pharm exam 4: antidiabetic medications

type I diabetes mellitus

autoimmune destruction of pancreatic beta cells, results in absolute insulin deficiency and hyperglycemia, insulin replacement therapy required

type II diabetes mellitus

primarily insulin resistance leads to hyperglycemia but also reduced insulin secretion; insulin may be required to achieve target blood sugar levels

oral medications and other innjectables used to treat

insulin secretagogoues

sulfonylureas

meglitinides

both stimulate release of insulin from the pancreas

meglitinides are significantly faster and shorter acting

sulfonylureas MOA

stimulates the release of insulin from the pancreas for type II diabetes, duration 12-24 hours

sulfonylureas and meglitinides adverse effects

hypoglycemia, weight gain

sulfonylureas nursing considerations

contraindiacted in pregnancy, caution with renal and hepatic disease, alcohol and beta blocker use

meglitinides MOA

stimulate release of insulin from the pancreas for type II diabetes, peak at one hour, duration four hours

meglitinides nursing considerations

dosing must be followed by a meal and caution with liver dysfunction

incretin mimetics

glucagon-like peptide-1 (GLP-1) receptor agonists

incretin promotors

dipeptidyl peptidase - IV (DPP-4) inhibitors

incretin hormones

two important incretin hormones secreted by the gut in response to eating are

1. glucogon-like peptide-1 (GLP-1) - stimulates the glucose-dependent release of insulin, inhibits the postprandial release of glucagon, slows gastric emptying, and suppresses appetite

• rapidly inactivated by the enzyme dipeptidyl peptidase-IV (DPP-IV)

2. glucose-dependent insulinotropic polypeptide (GIP) - stimulates the glucose-dependent relese of insulin, promotes beta cell proliferation and is inactivated by DPP-IV

ORAL glucagon-like peptide 1 (GLP-1) receptor agonist MOA

stimulates glucose-dependent release of insulin, inhibits postprandial glucagon release, slows gastric emptying and promotes satiety

ORAL glucagon-like peptide 1 (GLP-1) receptor agonist - therapeutic use

oral adjuvant therapy for type 2 diabetes in patients taking metformin

ORAL glucagon-like peptide 1 (GLP-1) receptor agonist - AE

GI (N/V, abdominal pain), risk of pancreatitis thyroid cancers

dipeptidyl peptidase - IV (DPP-4) inhibitors MOA

enhances the action of incretin hormones by inhibiting dipeptidyl pepsidase and enzyme that inactivated incretin

dipeptidyl peptidase - IV (DPP-4) inhibitors AE

nasal inflammation, upper respiratory infection, risk of pancreatitis, headache

other oral agents that do not cause hypglycemia on their own

Biguanides

sodium-glucose co-transporter 2 inhibitors

thiazolidinediones (glitazones or TSDs)

alpha-glucosidase inhibitors

biguanide - metformin MOA

suppression of hepatic glucose production, enhances glucose uptake and utilization by muscle, decreases glucose absporption in the gut

biguanide - metformin Therapeutic use

type 2 diabetes and PCOS

biguanide - metformin ADVERSE EFFECT

GI disturbances, LACTIC ACIDOSIS

biguanide - metformin nursing considerations

do not use IV dye studies, contraindicated in renal insufficiency, caution in heart failure, avoid alcohol, can cause B-12 and folate deficiencies

sodium glucose Co-transporter 2 (SGLT2) inhibitors MOA

blocks the action of SGLT2. SGLT2 works in the kidney to reabsorb glucose. Blocking SGLT2 results in more glucose being excreted in the urine

sodium glucose Co-transporter 2 (SGLT2) inhibitors - therapeutic use

type 2 diabetes, cardiovascular and renal protective, reduce heart failure risk

sodium glucose Co-transporter 2 (SGLT2) inhibitors - AE

UTI and yeast infections because of more glucose in urine

sodium glucose Co-transporter 2 (SGLT2) inhibitors - nursing considerations

can cause postural hypotension in elderly due to increased urination reducing plasma volume. reduces blood sugar independent of insulin

thiazolidinediones - TZDs MOA

reduces insulin resistance of fat & muscle, may decrease glucose production

thiazolidinediones - TZDs AE

edema, URI, sinusitis, myalgia, HF d/t fluid retention is greatest concern

thiazolidinediones - TZDs nursing consideration

report signs of HF, weight gain, possible hepatotoxicity, monitor ALT levels, increased risk of bone fractures; contrindicated in bladder cancer

alpha-glucosidase inhibitors MOA

inhibit alpha-glucosidase which breaks dwon complex carbohydrates. delayes intestinal absorption of carbohydrates, reducing postprandial hyperglycemia

alpha-glucosidase inhibitors AE

GI disturbances, abdominal pain, diarrhea, liver dysfunction

alpha-glucosidase inhibitors nursing considerations

contradindicated with some GI disease but does not cause hypoglycemia