Antidiabetic Drugs Part 2 Flashcards
What are oral antihyperglycemics and what is their target?
Oral drugs that lower blood sugar and the target is to lower a1c
What elements are involved in the success of oral anti-diabetic drugs?
Lifestyle changes, careful monitoring of blood glucose, therapy with one or more drugs, Treatment of associated comorbid conditions such as high cholesterol and hypertension
How does metformin (biguanides) treat diabetes and why is it preferred to other treatments?
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.
What are the adverse effects of metformin?
Abdominal bloating, nausea, cramping, feeling of fullness, diarrhea, metallic taste, hypoglycemia, reduction in B12 levels, lactic acidosis
What is the function of sulfonylureas and what are their limitations?
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.
What is an example of a sulfonylureas and what are the adverse effects?
Gliclazide. Hypoglycemia, weight gain, skin rash, epigastric fullness and heartburn
What interacts with Gliclazide to enhance the effect?
Alcohol, anabolic steroids, beta-blockers, chloramphenicol, MAOIs, oral anticoagulants, sulfonamides, garlic, ginseng
What interacts with gliclazides to decrease the effect?
Adrenergics, corticosteroids, thiazides, thyroid drugs.
What are the contraindications of Gliclazide?
Severe liver and kidney disease, active hypoglycemia, Not used in pregnancy.
What is the function of thiazolidinediones (glitazones) and what is an example?
Insulin sensitzing drugs, enhancing receptor sensitivity and slows onset up to months. Pioglitazone (Actos)
What is the function of glinides and what is an example
Similar sulfonylureas, increases insulin secretion in pancreas, much shorter duration of action. Repaglinide (GlucoNorm)
What is the function of dipeptyl petidase 4 (DPP-4) inhibitors and what is an example?
Slow down incretin hormone breakdown and increases insulin secretion and lower glucagon secretion. sitagliptin ( Januvia)
What are the function of sodium glucose cotransporter inhibitors and what do they improve?
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.
What are the adverse effects of sodium glucose contransporter inhibitors?
Vaginal yeast infections, UTI, increased insulin sensitivity, increased glucose uptake, decrease gluconeogenesis
What type of diet can improve hypoglycemia and why
Higher protein intake and lower carbs. Prevents rebound postprandial hypoglycemia
What are the adrenergic symptoms of hypoglycemia
Anxiety, tremors, sensation of hunger, palpitations, sweating
What are the central nervous system symptoms of hypoglycemia
Difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, dizziness and headache
What are the late signs of hypoglycemia
Hypothermia, seizures. Coma and death will occur if not treated
What are the 4 different treatments methods for hypoglycemia
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)
What 4 things needs to be assessed before giving drugs that alter glucose levels?
Thorough history, VS, CBG and HbA1c, Potential complications and drug interactions
What sensitivity can oral hyperglycaemics cause?
Photosensitivity (light)
What is a concern if a patient is given anti diabetic drugs and is not eating
Hypoglycemia
What happens if a patient is NPO and is receiving anti diabetic drug therapy?
Consult the PCP to clarify orders.
How do you mix an insulin suspension
Roll between hands. Do not shake
What other non pharmacological things should be monitored when taking anti diabetic drugs?
Weight, dietary management, exercise, foot care, eye care
When drawing up 2 types of insulin in one syringe, which one always goes first?
Always withdraw the regular or rapid-acting (clear) insulin first.
What should you do if hypoglycemia occurs and the patient is unconscious
Deliver D50W or IV glucagon
What should you do if hypoglycemia occurs and the patient is conscious?
Administer oral form of glucose
