Endocrine Medications: Oral Antidiabetics Flashcards
(73 cards)
1
Q
What are the different types of oral antidiabetic drugs?
A
- Sulfonylureas drugs
- Thiazolidinedione drugs
- Biguanides
- Alpha-glucosidase inhibitors
- Meglitinides
- Incretin modifiers
- Alpha-glucosidase inhibitors
- Selective Sodium Glucose Co Transporter 2 Inhibitors
2
Q
Incretin modifiers are also known as…
A
- Dipeptidyl Peptidase-4 Inhibitors
OR - “gliptins”
3
Q
Thiazolidinediones are also known as…
A
TZDs
4
Q
What are the generic and brand names of Sulfonylureas drugs?
A
glipizide (Glucotrol)
5
Q
What are the generic and brand names of Thiazolidinedione drugs?
A
- pioglitazone (Actos)
2. rosiglitazone (Avandia)
6
Q
What are the generic and brand names of Biguanides?
A
metformin (Glucophage)
7
Q
What are the generic and brand names of Alpha-glucosidase inhibitors?
A
acarbose (Precose)
8
Q
What are the generic and brand names of Meglitinides?
A
repaglinide (Prandin)
9
Q
What are the generic and brand names of Incretin modifiers?
A
sitagliptin (Januvia)
10
Q
What are the generic and brand names of SGLT-2 Inhibitors?
A
empagliflozin (Jardiance)
11
Q
Are oral antidiabetic drugs are absorbed well?
A
Yes
12
Q
Where are oral antidiabetic drugs are absorbed?
A
GI tract
13
Q
Where are oral antidiabetic drugs distributed?
A
Via the bloodstream throughout the body
14
Q
Where are oral antidiabetic drugs metabolized?
A
Liver
15
Q
How are MOST oral antidiabetic drugs excreted?
A
Mostly:
- Urine
Some excreted:
- Bile
16
Q
Which oral antidiabetic drugs are excreted differently?
A
Thiazolidinedione drugs
17
Q
How are Thiazolidinedione drugs excreted?
A
Equally in:
- Urine
- Bile
18
Q
What are the actions of oral antidiabetic drugs?
A
- Stimulates insulin release from the pancreatic beta cells
- Reduces glucose output by the liver
- Extrapancreatic effect increases peripheral sensitivity to insulin
19
Q
What does the actions of oral antidiabetic drugs of increasing Extrapancreatic effect on peripheral sensitivity to insulin cause to occur?
A
mild diuretic effect
20
Q
Who should takes oral antidiabetic drugs?
A
Type 2 diabetes
21
Q
What should be monitored when administering oral antidiabetic drugs?
A
- Adverse effects (hypoglycemia)
- Hypersensitivity reactions
- Hematologic disorders
22
Q
When may a patient develop hypoglycemia when taking oral antidiabetic drugs?
A
During times of stress
23
Q
If a patient is experiencing hypoglycemia due to stress what may be indicated?
A
Insulin
24
Q
What should a patient taking oral antidiabetic drugs avoid?
A
Alcohol
25
Why should a patient taking oral antidiabetic drugs avoid alcohol?
Produces a disulfiram-like reaction
26
What is disulfiram?
1. It is used to treat chronic alcoholism
| 2. It causes unpleasant effects when even small amounts of alcohol are consumed.
27
What are the effects of disulfiram?
1. Flushing of the face
2. Headache
3. N&V
4. Chest pain
5. Weakness
6. Blurred vision
7. Mental confusion
8. Sweating
9. Choking
10. Breathing difficulty
11. Anxiety
28
Where do oral antidiabetic drugs produce actions?
Within and outside the pancreas
29
How do oral antidiabetic drugs treat DM within the pancreas?
Stimulate pancreatic beta cells to release
| insulin in a patient with a minimally functioning pancreas
30
What can occur within a few week to months of starting sulfonylureas?
1. Pancreatic insulin secretion drops to pretreatment levels
BUT
2. BS levels remain normal
31
Other than treating DM within the pancreas, how else can oral antidiabetic drugs treat DM?
Extrapancreatic actions
32
What are oral antidiabetic drugs extrapancreatic actions?
1. Work in the liver to decrease glucose production (gluconeogenesis)
2. By increasing the number of insulin receptors in the peripheral tissues to provide more opportunities for the cells to bind sufficiently with insulin, initiating the process of glucose metabolism.
33
What specific action occurs with administration of pioglitazone?
Improves insulin sensitivity
34
What specific action occurs with administration of Metformin?
Decreases:
1. Liver production of glucose
2. Intestinal absorption of glucose
Improves:
Insulin sensitivity
35
What specific action occurs with administration of acarbose and miglitol?
Inhibit enzymes which delays glucose
| absorption.
36
What specific action occurs with administration of Sitagliptin?
Slows the breakdown of intestinal hormones that allow insulin levels to increase after a meal
37
Can Type 1 diabetics use oral antidiabetic drugs? why?
No, in type 1 the pancreatic cells aren't producing at a minimal level
38
Can you combine insulin and oral antidiabetic drugs?
