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Pharmacology Spring 2021: Set 2 > Endocrine Medications: Oral Antidiabetics > Flashcards

Endocrine Medications: Oral Antidiabetics Flashcards

1
Q

What are the different types of oral antidiabetic drugs?

A
  1. Sulfonylureas drugs
  2. Thiazolidinedione drugs
  3. Biguanides
  4. Alpha-glucosidase inhibitors
  5. Meglitinides
  6. Incretin modifiers
  7. Alpha-glucosidase inhibitors
  8. Selective Sodium Glucose Co Transporter 2 Inhibitors
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2
Q

Incretin modifiers are also known as…

A
  1. Dipeptidyl Peptidase-4 Inhibitors
    OR
  2. “gliptins”
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3
Q

Thiazolidinediones are also known as…

A

TZDs

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4
Q

What are the generic and brand names of Sulfonylureas drugs?

A

glipizide (Glucotrol)

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5
Q

What are the generic and brand names of Thiazolidinedione drugs?

A
  1. pioglitazone (Actos)

2. rosiglitazone (Avandia)

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6
Q

What are the generic and brand names of Biguanides?

A

metformin (Glucophage)

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7
Q

What are the generic and brand names of Alpha-glucosidase inhibitors?

A

acarbose (Precose)

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8
Q

What are the generic and brand names of Meglitinides?

A

repaglinide (Prandin)

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9
Q

What are the generic and brand names of Incretin modifiers?

A

sitagliptin (Januvia)

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10
Q

What are the generic and brand names of SGLT-2 Inhibitors?

A

empagliflozin (Jardiance)

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11
Q

Are oral antidiabetic drugs are absorbed well?

A

Yes

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12
Q

Where are oral antidiabetic drugs are absorbed?

A

GI tract

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13
Q

Where are oral antidiabetic drugs distributed?

A

Via the bloodstream throughout the body

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14
Q

Where are oral antidiabetic drugs metabolized?

A

Liver

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15
Q

How are MOST oral antidiabetic drugs excreted?

A

Mostly:

  1. Urine

Some excreted:

  1. Bile
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16
Q

Which oral antidiabetic drugs are excreted differently?

A

Thiazolidinedione drugs

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17
Q

How are Thiazolidinedione drugs excreted?

A

Equally in:

  1. Urine
  2. Bile
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18
Q

What are the actions of oral antidiabetic drugs?

A
  1. Stimulates insulin release from the pancreatic beta cells
  2. Reduces glucose output by the liver
  3. Extrapancreatic effect increases peripheral sensitivity to insulin
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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

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20
Q

Who should takes oral antidiabetic drugs?

A

Type 2 diabetes

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21
Q

What should be monitored when administering oral antidiabetic drugs?

A
  1. Adverse effects (hypoglycemia)
  2. Hypersensitivity reactions
  3. Hematologic disorders
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22
Q

When may a patient develop hypoglycemia when taking oral antidiabetic drugs?

A

During times of stress

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23
Q

If a patient is experiencing hypoglycemia due to stress what may be indicated?

A

Insulin

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24
Q

What should a patient taking oral antidiabetic drugs avoid?

A

Alcohol

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25
Q

Why should a patient taking oral antidiabetic drugs avoid alcohol?

A

Produces a disulfiram-like reaction

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26
Q

What is disulfiram?

A
  1. It is used to treat chronic alcoholism

2. It causes unpleasant effects when even small amounts of alcohol are consumed.

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27
Q

What are the effects of disulfiram?

A
  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
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28
Q

Where do oral antidiabetic drugs produce actions?

A

Within and outside the pancreas

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29
Q

How do oral antidiabetic drugs treat DM within the pancreas?

A

Stimulate pancreatic beta cells to release

insulin in a patient with a minimally functioning pancreas

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30
Q

What can occur within a few week to months of starting sulfonylureas?

A
  1. Pancreatic insulin secretion drops to pretreatment levels

BUT

  1. BS levels remain normal
31
Q

Other than treating DM within the pancreas, how else can oral antidiabetic drugs treat DM?

A

Extrapancreatic actions

32
Q

What are oral antidiabetic drugs extrapancreatic actions?

A
  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
Q

What specific action occurs with administration of pioglitazone?

A

Improves insulin sensitivity

34
Q

What specific action occurs with administration of Metformin?

A

Decreases:

  1. Liver production of glucose
  2. Intestinal absorption of glucose

Improves:

Insulin sensitivity

35
Q

What specific action occurs with administration of acarbose and miglitol?

A

Inhibit enzymes which delays glucose

absorption.

36
Q

What specific action occurs with administration of Sitagliptin?

