oral + non-insulin injectable Flashcards
Why are sulfonylureas (Glipizide, Glyburide, Glimepiride) no longer first-line therapy?
Risk of hypoglycemia and weight gain; metformin preferred.
How do sulfonylureas work?
Promote insulin secretion by the pancreas and may increase tissue response to insulin.
What are the major AEs of sulfonylureas?
Hypoglycemia, weight gain.
What should patients do if they are not going to eat after taking a sulfonylurea?
Delay the dose to avoid hypoglycemia.
What is the main nursing instruction for sulfonylureas?
Take 30 min before breakfast or with a meal.
What drugs increase hypoglycemia risk when taken with sulfonylureas?
NSAIDs, sulfonamide antibiotics, cimetidine, beta-blockers.
How do meglitinides (Repaglinide, Nateglinide) work?
Promote insulin secretion by the pancreas.
How are meglitinides different from sulfonylureas?
They are taken TID with meals (0-30 min before).
What additional drug interacts with meglitinides?
Gemfibrozil → increased hypoglycemia risk.
How does metformin work?
Decreases glucose production in the liver, increases glucose uptake in muscle/fat, and decreases GI glucose absorption.
What are the advantages of metformin?
No hypoglycemia risk, lowers triglycerides, LDL, cholesterol, may promote weight loss.
What are the main AEs of metformin?
GI upset, vitamin B12 & folic acid deficiency, lactic acidosis.
What should patients on metformin supplement?
Vitamin B12 & folic acid to prevent neuropathy.
When is metformin contraindicated?
Severe infection, shock, kidney impairment, hypoxia.
What increases the risk of lactic acidosis with metformin?
Alcohol (EtOH), cimetidine.
Why should metformin be held before iodine contrast imaging?
Risk of acute kidney failure.
How do thiazolidinediones (TZDs, Glitazones) work?
Increase insulin sensitivity, increase glucose uptake, decrease glucose production.
What are the main AEs of TZDs (Pioglitazone, Rosiglitazone)?
Fluid retention, increased LDL, hepatotoxicity, possible ovulation in perimenopausal women.
When are TZDs contraindicated?
Severe HF, history of bladder cancer, active liver disease.
What are key drug interactions with TZDs?
Insulin → fluid retention, CYP450 interactions (ketoconazole, gemfibrozil → increased levels, rifampin, cimetidine → decreased levels).
How do alpha-glucosidase inhibitors (Acarbose, Miglitol) work?
Delay carbohydrate digestion & absorption.
Who may benefit more from alpha-glucosidase inhibitors?
Latino & African American patients.
When should alpha-glucosidase inhibitors be taken?
With the first bite of each meal, TID.
What are the main AEs of alpha-glucosidase inhibitors?
GI effects, anemia (due to iron malabsorption), hepatotoxicity.
When are alpha-glucosidase inhibitors contraindicated?
GI disorders (IBD, ulcers, obstruction).
How do DPP-4 inhibitors (Gliptins) work?
Enhance incretin activity → increase insulin release, decrease glucagon secretion.
What are common AEs of DPP-4 inhibitors?
HA, nausea, joint pain, rare pancreatitis.
How often are DPP-4 inhibitors taken?
Once daily with or without food.
How do SGLT-2 inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin) work?
Increase glucose excretion in urine → lower blood glucose and cause weight loss.
Why do SGLT-2 inhibitors increase UTI risk?
More glucose in the urine creates a good environment for infections.
What are the main AEs of SGLT-2 inhibitors?
UTIs, candidiasis, polyuria, dizziness, hypotension.
When are SGLT-2 inhibitors contraindicated?
Renal failure (GFR <45), dialysis patients.
How should SGLT-2 inhibitors be taken?
Once daily before breakfast.
How do GLP-1 receptor agonists (Semaglutide) work?
Incretin mimetics that enhance insulin secretion.
What are the main AEs of GLP-1 receptor agonists?
Nausea, anorexia, pancreatitis.
When are GLP-1 receptor agonists contraindicated?
Type 1 diabetes.
What are examples of amylin mimetics?
Pramlintide (Symlin).
How does pramlintide work?
Used with insulin to slow gastric emptying and suppress glucagon.
What are common AEs of pramlintide?
Nausea, injection site reactions.
When is pramlintide contraindicated?
Kidney failure, dialysis.
How is pramlintide administered?
SQ prior to meals.
What are examples of incretin mimetics?
Exenatide, Liraglutide, Albiglutide, Dulaglutide, Semaglutide.
What are the main AEs of incretin mimetics?
GI effects (N/V/D), pancreatitis.
When are incretin mimetics contraindicated?
Kidney failure, Crohn’s, UC, pancreatitis history.
How are incretin mimetics administered?
SQ injection.
