Exam 4 Medications

Conventional Insulin Types

Regular (Rapid-acting), NPH (Intermediate-acting, longer duration), Lente (Intermediate-acting, longer duration), Ultralente (long duration)

Analogue Insulins

Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra), Detemir (Levemir), Glargine (Lantus, Basaglar), Degludec (Tresiba)

Human Regular Insulin Therapeutic Class

Antidiabetic, pancreatic hormone

Human Regular Insulin Pharm Class

Short-acting hypoglycemic

Human Regular Insulin MOA

Increases glucose uptake, stimulates glycogen storage, and inhibits glucagon release

Human Regular Insulin ADRs

Lipodystrophy, weight gain, and hypoglycemia

Human Regular Insulin Nursing Considerations

Ensure the patient carries a glucose supply, rotate injection sites, monitor for hypoglycemia

Antidiabetic Agents Classes

Insulinotropic (Sulfonylureas, Meglitinides), Biguanides, Thiazolidinediones (TZD), Alpha-Glucosidase Inhibitors, Amylin Mimetics, Incretin Mimetics (GLP-1 and G1P Agonists), DPP-4 Inhibitors, SGLT2 Inhibitors

Sulfonylureas MOA

Stimulate pancreatic beta cells to secrete insulin

Sulfonylureas Lab Effect

A1C decrease (0.6-1.2%)

Sulfonylureas Risk

Caution with hypoglycemia

Sulfonylureas Dosing

Take 30 minutes before a meal

Glyburide Pharm Class

Sulfonylurea

Glyburide MOA

Stimulates insulin secretion from pancreatic beta cells, increasing insulin in the blood and lowering blood glucose in T2DM patients

Glyburide ADRs

Hypoglycemia and weight gain

Glyburide Contraindications

T1DM, DKA

Glyburide Nursing Considerations

Take oral, monitor glucose levels, and monitor for signs of hypoglycemia

Meglitinides MOA

Stimulates rapid, short-acting insulin from pancreatic beta cells

Meglitinides Dosing

Take before meals (up to 3x/day)

Meglitinides Risk

Hypoglycemia and weight gain

Repaglinide Pharm Class

Meglitinide

Repaglinide MOA

Stimulates insulin release from pancreatic islet cells

Repaglinide DDI

Interacts with CYP3A4 inducers and grapefruit juice

Biguanides MOA

Increases insulin sensitivity, decreases liver glucose production

Biguanides Effects

Lowers triglycerides and raises HDL

Biguanides Risk

May cause B12 deficiency, caution with lactic acidosis

Metformin Therapeutic Class

Antidiabetic

Metformin MOA

Decreases glucose by inhibiting gluconeogenesis, decreases hepatic glucose production, and raises glucose uptake and insulin sensitivity

Metformin ADRs

Diarrhea and abdominal pain

Metformin Black Box Warning

Lactic acidosis

Metformin Contraindications

IV contrast (stop 2 days before), and CKD

Thiazolidinediones (TZD) MOA

Increases insulin sensitivity (like biguanides), and decreases hepatic glucose production

Thiazolidinediones (TZD) Effects

Inreases HDL and LDL

Thiazolidinediones (TZD) Benefits

Potential CV benefits

Thiazolidinediones (TZD) Risks

Fluid retention and HF

Rosiglitazone Therapeutic Class

Antidiabetic Drug

Rosiglitazone Pharm Class

Thiazolidinedione

Rosiglitazone MOA

Decreases glucose by increasing cellular sensitivity to insulin

Rosiglitazone ADRs

May increase lipids (HDL, LDL, and TRG)

Rosiglitazone Black Box Warning

Fluid retention

Rosiglitazone Contraindications

Heart failure

Alpha-Glucosidase Inhibitors MOA

Delays carbohydrate absorption in the small intestine by inhibiting alpha-glucosidase enzymes (indirectly helps with lowering BS)

Alpha-Glucosidase Inhibitors Risks

Flatulence, diarrhea, abdominal pain (GI side effects), and contraindicated in bowel diseases

Acarbose Drug Class

Alpha-Glucosidase Inhibitor

Acarbose MOA

Inhibits alpha-glucosidase in the GI tract, reduces carbohydrate absorption and lowers postprandial BS levels in T2DM

Acarbose ADRs

Diarrhea, flatulence, abdominal distention, and anemia (iron deficiency)

Acarbose Nursing Considerations

Administer orally with 1st bite of food for each meal to reduce GI side effects

Take w/ meals to reduce GI side effects

Amylin Mimetics MOA

Suppresses postprandial glucagon and works w/ insulin to prevent post-meal glucose spikes

Amylin Mimetics Effects

Decreases postprandial glucose

Amylin Mimetics Dosing

Subcutaneous before meals

Amylin Mimetics Benefits

Helps control post-meal spikes, supports weight management

Pramlintide Drug Class

Amylin Mimetic

Pramlintide MOA

Mimics the action of amylin to delay gastric emptying (decreases weight)

