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Pathophysiology and Pharmacology > Antidiabetic Drugs > Flashcards

Antidiabetic Drugs Flashcards

1
Q

Subcutaneous antidiabetic drugs

A

– Insulin

– Incretin Mimetics SC

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2
Q

Oral antidiabetic drugs

A 
– 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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3
Q

Biguanide Classification

A

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

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4
Q

Biguanide Movement

A

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

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5
Q

Biguanide Action

A

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

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6
Q

Biguanide Nursing Considerations

A

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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7
Q

Biguanide Indication

A

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

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8
Q

Biguanide Administration

A

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

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9
Q

Sulfonylureas Classification

A 
oldest	drug	– most	current	used	is	second	generation	– gliclazide (Diamicron)	
and	glyburide	(Diabeta)
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10
Q

Sulfonylureas Movement

A

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

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11
Q

Sulfonylureas Action

A

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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12
Q

Sulfonylureas Nursing Considerations

A

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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13
Q

Sulfonylureas Indication

A

Type 2 DM

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14
Q

Sulfonylureas Administration

A

PO – IR and LR formulations, doses vary

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15
Q

Glinides Classification

A

repaglinide (GlucoNorm) and nateglinide (Starlix)

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16
Q

Glinides Movement

A

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

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17
Q

Glinides Action

A

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

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18
Q

Glinides Nursing Considerations

A

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

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19
Q

Glinides Indication

A

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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20
Q

Glinides Administration

A

give with meals PO doses vary

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21
Q

thiazolidinedione (glitazones) Classification

A

Rosiglitazone ( Avandia), Pioglitazone (Actos)

22
Q

thiazolidinedione (glitazones) Movement

A

onset delayed, peak 2H, ½ life 3-7H, duration unknown

23
Q

thiazolidinedione (glitazones) Action

A

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

24
Q

thiazolidinedione (glitazones) Nursing Considerations

A

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

25
Q

thiazolidinedione (glitazones) Indication

A

Type 2 DM

26
Q

thiazolidinedione (glitazones) Administration

A

slow onset of activity – several weeks; 15-45 mg PO daily

27
Q

A – Glucosidase Inhibitors Classification

A

Acarbose (Glucobay) used less commonly

28
Q

A – Glucosidase Inhibitors Movement

A

onset 1-1.5H, peak 2H, ½ life 2-3H, duration unknown

29
Q

A – Glucosidase Inhibitors Action

A

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

30
Q

A – Glucosidase Inhibitors Nursing Considerations

A

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

31
Q

A – Glucosidase Inhibitors Indication

A

Type 2 DM

32
Q

A – Glucosidase Inhibitors Administration

A

with first bite of food, 50-100 mg PO TID

33
Q

Dipeptidyl 4 (DPP-4) Inhibitors Classification

A

sitagliptin (Januvia), alogliptin (Nesina), saxagliptin (Onglyza), linagliptin
(Tradjenta) – also available in combination with Metformin

34
Q

Dipeptidyl 4 (DPP-4) Inhibitors Movement

A

onset 15-30min, peak 1H, ½ life 12 H, duration unknown

35
Q

Dipeptidyl 4 (DPP-4) Inhibitors Action

A

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

36
Q

Dipeptidyl 4 (DPP-4) Inhibitors Nursing Considerations

A

contradiction – allergy;
adverse effects – URTI, headache, diarrhea; hypoglycemia
esp. in combination with a sulfonylurea; pancreatitis;

37
Q

Dipeptidyl 4 (DPP-4) Inhibitors Indication

A

Type 2 DM

38
Q

Dipeptidyl 4 (DPP-4) Inhibitors Administration

A

PO, daily administration, with or without food; doses vary

39
Q

Sodium-Glucose Cotransporter 2 Inhibitor Classification

A

canagliflozin (Invokana), dapagliflozin (Forxiga)

40
Q

Sodium-Glucose Cotransporter 2 Inhibitor Movement

A

slide empty :(

41
Q

Sodium-Glucose Cotransporter 2 Inhibitor Action

A

block reabsorption of glucose in kidney via the sodium-glucose cotransporter –
result – decrease plasma glucose – weight loss, decreased SBP, increased HDL and
LDL

42
Q

Sodium-Glucose Cotransporter 2 Inhibitor Nursing Considerations

A

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

43
Q

Sodium-Glucose Cotransporter 2 Inhibitor Indication

A

Type 2 DM - adjunct to use of other oral agents; monotherapy for Metformin
intolerant

44
Q

Sodium-Glucose Cotransporter 2 Inhibitor Administration

A

PO, AC BF, doses vary

45
Q

Incretin Mimetics Classification

A

albiglutide (Eperzan), dulaglutide (Trulicity), exenatide (Byetta), liraglutide
(Victoza)

46
Q

Incretin Mimetics Movement

A

slide is empty on this one. Keep up the good work. You’ll do great.

47
Q

Incretin Mimetics Action

A

enhance insulin secretion, suppress elevated glucagon secretion, slow gastric
emptying

48
Q

Incretin Mimetics Nursing Considerations

A

contraindications – allergy, ESRD, severe kidney failure; adverse effects – nausea, vomiting, diarrhea; rapid weight loss up to 1.5 hg/week.

49
Q

Incretin Mimetics Indication

A

Type 2 DM

50
Q

Incretin Mimetics Administration

A

SC q weekly, prefilled syringe or pen, dose varies

Pathophysiology and Pharmacology (17 decks)

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