Diabetes Drugs Flashcards
primary goal of diabetic pharmacology
prevent hyperglycemia and dec chance of long term complications
- maintain tight glycemic control and blood lipid levels
types of insulin
- rapid acting: insulin lispro
- short acting: human regular
- intermediate acting insulin: NPH
- long acting insulin: glargine
insulin administration
subq injection
- sites: back of arms, stomach, thighs
- ordered in units
lispro
rapid acting
- starts working in 15 mins
- peaks in 1 hr
- works for 2-4 hrs
-administer w food
- must be in conjunction w either an intermediate or long acting
insulin regular
short acting
- onset 30-60 mins
- peak 2-6 hr
- duration 3-8 hrs
- give before meals to control hyperglycemia
- often given for tube feeding
- used in insulin infusions
NPH
intermediate acting insulin, neutral protamine hagedron –> protamine helps slow down absorption so that is lasts longer
- onset: 2-4 hrs
- peak: 4-10 hrs
- duration: 10-20 hrs
NPH info
cloudy insulin so agitate before using
- typically injected 2x/day
- can be administered w rapid and short acting
- clear before cloudy
glargine
long acting insulin
- once a day
- onset: 70 mins
- duration: all day
- helps control blood sugar all day so do not mix w other insulins
- often given at night
blood sugar monitoring
need to know blood sugar before administering any type of insulin
insulin pumps
computerized devices with basal infusion of regular insulin
- mostly used for type 1 diabetics
- bolus can be calculated when necessary
- surgically implanted
- still require a FSBG
insulin regimens
most common is the sliding scale
- given based on blood glucose level
- can include basal dose of long acting
- important to educate
insulin complications
- hypoglycemia
- allergic reactions are rare
- lipodystrophies,lipoatrophy
hypoglycemia causes
insulin overdose, dec cal intake, V/D, excessive alc, unaccustomed exercise, childbirth
hypoglycemia s/s
tachycardia, sweating, nervousness, headache, drowsy, fatigue, dec LOC
hypoglycemia treatment
oral carbs, parenteral glucagon, IV dextrose
lipodystrophies, lipoatrophy
depressions of skin at injection sites
- feels hard and changes color
- fat cells harden and no longer absorbs insulin
somogyi effect
overdose of insulin that causes hypoglycemia and counter regulatory mechanisms cause hyperglycemia and ketosis
- usually results from poor management
dawn phenomenon
hyperglycemia in the morning due to natural hormonal release
teaching points of glucose
- monitor glucose level as directed
- carry a good source of carbs in case hypo
- rotate insulin sites
- insulin vials are good for 30 days at room temp
glipizide, glyburide class
sulfonylure
glipizide, glyburide suffix
-ide
glipizide, glyburide moa
binding and closing K-ATP channels in the pancreatic beta cells which stimulates the secretion of insulin
- inc body’s sensitivity or response
- reduces release of glucose
glipizide, glyburide side effects
- hypoglycemia
glipizide, glyburide nursing considerations
- dont take if pregnant
- Etoh, nsaids, tagamet, sulfa based ATB potentiates side effects
metformin class
biguanides
metformin moa
lowers glucose by dec production of glucose in liver
- enhances glucose uptake by muscles
- does not promote insulin from pancreas
- does not cause hypoglycemia
metformin side effect
abdominal bloating, N/V/D, risk for acidosis in pt w elevated creatinine
metformin nursing implications
- no if elevated ALT levels
- monitor serum glucose levels
- give 30 mins before meals
- must be held for 48 hrs post iv contrast usage
- do not use w pt for heart failure, kidney disease, liver disease, excessive alc
metformin therapeutic usage
glycemic control, prevent t2d, pcos
linagliptin, sazagliptin, sitagliptin class
DPP4 inhibitor
linagliptin, sazagliptin, sitagliptin moa
inhibits dipeptidyl peptidase 4, the enzyme that inactivates incretin hormone
- inc insulin by inc activity of incretins
- reduce glucagon release
- dec hepatic glucose production
- slow down digestion and appetite
linagliptin, sazagliptin, sitagliptin side effects
- GI problems, flu like symptoms, skin rxns, inc risk of pancreatitis
- not a high incidence of hypoglycemia
linagliptin, sazagliptin, sitagliptin indicated use
in combination w diet and lifestyle modifications
- can be mono therapy or w other medications
dulaglutide, exenatide, semaglutide class
GLP-1 receptors agonists
dulagluide, exenatide, semaglutide suffix
- tide
dulagluide, exenatide, semaglutide moa
enhance glucose dependent insulin secretion
- stimulates glucose dependent release of insulin
- inhibits prostaglandin release of glucagon
- suppress appetite
- slowed gastric emptying
dulagluide, exenatide, semaglutide side effects
N/V/D, injection site rxn, headaches, upper respiratory infection, wt loss
dulagluide, exenatide, semaglutide nursing indications
- do not use if have pancreatitis
- black box warning: risk of thyroid c cell tumor
- not recommended for ppl w ESRD
- given through SQ
- usually given as adjunct therapy w metformin or other meds
- plasma levels peak in 2 hrs, half life 2.5
- gila monster saliva
dapagliflozin class
sodium glucose cotransport ER 2 inhibitor
- SLG2
dapagliflozin suffix
-flozin
dapagliflozin moa
prevent the kidneys from reabsorbing glucose back into the blood by blocking sodium-glucose transport proteins
- allows kidneys to lower glucose levels by excreting it
dapagliflozin side effects
- inc risk of UTI
- genital mycotic infection
- hypotension
- dizziness
- fatigue
dapagliflozin nursing considerations
- PO
- dont give to pt w ESRD or severe kidney disease
- not FDA approved for t1d
- can be given in conjunction w other meds
- inc in use for other conditions like heart fail
glucagon
hypoglycemia antidote
glucagon moa
activates hepatic glucagon receptors, stimulates glycogenolysis and release of glucose
glucagon nursing considerations
- PO (awake pts) , SQ/IV/IM (low LOC pts)
- short duration so may need multiple doses
- check FSBG 15 mins after
result of steriods
inc blood sugar
being sick w diabetes
- sickness inc stress, which can inc glucose, so need to check more frequently
- pts more prone to DKA, HHNS
- stomach virus means dec food so need to watch bs closely and continue to take oral meds
diabetes diet
for both t1 and 2, need healthy variety of food
- plate method and carb counting
exercise for diabetes pts
can help lower glucose levels, always be watchful tho bc can risk hypoglycemia if too hard of a change