A

Slows the breakdown of intestinal hormones that allow insulin levels to increase after a meal

37
Q

Can Type 1 diabetics use oral antidiabetic drugs? why?

A

No, in type 1 the pancreatic cells aren’t producing at a minimal level

38
Q

Can you combine insulin and oral antidiabetic drugs?

A

Yes

39
Q

When would you combine insulin and oral antidiabetic drugs?

A

In patients who don’t respond to either drug when used alone

40
Q

What can occur when oral antidiabetic drugs interact with other drugs?

A

Hypoglycemia and hyperglycemia

41
Q

Which drug interactions cause Hypoglycemia?

A

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
Q

Which drug interactions cause Hyperglycemia?

A

Sulfonylureas combined with:

  1. Corticosteroids
  2. Rifampin
  3. Sympathomimetics
  4. Thiazide diuretics.
43
Q

Hypoglycemia is less likely to occur when metformin is used how?

A

As a single agent

44
Q

Other than hyperglycemia and hyporglycemia what drug-drug interaction can occur with oral antidiabetic drugs?

A

Renal failure

45
Q

Which two drugs take together can cause renal failure?

A

Iodinated contrast dyes

46
Q

When are Iodinated contrast dyes used?

A

During some procedures

47
Q

If a patient is undergoing a procedure that requires Iodinated contrast dyes what should occur?

A

Metformin doses should be withheld

48
Q

What increases risk of adverse reaction of hypoglycemia when using oral antidiabetic drugs?

A

Combination therapy

49
Q

Which oral antidiabetic drugs causes adverse reactions?

A
  1. Sulfonylureas
  2. Metformin
  3. Acarbose
  4. Thiazolidinediones
50
Q

What are the adverse reactions that can occur when taking Sulfonylureas?

A
  1. Nausea
  2. Epigastric fullness
  3. Blood abnormalities
  4. Fluid retention
  5. Rash
  6. Hyponatremia
  7. Photosensitivity
51
Q

What are the adverse reactions that can occur when taking Metformin?

A
  1. Metallic taste
  2. N&V
  3. Abdominal discomfort
52
Q

What are the adverse reactions that can occur when taking Acarbose?

A
  1. Abdominal pain
  2. Diarrhea
  3. Gas
53
Q

What are the adverse reactions that can occur when taking Thiazolidinediones?

A
  1. Weight gain

2. Swelling

54
Q

What to assess for when prescribing oral antidiabetic drugs?

A
  1. BS level
  2. Adverse reactions/interactions
  3. Compliance
55
Q

When a patient is transferring from insulin therapy to oral antidiabetics what action should occur?

A

Glucose monitoring at least three times

daily before meals

56
Q

Goals of oral antidiabetic drug therapy?

A
  1. BS level in normal limits
  2. Injury to the patient minimized
  3. Pt ad family understand drug therapy
57
Q

How often are sulfonylureas administered?

A

Once a day or twice a day

58
Q

When should sulfonylureas be administered when they are being dosed once a day?

A

30 min before AM meal

59
Q

When should sulfonylureas be administered when they are being dosed twice a day?

A

30 min before AM meal and PM meal

60
Q

How often is metformin administered?

A

Twice a day

61
Q

When should metformin be administered?

A

Before AM meal and PM meal

62
Q

How often are Alpha-glucosidase inhibitors administered?

A

Three times a day

63
Q

When should Alpha-glucosidase inhibitors be administered?

A

With the first bite of each main meal (3)

64
Q

What should be monitored in patients taking thiazolidinedione?

A

Liver enzyme levels

65
Q

How long should Liver enzyme levels be monitored in patients taking thiazolidinedione?

A
  1. Every 2 months for the first year of therapy

2. Periodically thereafter

66
Q

Do patients transferring from one oral antidiabetic drug to another TYPICALLY need a transition period?

A

No

67
Q

How often do most patients take oral antidiabetic drugs?

A

Once daily

68
Q

When would a patient take oral antidiabetic drugs twice daily (or more)?

A

When a patient is requiring increased doses (once a day) they may achieve better effect with twice a day dosing

69
Q

What should be done if a patient has a hypoglycemic reaction?

A
  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
Q

When might a patient taking oral antidiabetic drugs require insulin?

A

During times of stress including…

  1. Infection
  2. Fever
  3. Surgery
  4. Trauma
71
Q

During times of stress when insulin therapy is indicated with oral antidiabetic drugs what is important to monitor?

A

Monitor for hyperglycemia

72
Q

What adjunct therapy should always be used during oral antidiabetic drug therapy?

A

Diet and exercise

73
Q

Patient education when using oral antidiabetic drugs?

A
  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
  9. Wear/carry medical ID at all times.

Pharmacology Spring 2021: Set 2 (14 decks)

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