Antidiabetic Drugs Flashcards by Lindsay de Carvalho

Subcutaneous antidiabetic drugs

– Insulin

– Incretin Mimetics SC

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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

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Biguanide Classification

One drug in this class – metformin (Glucophage, Glumetza) – most commonly used drug to treat Type 2 DM; first line treatment

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Biguanide Movement

onset 8h, peak 1-3h, 1/2life 1.5-5h, duration 24h; excreted by kidneys

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Biguanide Action

decreases hepatic glucose production, decreases intestinal glucose absorption,
improves insulin receptor sensitivity

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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

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Biguanide Indication

Type 2 DM (Also Pre-diabetes/IFG, PCOS)

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Biguanide Administration

PO, with meals; 500-850 mg PO BID to TID

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Sulfonylureas Classification

oldest	drug	– most	current	used	is	second	generation	– gliclazide (Diamicron)	
and	glyburide	(Diabeta)

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Sulfonylureas Movement

onset 1h, peak 6h, ½ life 10h, duration 4-6h

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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)

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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)

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Sulfonylureas Indication

Type 2 DM

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Sulfonylureas Administration

PO – IR and LR formulations, doses vary

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Glinides Classification

repaglinide (GlucoNorm) and nateglinide (Starlix)

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Glinides Movement

onset 15-60min, peak 1-3H, ½ life 1.5-5H, duration 24H

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Glinides Action

similar to sulfonylureas – also increase insulin secretion from the pancreas -but
shorter duration of action

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Glinides Nursing Considerations

contraindications similar to sulfonylureas; adverse effects – hypoglycemia, weight gain

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Glinides Indication

Type 2 DM – esp. those with high post prandial sugars; cannot be given with
sulfonylureas; can be given with metformin and thiazolidinedione

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Glinides Administration

give with meals PO doses vary

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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

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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

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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