Endocrine Drugs - for Diabetes

Question 1

Drugs that stimulate insulin secretion

Answer 1

Sulfonylureas
Secretagogues (MEGLITINIDES)
DPP-4 Inhibitors/Incretins

Question 2

Drugs that don’t stimulate insulin secretion

Answer 2

Alpha-Glucosidose Inhibitors
Biguanides
TZDs
Dopamine agonists 
SGLT 2 Inhibitors

Question 3

Biguanides

Answer 3

MOA:
Decrease liver glucose production/release and cellular insulin resistance

Contraindication:
Renal Failure
Liver Disease
Severe CHF
Elderly: 80 +
Alcoholism

Adverse Effects:
Lactic acidosis
Hypoglycemia
GI Disturbances
Increased risk for acute renal failure

Nursing Considerations:
Monitor for lactic acidosis and hypoglycemia.

Question 4

Sulfonylureas

Answer 4

Prototypes: 
Glipizide
Glyburide
Glimepiride
Chlorpropamide
Tolazamide
Tolbutamide

MOA:
Stimulates pancreas to secrete insulin and improves insulin action at cellular level

Contraindication:
Sulfa allergy
Drug to drug interactions: NSAIDS, sulfonamides

Adverse Effects:
Hypoglycemia
Weight Gain
Mild GI, nausea and heartburn

Nursing Considerations:
Monitor for hypoglycemia, blood glucose, ketones in urine

Question 5

TZDs

Answer 5

Prototypes:
Pioglitazone
Rosiglitazone

MOA:
Sensitize body tissue to insulin, stimulates insulin receptor sites to lower blood glucose and improve action of insulin.

Life Threatening Adverse Effects:
Can cause Heart Attack,
Heart Failure, or
Worsen heart failure.

Adverse Effects:
Impaired liver function, reduce effectiveness of oral birth control, anemia, hypoglycemia, weight gain, hyperlipidemia

Nursing Considerations:
Monitor liver function test before and during, monitor blood glucose levels, arrange dietary teaching to establish weight control program.

Question 6

Alpha-Glucosidase Inhibitors

Answer 6

Prototypes:
Acarbose
Miglitol

MOA:
Delays absorption of carbs in the intestine and slows the entry of glucose into systemic circulation

Contraindications:
GI/Renal dysfunction or cirrhosis

Adverse Effects:
Hypoglycemia
GI: discomfort, distention, diarrhea, flatulence

Nursing Considerations:
MUST BE TAKEN RIGHT BEFORE A MEAL OR WITH ST BITE TO BE EFFECTIVE.
Monitor for GI, BG,

Question 7

Nonsulfonylureas Insulin Secretagogues / Meglitinides

Answer 7

Prototype:
Repaglinide
Neteglide

MOA:
Stimulates the beta cells in the pancreas to secrete and release insulin

Adverse Effects-
Same as Sulfonylureas:
Hypoglycemia
Weight Gain
Mild GI, nausea and heartburn

Nursing Considerations:
Avoid ALCOHOL and monitor liver function/ BG.

Question 8

Dopamine Agonist

Answer 8

Bromocriptine (Cycloset)

MOA:
Inhibit excessive sympathetic tone within the central nervous system (CNS), resulting in a reduction in postmeal plasma glucose levels due to enhanced suppression of hepatic glucose production; Quick release and then extended duration

Adverse Effects:
Nausea , orthostatic hypotension,

Nursing Considerations:
May cause somnolence, see how it affects the person b/f they drive

Question 9

SGLT 2 Inhibitors

Answer 9

SGLTs Inhibitors:
Canagliflozin
Dapagliflozin

MOA:
Blocks reuptake of glucose in the kidneys, see below.

Contraindications:
Kidney Impairment

Adverse Effects:
More prone to UTI’s b/c of increased sugar in the kidneys

Nursing Considerations:
Monitor kidney function

Question 10

DDP-4 Inhibitors

Answer 10

Prototypes:
Sitagliptin
Saxaglipton
Exenatide

MOA:
Stimulates secretion and release of insulin from beta cells, slows gastric emptying, and prevents secretion of glucagon

Adverse Effects:
GI disturbances, hypoglycemia possible acute pancreatitis

Nursing Considerations:
If gastric emptying is too slow it can cause N & V, monitor BG