Diabetes Medications

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What drugs are Sulfonylureas?
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1st generation: chlorpropamide (Diabinese) 2nd generation: More potent at lower doses glyburide (Diabeta,Glynase, Micronase) Glipizide(Glucotrol) 3rd generation: glimepiride (Amaryl)
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What do Sulfonylureas do?
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Stimulates secretion of insulin by beta cells & increases sensitivity of receptor cell sites to insulin
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How do you administer Sulfonylureas?
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With meals once to twice per day
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What are some adverse effects of Sulfonylureas?
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Hypoglycemia Weight gain (fluid retention) GI upset Teratogenic in pregnancy & may result in hypoglycemia in NB after delivery. Drug Interactions: ETOH Flushing, palpitations, nausea. NSAIDS, sulfa antibiotics, ranitidine (Zantac) increase effects of hypoglycemia.
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What are the nursing implications for Sulfonylureas?
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Watch for hypoglycemia Teach pt. S&S and how to prevent. Use with caution in pts. with renal/liver dysfunction. Lower incidence of hypoglycemia with Amaryl.
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What medications are Biguanides?
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Metformin (Glucophage)
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What is the action of Biguanides?
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Reduces amt. of glucose produced in liver. Increases sensitivity of receptor site cells to insulin. Improves lipid profile.
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What are some side effects of Biguanides?
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GI- diarrhea, N, V, flatulence, indigestion. Metallic taste. Drug Interactions: ETOH -increases risk of lactic acidosis Use with caution with HF.
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What should nurses monitor for in patients on Biguanides?
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Monitor renal/liver function. Monitor creatinine levels (>1.4 mg/dL). Monitor for hypoglycemia- Teach S&S and how to prevent
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What medications are Meglitinides?
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Repaglinide (Prandin) Onset: 30 min Duration: < 4hrs Nateglinide (Starlix) Onset: 20-60 min Duration: 4 hrs
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What is the action of Meglitinides?
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Stimulates beta cells to secrete insulin related to meals. Prandin controls fasting glucose better. Starlix controls prandial rise in glucose.
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How should you administer Meglitinides?
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Take 1-30 min before every meal. Omit if meal skipped. Add dose if an extra meal is eaten.
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What are some side effects of Meglitinides?
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Hypoglycemia Drug Interactions: gemfibrozil [Lopid] – inhibits metabolism by liver & increases hypoglycemic effect.
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What should you monitor for in a patient on Meglitinides?
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Use with caution with liver dysfunction. Teach client what to do when pattern of meals changes.
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What are the Alpha-Glucosidase Inhibitors?
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Acarbose (Precose) Duration 2-4 hr Miglitol (Glyset)
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What is the action of Alpha-Glucosidase Inhibitors?
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Blocks enzyme in intestinal tract necessary for breaking CHO into monosaccarides- delays glucose digestion & absorption of glucose.
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What are the side effects of Alpha-Glucosidase Inhibitors?
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Hypoglycemia if given with other hypoglycemic. GI- flatus, bloating, cramps, diarrhea; contraindicated with IBD SBO, cirrhosis. Caution with renal/liver dysfunction. Monitor liver enzymes & creatinine levels.
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What do you teach the patient who is on Alpha-Glucosidase Inhibitors?
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Teach client to use oral glucose gel, or low fat milk for hypoglycemia.
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What medications are Thia/zolidine/di/o/nes TZD’s (Glitazones)?
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Rosiglitazone (Avandia*) pioglitazone (Actos)
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What do Thia/zolidine/di/o/nes TZD’s (Glitazones) do?
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Decreases insulin resistance at cell level. Decreases glucose production by liver. Increases glucose uptake in muscles. Increases sensitivity of tissue cells to insulin. Reduces serum lipid levels.
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How do you administer Thia/zolidine/di/o/nes TZD’s (Glitazones)?
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Take without regard to meals.
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What are the side effects of Thia/zolidine/di/o/nes TZD’s (Glitazones)?
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Fluid retention, weight gain, Liver failure, HA. Increases HDL, LDL. Decreases triglycerides. Bone fractures. Drug Interactions: Reduce effectiveness of oral contraceptive meds. Gemfibrozil [Lopid] increases hypoglycemic effect.
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What are the nursing implications for Thia/zolidine/di/o/nes TZD’s (Glitazones)?
