Diabetes Drugs Flashcards
Medication example for rapid-acting insulin
Insulin lispro (Humalog)
Insulin Aspart (Novolog)
Medication example for short-acting insulin
Regular insulin (Humulin R)
Medication example for intermediate-acting insulin
NPH
Medication example for long-acting insulin
Insulin Glargine (Lantus)
Medication example for ultra-long duration
Insulin Glargine (Toujeo)
Medication example for combination insulin
Humulin 50/50
Medication example for Biguanides
Metformin (Glugophage)
Medication example for Sulfonylureas
Glyburide (Diabeta)
Medication example for Meglitinides
Repaglinide (GlucoNorm)
Medication example for Thiazolidinediones
Rosiglitazone (Avandia)
Medication example for Alpha-Glucosidase Inhibitors
Acarbose (Glucobay)
Medication example for Sodium-Glucose Co Transporter 2 Inhibitors
Canagliflozin (Invokana)
Medication example for Dipeptidyl peptidase 4 inhibitors
Sitagliptin (Januvia)
Medication example for Incretin Mimetics
Liraglutide (Victoza)
Nursing considerations of insulin during stress and infection
Increase insulin
Nursing considerations of insulin during skipping meals and exercise
Decrease insulin
When to administer short-duration, rapid-acting insulin?
For example, Insulin lispro (Humalog) or Insulin Aspart (Novolog) should be administered within 15 minutes before or just after meals
When to administer short-duration, short-acting insulin?
For example, regular insulin (Humulin R) should be administered 30 minutes before meals
Which is the only insulin that can be mixed? (Hint: only cloudy insulin)
Neutral Protamine Hagedorn insulin suspension (NPH)
When to administer NPH?
Twice daily at the same times each day (am + pm)
What does NPH stand for?
Neutral Protamine Hagedorn insulin suspension (NPH)
When to administer combination insulin?
For example, Humulin 50/50 should be given twice daily
Another name for sliding scale
Also called corrective or supplemental
Key takeaways: biguanides
An example is metformin.
MOA is decreasing liver production and intestinal absorption of glucose. Also increases insulin sensitivity
DO NOT give it to patients with renal impairment because it’s not metabolized and excreted by the kidneys; it can accumulate and become toxic when there’s renal impairment.
HOLD metformin before and after CT dye because it can be very hard on the kidneys (48 hours before and again after)
Why are biguanides favourable?
Does not stimulate insulin release from the pancreas - therefore less risk for hypoglycemia.
Does not cause weight gain
Key takeaways: sulfonylureas
MOA is triggering the release of insulin from pancreatic beta cells. It requires insulin synthesis in the pancreas, therefore ineffective in Type 1 Diabetes.
Adverse effects and notable interactions with sulfonylureas
Risk for hypoglycemia → cause reduction in blood glucose regardless of the blood sugar level dangerous.
Weight gain.
NSAIDs and alcohol can worsen hypoglycemia
Beta Blockers block the early SNS warning signs of hypoglycemia and insulin secretion simultaneously.
Key takeaways: meglitinides
MOA stimulates pancreatic insulin release → more short-acting than glyburide (sulfonylurea).
Require the insulin synthesis in the pancreas, therefore ineffective in Type 1 Diabetes
Adverse effect: hypoglycemia → patients must eat within 30 minutes of taking this drug
Key takeaways: Insulin Sensitizers thiazolidinediones (glitazones)
Flagged for high-risk to heart failure so not used in Canada
Key takeaways: alpha-glucosidase inhibitors
This drug inhibits alpha-glucosidase (enzyme) which breaks down carbohydrates. Hypoglycemia may develop when used in combination with insulin or sulfonylureas.
Key takeaways: Didpeptidyl peptidase-4 (DPP-4) inhibitors (Gliptins)
DPP-4 is an enzyme that inactivates incretin hormones (a hormone that encourages insulin secretion). It enhances the actions of incretin hormones like insulin secretion; suppresses glucagon secretion; reduces liver production of glucose; and delays gastric emptying.
Key takeaways: Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors
Inhibits SGLT-2 in the kidney → reduces the reabsorption of glucose. By blocking the reabsorption of glucose, glucose will be lost in the urine in addition to sodium. Risk of increased urination, UTI, and yeast infections.
Key takeaways: Incretin Mimetics Glucagon-like Peptide-1 (GLP-1) Receptor Agonists
It activates receptors for GLP-1. GLP-1 is a hormone produced in the intestines. It is released from cells in the GI tract after a meal, promoting insulin release and inhibiting glucagon release. This one induces weight loss. It is also injectable