Pramlintide Nursing Considerations

SubQ injection before meals

SGLT2 Inhibitors (sodium-glucose co-transporter 2) MOA

Decreases A1c

Canagliflozin Drug Class

Antidiabetic, SLGT2 Inhibitor

Canagliflozin MOA

Inhibits SGLT2 in the kidneys to reduce glucose reabsorption and increase glucose excretion in urine

Canagliflozin Contraindications

CKD (eGFR <30)

Canagliflozin Nursing Considerations

Regularly monitor renal function through labs and testing

GLP-1 and GIP Agonists MOA

Activates GLP-1 and G1P receptors to increase insulin secretion, decrease glucagon, slows gastric emptying, and promote satiety

GLP-1 and GIP Agonists Benefits

Significant weight loss

GLP-1 and GIP Agonists Risks

Pancreatitis, medullary thyroid cancer, and MEN2

Exenatide Drug Class

GLP-1 Receptor Agonist

Exenatide MOA

Mimics GLP-1 to to increase insulin secretion, inhibit glucagon release, delay gastric emptying and promote satiety

Exenatide ADRs

N/V/D, and pancreatitis

Exenatide Nursing Considerations

SubQ injection

DPP-4 Inhibitors (Gliptins) MOA

Inhibits DPP-4 enzyme to increase endogenous GLP-1 and GIP to increase insulin secretion and decrease glucagon

DPP-4 Inhibitors (Gliptins) Dosing

Oral, once daily

DPP-4 Inhibitors (Gliptins) Benefits

Low risk of hypoglycemia

Sitagliptin Drug Class

DPP-4 Inhibitor

Sitagliptin MOA

Inhibits DPP-4 enzyme to breakdown incretin hormones, inhibits incretin levels leading to increased insulin secretion, decreased glucagon to lower BS levels in T2DM

Sitagliptin ADRs

Nasopharyngitis and pancreatitis (rare)

Sitagliptin Nursing Considerations

Monitor renal function (through eGFR & BS levels)

Pharmacotherapy for T2DM goals

A1c <6.5%, FBS <130 mg/dL, may need 2nd drug, avoid hypoglycemia (<70 mg/dL)

Nausea and Vomiting Pharmacologic Treatment

Antiemetics, antihistamines, anticholinergics, corticosteroids, and rehydration therapy

Ondansetron Classification

Antiemetic

Ondansetron MOA

Blocks serotonin receptors in CTZ and peripherally

Ondansetron Uses

N/V prevention & treatment (chemotherapy)

Ondansetron ADRs

QT prolongation and serotonin syndrome

Loperamide (Imodium) Classification

Antidiarrheal

Loperamide (Imodium) MOA

Slows intestinal motility by acting on opioid receptors in the gut

Loperamide (Imodium) Contraindications

Infectious diarrhea (like C. Diff)

GERD Pharm Treatment

PPIs, H2 blockers, and antacids

Bismuth Subsalicylate (Pepto Bismol) Classification

Antidiarrhea and antimicrobial

Bismuth Subsalicylate (Pepto Bismol) MOA

Reduces intestinal inflammation and inhibits bacterial growth

Bismuth Subsalicylate (Pepto Bismol) ADRs

Black stools and black tongue

Bismuth Subsalicylate (Pepto Bismol) Contraindications

Children with viral infections (Reye’s syndrome)

Bismuth Subsalicylate (Pepto Bismol) Nursing Considerations

Discoloration of stool and tongue

Diphenoxylate/Atropine Pharm Class

Antidiarrheal (Opioid agonist, Anticholinergic)

Diphenoxylate/Atropine MOA

Slows intestinal motility on opioid receptors and reduces cramping with atropine

Psyllium (Metamucil) Pharm Class

Bulk-forming laxative

Psyllium (Metamucil) MOA

Absorbs water into the intestine forming a gel that promotes peristalsis soften stool

Psyllium (Metamucil) Nursing Considerations

Administer with plenty of water, monitor for signs of impaction, and do not take within 2 hours of other medications

Polyethylene Glycol (MiraLAX) Pharm Class

Osmotic laxative

Polyethylene Glycol (MiraLAX) MOA

Increases water content in the stool by drawing water into the colon causing softer stool and easier passage

Polyethylene Glycol (MiraLAX) Indications

Bowel preparation for colonoscopy

Polyethylene Glycol (MiraLAX) ADRs

Diarrhea

Polyethylene Glycol (MiraLAX) Nursing Considerations

Can be mixed with water, juice, or other liquids, usually take 1-3 days for full effect, so it is not immediate relief

Bisacodyl (Dulcolax) Pharm Class

Stimulant laxative

Bisacodyl (Dulcolax) MOA

Stimulates peristalsis by irritating the colonic mucosa by increasing water electrolyte secretion into colon