20.14g Oral Hypoglycemic Agents & Hyperglycemic Agents

Oral hypoglycemic agents

(?) are used to stimulate insulin secretion from the pancreas in patients with NIDDM.

type 1 diabetes

These agents are ineffective in people with (?) because those patients cannot secrete insulin.

sulfonylureas

This functional class comprises four pharmacologic classes: (?), biguanides, alpha-glucosidase inhibitors, and thiazolidinediones.

first-generation or second-generation oral hypoglycemics

The sulfonylureas were the first class of oral hypoglycemics available and as such are also known as (?), depending on when they were released.

tolbutamide (Orinase)

Medications in this class include (?), chlorpropamide (Diabinese), glipizide (Glucotrol), and glyburide (Micronase).

insulin secretion

They work by increasing (?) from the pancreas and can also increase tissue response to insulin.

hypoglycemia

Their major side effect is (?).

metformin (Glucophage)

The only agent in the biguanide class is (?).

glucose synthesis

It decreases (?) and increases glucose uptake.

hypoglycemia

It does not stimulate the release of insulin from the pancreas and therefore does not cause (?).

nausea

Its primary side effects are (?), vomiting, and decreased appetite.

acarbose (Precose)

Alpha-glucosidase inhibitors include (?) and miglitol (Glyset).

delaying carbohydrate metabolism

They work by (?), which moderates the increase in blood glucose that occurs after meals.

flatulence

These agents’ primary side effects are (?), cramps, diarrhea, and abdominal distention resulting from colonic bacteria feeding on the increased number of carbohydrates remaining in fecal matter.

Thiazolidinediones

(?) are a new class of oral hypoglycemic agents unrelated to the others.

troglitazone (Rezulin)

The only medication in this class is (?).

tissue response to insulin

It works by promoting (?) and thus making the available insulin more effective.

no major side effects

Troglitazone has (?).

glucagon

Two hyperglycemic agents, (?) and diazoxide (Proglycem), act to increase blood glucose levels.

emergency treatment

Glucagon is indicated for the (?) of patients with hypoglycemia.

intramuscularly

It is frequently given (?) to hypoglycemic patients in whom an IV line is unobtainable.

nausea

Occasional side effects are (?) and vomiting and, uncommonly, allergic reactions.

Diazoxide (Proglycem)

(?) inhibits insulin release and is typically used only for patients with hyperinsulin secretion resulting from pancreatic tumors; it is more commonly used for hypertension.

not indicated

It is (?) for treating diabetes-induced hypoglycemia.

D50W (50 percent dextrose in water)

(?) is a sugar solution given intravenously for acute hypoglycemia.

local tissue necrosis

Its primary side effect is (?) if infiltration occurs.

D10W (10 percent dextrose in water)

Many EMS systems have transitioned from D50W to (?), which is less expensive and equally effective.

less persistent hyperglycemia

Furthermore, it causes (?) following administration.

less hypertonic

It is (?) than D50W and that decreases the likelihood of tissue damage if the solution extravasates.