Anti-diabetic, gastrointestinal, deficiency anemia, hematopoietic agents Flashcards
Manifestations of Diabetes Mellitus
poydipsia, polyphagia, polyuria (more common in type 1) type 2 may be more asymptomatic initially
Complications of diabetes mellitus
vascular injuries found in the eye, kidney, brain, heart, extremities, and neuropathy
Diagnostics for diabetes mellitus
HA1C q3 months for pt with diabetes, FPG (fasting plasma glucose)
Rapid acting insulin
Novolog, Humalog, Apidra
Short acting (regular) insulin
Novolin R, Humulin R
Intermediate acting (NPH)
Novolin N, Humulin N
Long acting insulin
Lantus, Levemir
Metformin (Glucophage) class and indications
Biguanide class oral antidiabetic (first line)
lowers glucose but does not stimulate insulin release indicated for Type 2 and gestational DM
Adverse effects of Metformin (Glucophage)
N/D, decreased appetite, toxicity related lactic acidosis, decreased B12 and folic acid absorption
Nursing considerations Metformin (Glucophage)
LA signs, monitor renal, stop for contrast CT and for admission, B12 and folic acid supplement, potential for weight loss
Metformin (Glucophage) MOA
Sensitizes insulin receptors in target tissues, inhibits gastric glucose reabsorption, inhibits hepatic gluconeogenesis
Glipizide (Glucotrol) class and indication
Sulfonylurea class, Type 2 DM
Glipizide (Glucotrol) MOA
stimulates pancreatic insulin release by binding with and blocking ATP-sensitive potassium channels in the cell membrane to cause depolarization
Adverse effects Glipizide (Glucotrol)
hypoglycemia (more likely with kidney and or liver dysfunction), rare SJS/TENS and CV toxicity
Nursing considerations Glipizide (Glucotrol)
monitor for hypoglycemia, contraindicated for pregnant or breastfeeding, avoid alcohol, beta blockers can diminish benefits of sulfonylurea (glipizide)
Pioglitazone (Actos) class and indication
Thiazolidinediones class, Type 2 DM
MOA Pioglitazone (Actos)
activates PPAR gamma to turn on insulin-responsive genes that are responsible for carp and lipid metabolism
Adverse effects Pioglitazone (Actos)
HF 2/2 fluid retention, ovulation in premenopausal women, increased risk of fractures in women, bladder cancer
Nursing considerations Pioglitazone (Actos)
monitor and educate ab HF s/s, assess GU history, interactions with CYP2C* inhibitors (atorvastatin, ketoconazole, rifampin, cimetidine)
Acarbose (Precose) class and Indications
Alpha-glucosidase inhibitor, Type 2 DM
Acarbose (Precose) MOA
delays absorption of dietary carbohydrates to reduce postprandial hyperglycemia by inhibiting glucosidase that is needed for complex carb catabolism
Acarbose (Precose) adverse effects
GI, liver dysfunction, anemia b/c of decreased absorption of Fe (iron)
Acarbose (Precose) nursing considerations
hypoglycemia if used with insulin or sulfonylurea, monitor LFT and s/s liver dysfunction
Canagliflozin (Invokana) class and indication
Sodium-glucose Co-transporter 2 (SGLT-2) inhibitor, Type 2 DM
Canagliflozin (Invokana) MOA
Inhibits SGLT-2 to block receptor reabsorption of filtered glucose, leading to glucosuria
Sitagliptin (Januvia) class and indications
Dipeptidyl peptidase-4 (DPP-4) inhibitor, Type 2 DM (usually adjunct with metformin)
Sitagliptin (Januvia) MOA
enhances actions of incretin hormones to stimulate glucose-dependent release of insulin and suppress postprandial release of glucagon by inhibiting DPP-4
Semaglutide (Ozempic/Wegovy) class and indication
Glucagon-like peptide-1 (GLP-1) class SQ injectiable, Type 2 DM (can be used w/ozempic with CV benefits or chronic weight management as Wegovy)
MOA Semaglutide (Ozempic/Wegovy)
activates GLP-1 receptors to cause same effects as endogenous incretins (slow gastric emptying, stimulate release of insulin, inhibit postprandial glucagon release, suppress appetite)
Adverse effects Semaglutide (Ozempic/Wegovy)
N/V/D, increased risk of pancreatitis and renal impairment/AKI, hypersensitivity reaction, possible MTC (medullary thyroid carcinoma)
Tirzepatide (Monjaro) class and indication
Glucose-dependent insulinotropic (GIP) & glucagon-like peptide-1 (GLP-1) class SQ injection, Type 2 DM
Tirzepatide (Monjaro) MOA
GLP-1 agonist effects, acts as agonist at GIP receptors to produce similar effects
Tirzepatide (Monjaro) adverse effects
GI (N/V/D), constipation, abdominal pain, increase risk pancreatitis, renal impairment/AKI, hypersensitivity, possible MTC (medullary thyroid carcinoma)
Glargine (Lantus) indication, class
Long acting once or twice daily insulin
Stimulates glucose, amino acids, nucleotides, and K
Basal glycemic control in Type 1 & 2 DM
SQ NEVER IV
Adverse effects Glargine (Lantus)
hypoglycemia, hypokalemia, lipohypertrophy
Nursing considerations Glargine (Lantus)
baseline labs and monitor glucose, rotate injection site, Clear medication (throw out and don’t use if cloudy), **usually admin HS but can be twice
Glulisine (Apidra) indication and MOA
Rapid acting insulin that stimulates uptake of glucose, amino acids, nucleotides, and K+
Postprandial glycemic control in Type 1 & 2 DM
Glulisine (Apidra) adverse effects
hypoglycemia, hypokalemia, lipohypertrophy
Nursing considerations Glulisine (Apidra)
baseline labs and monitor glucose, rotate injections, clear medication (cloudy throw out), **administered AC (before meals) and PC (after meals)
Regular (Humulin R/Novolin R) indication and action
Short acting insulin stimulates uptake of glucose, amino acids, nucleotides, and K+
Postprandial glycemic control via SQ injection or basal glycemic control via SQ infusion in type 1 & 2 DM
Regular (Humulin R/Novolin R) adverse effects
hypoglycemia, hypokalemia, lipohypertrophy
Regular (Humulin R/Novolin R) nursing considerations
baseline labs and monitor glucose, rotate injection site, clear medication (throw out if cloudy), **administer 20-30 minutes AC (before meals)
