oral medications for diabetes Flashcards
what is a post-prandial glucose?
glucose 2 hrs after eating
What is the goal for post-prandial glucose?
<140
What do post-prandial glucose levels depend on?
the amount of food eaten
How does pst-prandial glucose work in nondiabetics?
plasma glucose concentrations peak around 60 minutes after the start of a meal (rarely >140) & return to pre-prandial levels within 2-3 hrs
What is a step wise approach that begins with lifestyle modifications?
non- insulin management of diabetes
What are the lifestyle modifications that need to be made to manage diabetes?
siet & excercise
there are approximately __ groups of medication used to treat type 2 diabetes; different mechanism of action
12
What are the glycemic targets for diabetics trying to manage glucose?
individualized to person
A1C < 7%
FPG 80-130
PPG <140
What medication is in the biguanides class?
metformin (glucophage)
What is considered to be the first-line tx for type 2 diabetes?
metformin
What does metformin do?
- decreases absorption of carbs
- decreases glucose production in the liver
- improves how insulin works in the body (insulin sensitizer)
can metformin be given with other medications?
yes; given alone or in combination with other medications
What are the side effects of metformin?
GI side effects
- decreases appetite
- bloating
- abd pain
- nausea
- metallic taste
- may cause weight loss
what does metformin increases risk of?
increases risk of B12 deficiency (risk of pernicious anemia)
is hypoglycemia a side effect of metformin?
hypoglycemia is not a problem when used alone
What does metformin do to the blood?
decreases platelet aggregation & reduces viscocity
What can metformin do to lipids?
can help decrease lipids
What can help with GI effects of metformin?
taking it with food
What is a nursing consideration for metformin?
hold 48 hrs before & after contrast dyes to prevent lactic acidosis or AKI
When is metformin contraindicated?
- renal impairment
- hepatic impairment
- heart failure
What medications are in the sulfonylurea class?
glipizide (glucotrol)
glyburide (DiaBeta)
glymepride (amaryl)
What is the most commonly prescribed & most inexpensive class of oral diabetic medications?
sulfonylureas
How do sulfonylureas work?
stimulates beta cells to secrete insulin
- decrease glucose production by the liver
what can sulfonylureas be taken with?
used alone or with metformin/insulin
What are the side effects of sulfonyureas?
- hypoglycemia
- weight gain
- GI disturbances
- increase risk for sunburn (photosensitivity)
When should sulfonylureas be used cautiously?
renal impairment
hepatic impairment
When is the onset & peak of sulfonylureas?
onset - 90 minutes
peak - 2-3 hrs
When are sulfonylureas contraindicated?
- allergic to sulfa medications
- pregnant or lactating
What are drug interactions with sulfonylureas?
- oral anticoagulants
- NSAIDS
- H2 blockers
- warfarin
- beta blockers
- alcohol
Should sulfonylureas be taken with or without food?
with food
What should you not do when taking sulfonylureas?
drink alcohol!
What causes decreased concentrations of sulfonylureas?
- thiazides
- steroids
- TB meds
What medications are in the metglitinides class?
repaglinide (prandin)
nateglinide (starlix)
How do metglitinides work?
stimulates beta cells to produce more insulin
Can metglitinides be used in those with allergies to sulfa?
yes
Can metglitinides be used with other meds?
yes; alone or in combination; often with metformin
how should metglitinides be taken?
should be taken with first bite of good; must eat within 15 minutes of taking med
should you take metglitinides if skipping meal or NPO?
no; skip dose if skipping meal
- hold if pt is NPO
What are the side effects of metglitinides?
weight gain
angina
hypoglycemia
is hypoglycemia more of a risk with metglitinides or sulfonylureas?
sulfonylureas
How do thiazolidinediones work?
improve the effectiveness of insulin by decreasing insulin resistance in adipose & muscle cells
- block hepatic gluconeogenesis
- increases insulin sensitivity
What line tx are thiazolidinediones?
2nd or 3rd line
can thiazolidinediones be combined with other meds?
yes; alone or in combination
Is thiazolidinediones taken with or without food?
can be taken with or without food
What medication is in the thiazolidinediones class?
pioglitazone (actos)
What are the side effects of thiazolidinediones?
- weight gain
- fluid retention
- edema
- osteopenia (increased fracture risk)
- possible bladder cancer risk
when are thiazolidinediones contraindicated?
- heart failure
- hepatic impairment
What should you monitor when taking thiazolidinediones?
monitor LFTs before & during use
What are alpha glucosidase inhibitors also known as?
starch blockers (delay carbohydrate absorption)
What medications are in the alpha glucosidase inhibitor class?
acarbose (precose)
miglitol (glyset)
How do alpha glucosidease inhibitors work?
inhibit alpha-glucosidase, by delaying the absorption of glucose in the small intestine after a meal; does not increase insulin secretion
- slows glucose entry into bloodstream, reducing PPG spikes
What are the side effects of alpha glucosidase inhibitors?
anemia
GI effects
- diarrhea
- distention
- flatulence
hypoglycemia (esp in combo w/ other meds)
When are alpha glucosidase inhibitors contraindicated?
in renal impairment
in pt w/ GI problems
How should alpha glucosidase inhibitors be taken?
should be taken with the first bite of food
Can alpha glucosidase inhibitors be used with other meds?
yes; may be used in combination with other glucose-lowering meds
What should you monitor when taking alpha glucosidase inhibitors?
monitor liver function studies (LFTs)
What kind of therapy is glucagon-like peptide (GLP-1 receptor agonists?
incretin; hormone-based therapy
how do GLP-1s work?