Yes
39
When would you combine insulin and oral antidiabetic drugs?
In patients who don't respond to either drug when used alone
40
What can occur when oral antidiabetic drugs interact with other drugs?
Hypoglycemia and hyperglycemia
41
Which drug interactions cause Hypoglycemia?
Sulfonylureas combined with:
1. Alcohol
2. Anabolic steroids
3. Chloramphenicol
4. Gemfibrozil
5. MAOIs
6. Salicylates
7. Sulfonamides
8. Fluconazole
9. Cimetidine
10. Warfarin
11. Ranitidine
Metformin combined with:
1. Cimetidine
2. Nifedipine
3. Procainamide
4. Ranitidine
5. Vancomycin
42
Which drug interactions cause Hyperglycemia?
Sulfonylureas combined with:
1. Corticosteroids
2. Rifampin
3. Sympathomimetics
4. Thiazide diuretics.
43
Hypoglycemia is less likely to occur when metformin is used how?
As a single agent
44
Other than hyperglycemia and hyporglycemia what drug-drug interaction can occur with oral antidiabetic drugs?
Renal failure
45
Which two drugs take together can cause renal failure?
Iodinated contrast dyes
46
When are Iodinated contrast dyes used?
During some procedures
47
If a patient is undergoing a procedure that requires Iodinated contrast dyes what should occur?
Metformin doses should be withheld
48
What increases risk of adverse reaction of hypoglycemia when using oral antidiabetic drugs?
Combination therapy
49
Which oral antidiabetic drugs causes adverse reactions?
1. Sulfonylureas
2. Metformin
3. Acarbose
4. Thiazolidinediones
50
What are the adverse reactions that can occur when taking Sulfonylureas?
1. Nausea
2. Epigastric fullness
3. Blood abnormalities
4. Fluid retention
5. Rash
6. Hyponatremia
7. Photosensitivity
51
What are the adverse reactions that can occur when taking Metformin?
1. Metallic taste
2. N&V
3. Abdominal discomfort
52
What are the adverse reactions that can occur when taking Acarbose?
1. Abdominal pain
2. Diarrhea
3. Gas
53
What are the adverse reactions that can occur when taking Thiazolidinediones?
1. Weight gain
| 2. Swelling
54
What to assess for when prescribing oral antidiabetic drugs?
1. BS level
2. Adverse reactions/interactions
3. Compliance
55
When a patient is transferring from insulin therapy to oral antidiabetics what action should occur?
Glucose monitoring at least three times
| daily before meals
56
Goals of oral antidiabetic drug therapy?
1. BS level in normal limits
2. Injury to the patient minimized
3. Pt ad family understand drug therapy
57
How often are sulfonylureas administered?
Once a day or twice a day
58
When should sulfonylureas be administered when they are being dosed once a day?
30 min before AM meal
59
When should sulfonylureas be administered when they are being dosed twice a day?
30 min before AM meal and PM meal
60
How often is metformin administered?
Twice a day
61
When should metformin be administered?
Before AM meal and PM meal
62
How often are Alpha-glucosidase inhibitors administered?
Three times a day
63
When should Alpha-glucosidase inhibitors be administered?
With the first bite of each main meal (3)
64
What should be monitored in patients taking thiazolidinedione?
Liver enzyme levels
65
How long should Liver enzyme levels be monitored in patients taking thiazolidinedione?
1. Every 2 months for the first year of therapy
| 2. Periodically thereafter
66
Do patients transferring from one oral antidiabetic drug to another TYPICALLY need a transition period?
No
67
How often do most patients take oral antidiabetic drugs?
Once daily
68
When would a patient take oral antidiabetic drugs twice daily (or more)?
When a patient is requiring increased doses (once a day) they may achieve better effect with twice a day dosing
69
What should be done if a patient has a hypoglycemic reaction?
1. Give oral form of rapid-acting
glucose (if the patient can swallow)
2. Give glucagon or IV glucose (if the patient can’t be roused)
3. Follow administration with a complex carb snack
70
When might a patient taking oral antidiabetic drugs require insulin?
During times of stress including...
1. Infection
2. Fever
3. Surgery
4. Trauma
71
During times of stress when insulin therapy is indicated with oral antidiabetic drugs what is important to monitor?
Monitor for hyperglycemia
72
What adjunct therapy should always be used during oral antidiabetic drug therapy?
Diet and exercise
73
Patient education when using oral antidiabetic drugs?
1. Insulin relieves S&S but doesn’t cure
2. Follow the prescribed therapeutic regimen:
* specific diet
* weight reduction
* exercise
* personal hygiene (daily foot inspection)
* avoid infection
3. Know how and when to monitor BS
4. Know S&S of hyperglycemia and hypoglycemia and what to do if they occur
5. Dont change dosage without prescribers approval
6. Report adverse reactions
7. Don’t take other drugs, including OTC drugs and herbal remedies, without first checking with the prescriber
8. Avoid consuming alcohol
10. Wear/carry medical ID at all times.
