Antidiabetic Drugs Flashcards
Subcutaneous antidiabetic drugs
– Insulin
– Incretin Mimetics SC
Oral antidiabetic drugs
– Biguanide – Sulfonylureas – Glinides – Thiazolidinediones – a – Glucosidase Inhibitors – Dipeptidyl Peptidase 4 (DPP-4) Inhibitors – Sodium-Glucose Cotransporter 2 Inhibitors – Numerous combination oral agents
Biguanide Classification
One drug in this class – metformin (Glucophage, Glumetza) – most commonly used drug to treat Type 2 DM; first line treatment
Biguanide Movement
onset 8h, peak 1-3h, 1/2life 1.5-5h, duration 24h; excreted by kidneys
Biguanide Action
decreases hepatic glucose production, decreases intestinal glucose absorption,
improves insulin receptor sensitivity
Biguanide Nursing Considerations
not for use in children; contraindications kidney disease/dysfunction, alcoholism,
metabolic acidosis, liver disease, heart failure and other condition that can cause lactic
acidosis; adverse effects – GI upset, bloating, nausea, diarrhea; held with procedures
using contrast
Biguanide Indication
Type 2 DM (Also Pre-diabetes/IFG, PCOS)
Biguanide Administration
PO, with meals; 500-850 mg PO BID to TID
Sulfonylureas Classification
oldest drug – most current used is second generation – gliclazide (Diamicron) and glyburide (Diabeta)
Sulfonylureas Movement
onset 1h, peak 6h, ½ life 10h, duration 4-6h
Sulfonylureas Action
bind to receptors on B cells and stimulate the release of insulin; the patinet
must still have functioning B cells in the pancreas (once insulin started these drugs
are stopped)
Sulfonylureas Nursing Considerations
bind to receptors on B cells and stimulate the release of insulin; the patinet
must still have functioning B cells in the pancreas (once insulin started these drugs
are stopped)
Sulfonylureas Indication
Type 2 DM
Sulfonylureas Administration
PO – IR and LR formulations, doses vary
Glinides Classification
repaglinide (GlucoNorm) and nateglinide (Starlix)
Glinides Movement
onset 15-60min, peak 1-3H, ½ life 1.5-5H, duration 24H
Glinides Action
similar to sulfonylureas – also increase insulin secretion from the pancreas -but
shorter duration of action
Glinides Nursing Considerations
contraindications similar to sulfonylureas; adverse effects – hypoglycemia, weight gain
Glinides Indication
Type 2 DM – esp. those with high post prandial sugars; cannot be given with
sulfonylureas; can be given with metformin and thiazolidinedione
Glinides Administration
give with meals PO doses vary
thiazolidinedione (glitazones) Classification
Rosiglitazone ( Avandia), Pioglitazone (Actos)
thiazolidinedione (glitazones) Movement
onset delayed, peak 2H, ½ life 3-7H, duration unknown
thiazolidinedione (glitazones) Action
Regulate genes involved in glucose and lipid metabolism – decrease insulin
resistance by enhancing sensitivity of insulin receptors; directly stimulate peripheral
glucose uptake and storage and inhibit glucose and triglyceride production in the liver; thought to preserve B cell function and slow disease progression of Type 2 DM
thiazolidinedione (glitazones) Nursing Considerations
Rosiglitazone associated with increased CV risk and therefore contraindicated with
advanced HF, caution with renal and liver impairment; adverse effect – edema and
weight gain, reduced bone density and increase # risk
thiazolidinedione (glitazones) Indication
Type 2 DM
thiazolidinedione (glitazones) Administration
slow onset of activity – several weeks; 15-45 mg PO daily
A – Glucosidase Inhibitors Classification
Acarbose (Glucobay) used less commonly
A – Glucosidase Inhibitors Movement
onset 1-1.5H, peak 2H, ½ life 2-3H, duration unknown
A – Glucosidase Inhibitors Action
inhibits the enzyme a-glucosidase (small intestine) that is responsible for the
hydrolysis to oligosaccharides and disaccharides to glucose; the blocking of this enzyme delays glucose absorption; prevent postprandial glucose elevations
A – Glucosidase Inhibitors Nursing Considerations
contraindications: - IBD, malabsorption syndromes or intestinal obstruction;
adverse effects: - ++ flatulence, diarrhea and abdominal pain; hypoglycemia must be
treated with IV or PO glucose as CHOs are blocked
A – Glucosidase Inhibitors Indication
Type 2 DM
A – Glucosidase Inhibitors Administration
with first bite of food, 50-100 mg PO TID
Dipeptidyl 4 (DPP-4) Inhibitors Classification
sitagliptin (Januvia), alogliptin (Nesina), saxagliptin (Onglyza), linagliptin
(Tradjenta) – also available in combination with Metformin
Dipeptidyl 4 (DPP-4) Inhibitors Movement
onset 15-30min, peak 1H, ½ life 12 H, duration unknown
Dipeptidyl 4 (DPP-4) Inhibitors Action
delay the breakdown of incretin hormones by inhibiting DPP-4; incretin is released
at a basal rate with further bolus after meals; incretin increases insulin synthesis and lowers glucagon secretion; inhibition reduces fasting and postprandial sugars
Dipeptidyl 4 (DPP-4) Inhibitors Nursing Considerations
contradiction – allergy;
adverse effects – URTI, headache, diarrhea; hypoglycemia
esp. in combination with a sulfonylurea; pancreatitis;
Dipeptidyl 4 (DPP-4) Inhibitors Indication
Type 2 DM
Dipeptidyl 4 (DPP-4) Inhibitors Administration
PO, daily administration, with or without food; doses vary
Sodium-Glucose Cotransporter 2 Inhibitor Classification
canagliflozin (Invokana), dapagliflozin (Forxiga)
Sodium-Glucose Cotransporter 2 Inhibitor Movement
slide empty :(
Sodium-Glucose Cotransporter 2 Inhibitor Action
block reabsorption of glucose in kidney via the sodium-glucose cotransporter –
result – decrease plasma glucose – weight loss, decreased SBP, increased HDL and
LDL
Sodium-Glucose Cotransporter 2 Inhibitor Nursing Considerations
Contraindications – allergy, kidney disease; vaginal yeast infection and UTI d/t
increase glycosuria; diarrhea, constipation, nausea; osmotic diuresis causes symptoms of dehydration – hypotension, dizziness, syncope; hyperkalemia
Sodium-Glucose Cotransporter 2 Inhibitor Indication
Type 2 DM - adjunct to use of other oral agents; monotherapy for Metformin
intolerant
Sodium-Glucose Cotransporter 2 Inhibitor Administration
PO, AC BF, doses vary
Incretin Mimetics Classification
albiglutide (Eperzan), dulaglutide (Trulicity), exenatide (Byetta), liraglutide
(Victoza)
Incretin Mimetics Movement
slide is empty on this one. Keep up the good work. You’ll do great.
Incretin Mimetics Action
enhance insulin secretion, suppress elevated glucagon secretion, slow gastric
emptying
Incretin Mimetics Nursing Considerations
contraindications – allergy, ESRD, severe kidney failure; adverse effects – nausea, vomiting, diarrhea; rapid weight loss up to 1.5 hg/week.
Incretin Mimetics Indication
Type 2 DM
Incretin Mimetics Administration
SC q weekly, prefilled syringe or pen, dose varies