- stimulates pancreas = increases insulin secretion & blocks glucagon secretion
- delays gastric emptying = delays glucose spikes
- decreases appetite; increased feeling of fullness = leads to weight loss
- crosses BBB = increases satiety
- promotes growth & development of beta cells
What can GLP-1s cause in combination with other meds?
hypoglycemia
What are the side effects of GLP-1s?
- nausea
- abd pain
- constipation
- risk of pancreatitis
- injection site reactions
When are GLP-1s taken?
once a day or once a week injectable
What are the medications in the GLP-1 class?
semaglutide (rybelsus/ozempic)
- oral agent (rybelus)
- SQ inj. (ozempic)
- for weight loss (wegovy)
exenatide (byetta)
- SQ inj.
- caution in pt w/ pancreatitis, gallstones, kidney dysfunction & high triglycerides
- no alcohol
dulaglutide (trulicity)
- SQ inj.
Liraglutide (victoza)
What is important to differentiate with the types of semaglutide?
important to differentiate between ozempic & wegovy due to insurance. ozempic indicated for diabetes & wegovy indicated for weight loss
What medications are DPP-4 (gliptin) inhibitors?
sitagliptin (januvia)
saxagliptin (onglyza)
linagliptin (tradjenta)
alogliptin (nesina)
How do DPP-4 inhibitors work?
- inhibit dipetidyl peptidase 4 (DDP-4) enzyme, which destroys the GI incretin hormones GLP-1 & GIP
- increase insulin secretion
- decrease glucagon secretion to decrease glucose production
allows incretin hormones to remain in circulation longer (prolongs insulins effect) - slows gastic emptying
Can DPP-4 inhibitors cause weight loss?
yes
do DPP-4 inhibitors cause hypoglycemia?
do not cause hypoglycemia unless used in combination w/ insulin or sulfonylureas
How are DDP-4 inhibitors administered?
injection
What are the side effects of DPP-4 inhibitors?
- headache
- renal impairment
- diarrhea
- N/V
- constipation
- joint pain
- increased risk for pancreatitis
- increased risk for upper respiratory infections
- hypoglycemia
How do sodium glucose co-transporter 2 inhibitors (SGLT2) work?
- inhibit reabsorption of glucose in the proximal renal tubules; promote glucose excretion in urine
- blocks glucose reabsorption in kidneys = glucose excreted in urine
What medications are in the sodium glucose co-transporter 2 inhibitors (SGLT2) class?
canaglifozin (invokana)
apagliflozin (farxiga)
empalifozin(jardiance)
What are the benefits of sodium glucose co-transporter 2 inhibitors (SGLT2)?
- weight loss
- may reduce CV complications (anti-inflammatory effects)
Do sodium glucose co-transporter 2 inhibitors (SGLT2) causes hypoglycemia?
no; does not cause hypoglycemia unless used in combination
When are SGLT2s contraindicated?
w/ renal impairment
What are the side effects of SGLT2s?
- yeast infection
- UTIs
- amputations
- decreased risk of hyperkalemia
Should SGLT2 be taken with or without food?
can be taken with or without; take without regard to food
How do all SGLT2 inhibitors provide renal protection?
by decreasing the protein loss & reducing the damage caused by hyper filtration
What should you increase when taking SGLT2 inhibitors?
increase PO fluid intake
What medication is in the amylin analogues (amylinomimetic) class?
pramlintide: symlin injectable
What is special about amylinomimetics?
used for both type 1 & 2
How do amylinomimetics work?
- slows gastric emplying, which helps regulate postprandial rise in blood glucose
- reduces postprandial glucagon secretion
amylinomimetics increase the sense of ________, possibly reducing food intake and promoting _______ ______
satiety; weight loss
When should amylinomimetics be taken?
immediately before meal
When should a amylinomimetics not be given?
if not eating
by what route are amylinomimetics administered?
SQ injection
What will amylinomimetics cause?
hypoglycemia
How do you manage hypoglycemia?
using hyperglycemia agent
What is the primary hyperglycemic agent?
gluagon
How does glucagon work?
- triggers the liver to convert stored glucose (glycogen) into a usable form & then release it into your bloodstream. This process is called glycogenolysis
When should glucagon be used?
for sever hypoglycemia; when pt is unable to take oral glucose
What is D50 (AMPID-50)?
injectable glucagon
How can glucose (D50) be administered?
SQ,IM, or IV
What should you do when a pt is awake or able to swallow after a hypoglycemic event?
provide small snack
