Diabetes Meds Flashcards
Biguanides
Medication; metformin (glucophage)
Decreases the production of glucose from stored glycogen by the liver
first-line treatment for type 2
Can be given alone or in combination with other medications
Improved how insulin works in the body (Insulin sensitizer)
Slows down the conversion of carbohydrates into sugar
Biguanides Side Effects
Bloating
Diarrhea
Abdominal pain
Nausea
Metallic taste
Increase risk for B12 deficiency
Hypoglycemia not a problem when used alone
May cause weight loss
Decreases platelet aggregation and reduces viscosity
Can be given to pregnant women
Can also help decrease lipids
Hold 48 hours prior to contrast dyes (body scan) (may lead to lactic acidosis or acute kidney injury
Contraindicated in patients with renal or hepatic impairment, CHF
Sulfonylureas
Most commonly prescribed oral diabetic medication
Stimulates beta cells to secrete insulin
Decrease glucose production by the liver
Side Effects:
-Hypoglycemia
-Weight gain
-Sweating/dizziness
-Increase risk for sunburn
-Use cautiously w/renal and liver disease
Onset at 90 minutes
peak in 2-3 hours
Can be given with metformin or insulin
NO one pregnant, allergic to sulfa, or on a beta blocker
May interact with oral anticoagulants, NSAIDS, H2 blockers.
May have decreased concentrations from thiazides, steroids and TB meds
NO alcohol
Medications: END is “IDE”
Glipizide (Glucotrol)
Glyburide (DiaBeta)
Glymepride (Amaryl)
Metglitinides
Stimulates beta cells to produce more insulin
Side effects:
Weight gain
Angina
Hypoglycemia
Can be used in those allergic to sulfa
Can be used alone or in combination; often with Metformin
Should be taken with first bite of food
Do not take if not eating
Medications: (END in Glinide)
Repaglinide (Prandin)
Nateglinide (Starlix)
Thiazolidinediones
-decreasing insulin resistance in adipose and muscles cells
-Also block hepatic gluconeogenesis
Side effects: weight gain, fluid retention, osteopenia
-Can be used alone or in combination.
-Can be taken with or without food
-Offers cardioprotection
Do not use with clients w/heart failure or hepatic impairment
Concerns about bladder cancer in pioglitazone
-Monitor the liver functions studies
Medications:
Pioglitazone (Actos)
Rosiglitazone (Avandia) Off market)
Alpha Glucosidase Inhibitor
which prevents the release of glucose from carbohydrates in the diet
AKA: “Starch blocker”
Side effects: Anemia
GI effects common
Decreases postprandial glucose levels
Should be taken with first bite of food
DONT give to clients with GI issues and renal impairment
Medications:
Acarbose (Precose)
Miglitol (Glyset)
Monitor liver function studies
Glucagon like peptide receptor agonists (GLP-1 )
Work by:
Increase insulin secretion
Slowed gastric emptying
Reduction of postprandial glucagon levels
Reduce food intake( decreased appetite)
Promotes growth and development of beta cells
Can cause weight loss
Low risk for hypoglycemia; unless given with sulfonylureas or insulin
Medication:
Exenatide (Byetta)
Twice daily or one weekly injections. Use cautiously in pts with pancreatitis, gallstones, kidney dysfunctions and high triglycerides
Dulaglutide (Trulicity)
Once weekly injection
Semaglutide (Rybelsus)
Oral agent
Luraglutide(Victoza)
DPP-4 (Gliptin) inhibitors
Expensive medication given IV
Inhibit dipeptidyl peptidase 4 enzyme, which destroys the GI incretin hormones GLP-1 and GIP
Increase insulin secretion
Decrease glucagon secretion to decrease glucose production
Allows incretin hormones to remain in circulation longer
Slows gastric emptying
Can cause weight loss
Does not cause hypoglycemia unless used in combination with insulin or sulfonylureas
Medications:
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
Side effects
Headache runny or stuffy nose, sore throat, upper respiratory infections, nausea, joint pain; pancreatitis Hypoglycemia
Sodium Glucose Co-transporter 2 inhibitors (SGLT2) (incretins)
proteins that enhance glucose reabsorption and increase glucose excretion in the urine
Can cause weight loss
Can cause volume loss
Does not cause hypoglycemia unless used in combination
DO NOT use with clients who have renal failure
Increase risk:
Yeast infections
Urinary Tract Infections
Amputations
Can cause hyperkalemia
All the SGLT2 inhibitors provide renal protection by decreasing the protein loss and reducing the damage caused by hyper filtration.
Take without regard to food
Increase PO fluid intake
Medications:
Canagliflozin (Invokana)
Apagliflozin (Farxiga)
Empagliflozin (Jardiance)
Amylin Analogues (Amylinomimetics)
Slows gastric emptying, (regulate the postprandial rise in blood glucose).
Suppresses postprandial glucagon secretion, thus helping maintain better blood glucose control.
- Increases the sense of satiety (fullness) which could promote weight loss.
Medication:
Pramlintide: Symlin injectable
Give at least 2 inches away from insulin injection in thigh or abdomen
-Do not give if not eating
-Will cause hypoglycemia
Hyperglycemia Agent
Glucagon
For severe hypoglycemia (when patient is unable to take oral glucose)
Stimulates breakdown of glucogen into glucose in the liver
Glucose (D50) –preferred for severe cases
May be given SQ, IM, or IV
Once patient awake or able to swallow – provide small snack
Counter-regulatory hormones
Epinephrine
Cortisol-stress hormones
Growth hormones
Post prandial glucose
PPG
Glucose levels after 2 hrs of eating
Goal <140
Glycemic target
ADA
A1C <7%
FPG 80 -130
PPG <180
