Drug use for DM

Question 1

Oral antiDM drugs

Answer 1

• type 2 DM

- after fail diet & exercise (augment增加 effect)

Question 2

Sulphonylureas=

• tolbutamide
• Gliclazide
• Chlorpropamide
• Glibenclamide
• Glimepiride (amaryl)
• Glipizide

Answer 2

• augment insulin secretion
• effective: residual pancreatic beta-cell activity present. (organ function still on)

Recommend: x obese & contra to metformin

Short acting:

• tolbutamide
• Gliclazide

intermediate:
Glipizide

Long acting:

• Chlorpropamide
• Glibenclamide
• Glimepiride (amaryl)

Contra:

• severe hepa & renal impair
• pregnant
• elderly (Chlorpropamide, glibenclamide)

adverse effect:

• nausea, constipate
• good appetite
• hypo
• ALG

Question 3

Biguanides = only Metformin 500mg BD

Answer 3

Decrease gluconeogenesis in liver

• increase peripheral untilisation glucose by muscle
• act only when present endogenous insulin

Recommend: obese/ insulin resistant

Contra:

• hepatic/renal impair
• DKA
• severe dehydrate
• Shock, MI, PVD
• alcohol dependency
• if use xray contrast (x gv metformin 1st until renal func normal)

Adverse:

• LOA
• nausea, diarrhea
• low absorp vitB12 & folic acid
• ALG

Nursing alert?
1. Monitor RFT/LFT IX b4 serve metformin

2. tk w meal & increase dose slowly -> minimize GI effect
3. Monitor adverse effect (lactic acidosis-drowsiness, brady, hypoten) report to Dr.

Question 4

Alpha glucosidase inhibator?

Acarbose

Answer 4

• delay digest & absorp starch & sucrose by inhibit intestinal alpha glucosidase in intestine.
• Acarbose (Glucobay 50-100mg tds)

Contra:

• pregnant
• inflamme, intestinal disorder
• hepatic/renal x

Adverse:

• Flatulence, soft stool, abdo distent
• liver dysfunction

Nursing alert?

• w food
• absorption of sucrose block bt Acarbose. gv glucose only when Hypo

Question 5

Metglitinides =
*Repaglinide (NovoNorm)
500mcg

*Nateglinide
60mg tds

Answer 5

Stimulate insulin release

• rapid onset action & short duration
• tk shortly b4 meal

*Repaglinide (NovoNorm)
500mcg

*Nateglinide
60mg tds

MOA:
bind K channel (allosteric site)

Contra:

• DKA
• pregnant
• hepatic X (repaglinide)

Adverse:
Hypo
ALG
Abdo pain, diarrhea, consti, nausea

Alert:
1. Must w meal

Question 6

Thiazolidinediones?

• Rosiglitazone (Avandia)
• 4mg OD w metformin/sulphonylurea

*Pioglitazone (Actos)
15-30mg OD

Answer 6

= Glitazones
-Reduce peripheral insulin resistance by enhance uptake of glucose by skeletal muscle cell.

• Rosiglitazone (Avandia)
• 4mg OD w metformin/sulphonylurea

*Pioglitazone (Actos)
15-30mg OD

Contra:
hepatic X
hx MI, combi insulin
pregnant

Adverse:

• GI disturb, headeache, anemia
• gain weight
• Hypo

Nursing alert?
1. monitor LFT b4 tx -> every 2 month for 1 yr

2. go ER stat if nausea, abdo pai, fatigue, DARK URINE
3. Stop meds if Jaundice
4. Monitor edema & sign of CCF

Question 7

Insulin=

Answer 7

• supplement the insulin secrete by pancrease
• promote uptake glucose @muscle
• facilitate conversion glucose to glycogen @liver -> inhibit gluconeogenesis & glycogenolysis @liver.
• inhibit lipolysis & increase formation triglycerides
• Stimulate membrane bound energy-dependent ion transporters (NA/K ATPase)
• stimulate cell growth

Dose:
S/C

Precaution:
decrease requirement if renal/hepatic X, endocrine X, Coeliac disease

Nursing alert?
1. teach pt (prepare, use sc inj, area inj - abdo, thigh, deltoid)

2. rotate inj site prevent Lipohypertrophy. 1ch between site
3. storage
   Pen:
   2-8 cold chain, 1 mth

vial:
2-8 cold chain, room temp 6wks (novo nordisk)/ 28days(lilly)

4. teach S&S hypo (tachy, palpate, drowsiness, fatigue)
   Rapid tx needed -oral glucose / IV