Antidiabetic Drugs Part 2

Question 1

What are oral antihyperglycemics and what is their target?

Answer 1

Oral drugs that lower blood sugar and the target is to lower a1c

Question 2

What elements are involved in the success of oral anti-diabetic drugs?

Answer 2

Lifestyle changes, careful monitoring of blood glucose, therapy with one or more drugs, Treatment of associated comorbid conditions such as high cholesterol and hypertension

Question 3

How does metformin (biguanides) treat diabetes and why is it preferred to other treatments?

Answer 3

Reduces gluconeogenesis, Decreases intestinal absorption of glucose, and Improves glucose uptake by skeletal muscle, adipose and liver. Does not increase insulin secretion therefore does not cause hypoglycemia.

Question 4

What are the adverse effects of metformin?

Answer 4

Abdominal bloating, nausea, cramping, feeling of fullness, diarrhea, metallic taste, hypoglycemia, reduction in B12 levels, lactic acidosis

Question 5

What is the function of sulfonylureas and what are their limitations?

Answer 5

Stimulate insulin secretion from B cells, and enhance the action of insulin in muscle, liver and adipose tissue. Prevent liver from breaking down insulin as fast. It needs functioning beta cells.

Question 6

What is an example of a sulfonylureas and what are the adverse effects?

Answer 6

Gliclazide. Hypoglycemia, weight gain, skin rash, epigastric fullness and heartburn

Question 7

What interacts with Gliclazide to enhance the effect?

Answer 7

Alcohol, anabolic steroids, beta-blockers, chloramphenicol, MAOIs, oral anticoagulants, sulfonamides, garlic, ginseng

Question 8

What interacts with gliclazides to decrease the effect?

Answer 8

Adrenergics, corticosteroids, thiazides, thyroid drugs.

Question 9

What are the contraindications of Gliclazide?

Answer 9

Severe liver and kidney disease, active hypoglycemia, Not used in pregnancy.

Question 10

What is the function of thiazolidinediones (glitazones) and what is an example?

Answer 10

Insulin sensitzing drugs, enhancing receptor sensitivity and slows onset up to months. Pioglitazone (Actos)

Question 11

What is the function of glinides and what is an example

Answer 11

Similar sulfonylureas, increases insulin secretion in pancreas, much shorter duration of action. Repaglinide (GlucoNorm)

Question 12

What is the function of dipeptyl petidase 4 (DPP-4) inhibitors and what is an example?

Answer 12

Slow down incretin hormone breakdown and increases insulin secretion and lower glucagon secretion. sitagliptin ( Januvia)

Question 13

What are the function of sodium glucose cotransporter inhibitors and what do they improve?

Answer 13

Decrease blood glucose by increasing its renal excretion
Prevents glucose reabsorption in the kidneys which reduces the renal threshold for glucose and glycosuria
Improves glycemic control, weight loss and low risk of hypoglycemia.

Question 14

What are the adverse effects of sodium glucose contransporter inhibitors?

Answer 14

Vaginal yeast infections, UTI, increased insulin sensitivity, increased glucose uptake, decrease gluconeogenesis

Question 15

What type of diet can improve hypoglycemia and why

Answer 15

Higher protein intake and lower carbs. Prevents rebound postprandial hypoglycemia

Question 16

What are the adrenergic symptoms of hypoglycemia

Answer 16

Anxiety, tremors, sensation of hunger, palpitations, sweating

Question 17

What are the central nervous system symptoms of hypoglycemia

Answer 17

Difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, dizziness and headache

Question 18

What are the late signs of hypoglycemia

Answer 18

Hypothermia, seizures. Coma and death will occur if not treated

Question 19

What are the 4 different treatments methods for hypoglycemia

Answer 19

Rapidly dissolving buccal tablets and semisolid gels for oral use, IV glucose up to 50% D50W, Glucagon injection, Oral diazoxide (long term illnesses such as pancreatic cancer)

Question 20

What 4 things needs to be assessed before giving drugs that alter glucose levels?

Answer 20

Thorough history, VS, CBG and HbA1c, Potential complications and drug interactions

Question 21

What sensitivity can oral hyperglycaemics cause?

Answer 21

Photosensitivity (light)

Question 22

What is a concern if a patient is given anti diabetic drugs and is not eating

Answer 22

Hypoglycemia

Question 23

What happens if a patient is NPO and is receiving anti diabetic drug therapy?

Answer 23

Consult the PCP to clarify orders.

Question 24

How do you mix an insulin suspension

Answer 24

Roll between hands. Do not shake

Question 25

What other non pharmacological things should be monitored when taking anti diabetic drugs?

Answer 25

Weight, dietary management, exercise, foot care, eye care

Question 26

When drawing up 2 types of insulin in one syringe, which one always goes first?

Answer 26

Always withdraw the regular or rapid-acting (clear) insulin first.

Question 27

What should you do if hypoglycemia occurs and the patient is unconscious

Answer 27

Deliver D50W or IV glucagon

Question 28

What should you do if hypoglycemia occurs and the patient is conscious?

Answer 28

Administer oral form of glucose