose output from the liver, 2) Reduction of food intake by increasing satietym thereby reducing caloric intake, and 3) slowing gastric emptying. It is NOT indicated for use with insulin.
Amylin Analog: Mechanism of Action
- Amylin is a hormone normally co-secreted with insulin by the pancreas in response to food intake. It is indicated for type 1 diabetes and type 2 diabetics who have not achieved glucose control despite taking insulin at mealtimes. It is an adjunct to therapy, not a replacement for it. When taking concurrently with insulin, it provides for better glucose control. Works by 3 mechanisms: 1) slows gastric emptying, 2) reduces postprandial glucagon secretion, 3) increases satiety, thereby leading to decreased caloric intake.
- *It is administered subcutaneously into the thigh or abdomen. It cannot be injected into the arm because absorption from this site is too variable. It CANNOT be mixed with insulin.
What should the nurse be aware of when administering pramlintide (Symlin) ( an Amlyn analog) to a patient with diabetes?
Can cause severe hypoglycemia when used with insulin.
_____ can mask the symptoms of hypoglycemia and prolong the hypoglycemic effects of insulin.
_____ and _____ can potentiate hyperglycemia by inducing potassium loss.
Thiazide and loop diuretics
What medications fall into the a-Glucosidase Inhibitors class?
- arcabose (Precose)
- miglitol (Glyset)
What medications fall into the Thiazolidinedione's class?
- pioglitazone (Actos)
- rosiglitazone (Avandia)
What medications fall into the Dipeptyl Peptidase-4 (DPP-4) Inhibitor's class?
- sitagliptin (Januvia)
- saxagliptin (Onglyza)
What medications fall into the Incretin Mimetic class?
- exanatide (Byetta)
- liraglutide (Victoza)
What medications fall into the Amylin Analog class?
What are the side effects of sulfonylureas medications?
Weight gain, hypoglycemia
What are the side effects of Meglitinide medications?
Weight gain, Hypoglycemia
What are the side effects of the Biguanides?
Diarrhea, lactic acidosis; Needs to be held 1-2 days before IV contrast media given and for 48 hours after.
What are the side effects of a-Glucosidase Inhibitors?
Gas, Abdominal Pain, Diarrhea
What are the side effects of Thiazolidinediones?
Weight gain, edema; Increased risk for cardiovascular events such as myocardial infarction and stroke.
What are the side effects of DPP-4 Inhibitors?
Upper respiratory tract infection, sore throat, headache, urinary tract infection, diarrhea
What are the side effects of the Incretin Mimetics?
Nausea, vomiting, hypoglycemia, diarrhea, headache
What are the side effects of the Amlyn Analogs?
Hypoglycemia, nausea, vomiting, decreased appetite, headache.
What insulins are rapid acting?
- lispro (Humalog)
- aspart (Novolog)
- glulisine (Apidra)
What insulins are short acting?
Regular (Humulin R, Novolin R, ReliOn R)
What insulins are immediate acting?
NPH (Humulin N, Novolin N, ReliOn N)
What insulins are long-acting?
- glargine (Lantus)
- detemir (Levemir)
Onset, peak, and duration of rapid acting insulin?
- Onset: 15 min
- Peak: 60-90 min
- Duration: 3-4 hours
Onset, peak, and duration of short-acting insulin?
- Onset: 1/2 to 1 hour
- Peak: 2-3 hours
- Duration: 3-6 hours
Onset, peak, and duration of intermediate- acting insulin?
- Onset: 2-4 hr
- Peak: 4-10 hr
- Duration: 10-16 hr
Onset, peak, and duration of long- acting insulin?
- Onset: 1-2 hr
- Peak: no pronounced peak
- Duration: 24+ hr
Which general categories of insulin are clear?
What general categories of insulin are cloudy?
- Intermediate-acting insulin
- Combination Therapy (premixed)
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