LM3 - ppt. 2 endocrine drugs -> oral antidiabetic agents Flashcards
what are the oral antidiabetic drug classes?
- sulfonylureas
- biguanides
- alpha-glucosidase inhibitors
- glitazones
-meglitinide
when are oral diabetic agents effective?
when there is a functioning pancreas
- clients w/type 1 diabetes cannot use these agents bc pancreas no longer secretes insulin
- clients w/type 2 diabetes may have to use insulin if oral agents are not effective
combination therapy for type 2 diabetes?
- insulin + a sulfonylurea
- insulin + pioglitazone (Actos)
- sulfonylurea + acarbose (Precose) or miglitol (Glyset)
- Sulfonylurea plus metfomin (Glucophage)
- Sulfonylurea plus a glitizone
- Metformin plus repaglinide
about oral agents?
- admin. sulfonylureas about 30 minutes before breakfast (burst of insulin)
- administer acarbose and miglitol at the beginning of each meal, three times per day
- metformin is administered with meals
- insulin (with the exception of lispro) is administered 30 minutes before meals
what are adverse effects of antidiabetic agents?
hypoglycemia -> m/c with insulin but may occur w/oral sulfonylureas
s/s
- tachycardia, palpitations, nervousness, weakness, hunger, perspiration
- mental confusion, incoherent speech, blurred vision, headache, convulsions, coma
what is hypoglycemia defined as? (BS levels)
- <60-70mg/dL
- treatment depends of client’s LOC
what is the goal of hypoglycemia treatment?
- goal of treatment is to relieve hypoglycemia and restore the brain’s supply of glucose to prevent permanent brain damage
what are the different ways to treat hypoglycemia?
- If awake, give a 10-15 gram carbohydrate snack (2 sugar cubes, or 5-10 lifesavers), follow with a protein/carbohydrate snack
- If client is unconscious or cannot swallow, give parenteral glucose or IM glucagon (hormone that causes liver to convert stored glycogen into glucose and release it into bloodstream)
what are incretins and amylin?
- natural hormones that work with insulin to keep blood glucose levels within normal range
ex.) Byetta (exenatide) subQ, Januvia (sitagliptin) oral
what are the intended responses, side/adverse effects, and patient teaching of drugs that increase incretins and amylin?
- intended response: normal BG levels, no glucose in urine, weight loss
- side effects: nausea, vomiting, diarrhea
- adverse effects: hypoglycemia (severe)
- patient teaching: s/s of hypoglycemia, allergic reaction; take before two main daily meals, not after meals
lifespan considerations for drugs that increase incretins and amylin in pediatrics?
- not tested or recommended
lifespan considerations for drugs that increase incretins and amylin in pregnancy or breastfeeding?
- not recommended
- insulin preferred to manage diabetes during pregnancy, breastfeeding
lifespan considerations for drugs that increase incretins and amylin in older adults?
- higher risk of hypoglycemia, esp. if taking a sulfonylurea, beta blockers, or warfarin
- greater risk for infection at inj. sites
- blood glucose may be more difficult to control due to poor eating
