Test 2 - Oral Diabetics (Josh) Flashcards
Oral meds are for which type of diabetes?
Type 2
Why should we not call them oral hypoglycemics?
it implies that they lower blood sugar, but the really don’t. (then you’d have to worry a/b hypoglycemia)
they actually just block it from going up
MAO: Oral Diabetic Meds
block blood sugar from going up
Which drug is the cornerstone of T2DM mgmt?
Metformin
Which oral drug can be given prophylactically for T2DM?
Metformin
Flatulence and Diarrhea are common w/ —–
Metformin
tends to go away w/ time
Which oral agent lowers absorption of b12 & folic acid? What does this cause
Metformin
causes anemia
How can lowering B12 be very problematic w/ Diabetics taking Metformin?
lowering B12 leads to neuropathy. Metformin lowers B12. Neuropathy is already caused by diabetes, so it could be severe
How rare is lactic acidosis as a side effect for Metformin?
3 clients per 100,000 client years
Kussmaul respirations could be seen with which drug?
Metformin, b/c it can cause acidosis
Which oral diabetic drug is ‘weight neutral’?
Metformin
If having kidney problems, which oral agent should we monitor?
Sulfonylureas, b/c it is renally excreted
MOA: Sulfonylureas
causes the pancreas to increase insulin (hits it w/ a bat)
can result in hypoglycemia (b/c insulin moves the sugar out of blood into muscle cells)
Don’t drink —– when taking a sulfonylurea.
alcohol
Which drug is an add-on to metformin?
TZD
A client taking rosiglitazone sees no results after 3 wks, should they change drug?
no, TZD drugs work on DNA, which takes 3-4 months to take effect
Which medication should your worry about hypoglycemia?
sulfonylureas
Which medication should you worry about weight gain?
TZDs
Sulfonylureas (5-10 lbs)
Best oral diabetic drug?
Metformin
Client has lots of gas and diarrhea, which oral diabetic drug is she likley taking?
Metformin
Five types of Oral Diabetics:
1) Metformin
2) Sulfonylureas
3) TZDs
4) DPP-4 inhibitors
5) SGLT-2 inhibitors
MOA: Metformin
- tells LIVER to decrease glucose production
- tells GUT to decrease glucose absorption
- tells MUSCLE CELLS to increase sensitivity of insulin receptors
Do you worry about weight gain w/ Metformin?
no, it is weight neutral
Adverse Effects of Metformin:
- Diarrhea & Flatulence (most common)
- Decreased Vit B12
- Decreased Folic Acid
- Lactic Acidosis (rare)
Second most common T2DM medication?
sulfonylureas
- Glipizide
- Glyburide
- Glimepiride
Major Sulfonlurea Medications (Oral Diabetic Meds)
Glipizide
Glyburide
Glimepride
Adverse effects: Sulfonylureas
- Hypoglycemia (b/c it makes insulin)
- Weight gain (5-10 lbs)
- Burn out (5-10 years)
Which class of oral diabetic meds has the adverse effect of ‘burn out’?
Sulfonlureas (Glipizide, Glyburide, Glimepiride)
b/c the pancreas gets tired of being stimulated to produce insulin and just stops
Which class of T2DM oral meds are renally exrcreted?
Sulfonylureas
monitor kidney function
Which drug has an adverse effect w/ alcohol?
Sulfinylureas (Glipizide, Glyburide, Glimepride)
- has disulfiram like reaction (stress test in a pill)
- potentiates the hypoglycemic effect
If a client taking Glipizide begins to drink alcohol, what should we see?
- stress test like symptoms (acts like disulfiram
- very low blood sugar (alcohol potentiates the hypoglycemic effect)
Which T2DM Oral Med is typically an add-on to Metformin?
TZD (Thiazolidinediones)
MOA: TZD
Goes to DNA and increases insulin sensitivity of cells
prob is that DNA drugs take a long time to take effect (3-4 months)
Major TZD (T2DM Oral Agent)
RosiGLITAZONE
PioGLITAZONE
Which T2DM Oral Agent has a mixed effect on lipids?
Pioglitazone (TZD)
raises HDL (good) lowers TGs (good) raises LDL (bad)
Adverse effects of Rosiglitazone & Pioglitazone (TZD):
- Edema (causes kidneys to retain Na+)
- Weight gain (from the edema)
- Bone fractures
- Hepatotoxicity (rare)
- Bladder Cancer (rare)
How do DPP-4 Inhibitors work?
they lower blood glucose by preventing DPP-4 from breaking down Incretin Hormones (which increase gastric emptying, increase insulin, & decrease glucagon)
—- —– are secreted by body to help stomach digest food and help increase insulin production (lowering blood glucose). They are broken down by —–, which leads to an increase in blood glucose.
Incretin Hormones
DPP-4
important to know b/c DPP-4 Inhibitors block the breakdown of these hormones, and allows more of them to make insulin and lower blood sugar
Sitagliptan
DPP-4 Inhibitor (T2DM Oral Agent)
- well-tolerated
- upper respiratory issues is most common (runny nose, etc.)
- rarely causes PANCREATITIS
Which T2DM Oral Agents work in the nephron, altering the reabsorption of glucose?
SGLT-2 Inhibitors
When should you take SGLT-2 Inhibitors.
Before breakfast
If blood sugar is 180, sugar ——-
is reabsorbed
reabsorption is blocked
SGLT-2 Inhibitors block reabsorption of sugar when it is —–
> 80
Canagliflozin
SGLT-2 Inhibitor (T2DM Oral Agent)
canagliFLOzin allows urine to FLOw (along w/ the sugar)
Adverse Effects w/ canagliflozin
- Weight loss (5-7 lbs)
- Dehydration
- Hyperkalemia
- Genital Infections
Adverse Effects for canagliflozin (SGLT-2 Inhibitor): Weight Loss
patient loses 5-7 lbs due to increase in water loss
Adverse Effects for canagliflozin (SGLT-2 Inhibitor): Dehydration
water follows the sugar out into the urine
Adverse Effects for canagliflozin (SGLT-2 Inhibitor): Hyperkalemia
when sugar is being excreted, it allows less space for K+ to be excreted, leading to buildup of K+
Adverse Effects for canagliflozin (SGLT-2 Inhibitor): Genital Infections
yeast infection happens with 10% of women and 3-4% of men
Which oral medication works prophylactically (delays development of T2DM in at risk clients?
Metformin