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Benefits take several weeks to develop. Monitor liver function ALT level. *Use with caution with CHF & pre-existing CV disease. Increased risk for CV related mortality with Avandia.
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Combinations Metformin + glyburide (Glucovance) Metformin + Avandia (Avandamet) Metformin + saxagliptin (kombiglyse XR) Metformin + Actos (Actoplus Met) Avandia + Amaryl (Avandaryl)
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See each drug for actions. Give in divided doses with meals. See each drug for side effects +Hypoglycemia. See each drug for nursing implications + Caution with renal/liver dysfunction.
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What medications are Incretin Mimetics (Adjunct for Type 2 diabetes taking metformin, sulfonylurea, or both),
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Exenatide (Byetta)
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What is the action of Incretin Mimetics?
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Glucagon-Like Peptide (GLP-1) released from GI tract cells after meals. Drug binds to GLP-1. Results: Slows stomach emptying. Stimulates glucose-dependent release of insulin. Inhibits postprandial release of glucagon: Suppresses appetite.
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How do you give/take Incretin Mimetics?
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SQ in thigh, abdomen, or upper arm with prefilled injector pen. Administer 60 min before morning/evening meal. Adjunct with metformin. Not recommended for use with insulin.
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What are the side effects for Incretin Mimetics?
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Hypoglycemia. GI: nausea, vomiting, diarrhea, anorexia (usually resolves), weight loss. Pancreatitis. Develop antibodies to exenatide that reduces effect. Drug Interactions: can reduce effects of oral meds b/c slows gastric emptying.
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What are the nursing implications for Incretin Mimetics?
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Give antibiotics & BCP 1 hr before. Keep pen refrigerated – or room temp OK. Do not give after meals. Do NOT use with end-stage renal disease. May delay absorption of oral meds.
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What medications are DPP-4 Inhibitors (Gliptins)?
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Sitagliptin (Januvia) Saxagliptin (Onglyza)
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What is the action of Incretin Mimetics?
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Increases the amount of insulin produced by the body after meals when blood sugar is high. Prevents breakdown of GLP – so allows GLP-1 to work over longer period of time to lower glucose improves Hgb A1C
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How should Incretin Mimetics be taken?
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Daily with or without food Duration 24 hrs
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What are the side effects of Incretin Mimetics?
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Sore throat, nasal congestion, URI GI- abdominal pain, nausea, diarrhea
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What should you monitor for in a patient taking Incretin Mimetics?
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Monitor renal dysfunction
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What medications are Amylin Analogues?
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Pramlintide (Symlin) Synthetic hormone similar to amylin
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What is the action of Amylin Analogues?
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Decreases emptying of food from stomach
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How do you give/take Amylin Analogues?
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SQ injection before each meal. Use abdomen or thigh. Available as a prefilled pen or vial. Can be used with insulin in Type II diabetics Can be used in Type I diabetics as well
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What are the side effects of Amylin Analogues?
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Nausea, vomiting, anorexia (usually subside). Black Box Warning for hypoglycemia .
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What should you teach a patient taking Amylin Analogues?
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Do not use if client has hypoglycemic unawareness.
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What medications are Glucagon Like Peptide-1 (GLP-1) Receptor Agonist?
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Liraglutide (Vitoza)
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What is the action of Glucagon Like Peptide-1 (GLP-1) Receptor Agonist?
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Regulates glucose levels by stimulating glucose‐dependent insulin secretion and biosynthesis, and by suppressing glucagon secretion. Slows the rate of gastric emptying.
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How do you give/take Glucagon Like Peptide-1 (GLP-1) Receptor Agonist?
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SQ injection in abdomen, thigh or upper arm once daily. May take without regard to meals. Available as a prefilled pen.
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What are the side effects of Glucagon Like Peptide-1 (GLP-1) Receptor Agonist?
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HA, GI upset, constipation, anorexia .
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What should you teach the patient on Glucagon Like Peptide-1 (GLP-1) Receptor Agonist?
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May increase risk for thyroid cancer.
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How should you administer Biguanides?
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Give before or with meals. Hold for 48 hrs before & after contrast media & with surgical procedures requiring anesthesia.
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How do you take Alpha-Glucosidase Inhibitors?
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Take with first bite of each meal.

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