Antidiabetic Drugs Flashcards Preview

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Flashcards in Antidiabetic Drugs Deck (62):
0

Glipizide (Glucotrol)
(Functional Classification)

Antidiabetic

1

Glipizide (Glucotrol)
(Chemical Classification)

Sulfonylurea (2nd generation)

2

Glipizide (Glucotrol)
(Mechanism of Action)

Causes functioning beta cells in pancreas to release insulin; leading to drop in blood glucose levels; may improve insulin binding to insulin receptors or increase the number of insulin receptors with prolonged administration; may also reduce basal hepatic glucose secretion; not effective if patient lacks functioning beta cells

3

Glipizide (Glucotrol)
(Uses)

Type 2 diabetes mellitus

4

Glipizide (Glucotrol)
(Contraindications)

Hypersensitivity to sulfonylureas, type 1 diabetes, diabetic ketoacidosis

5

Glipizide (Glucotrol)
(Side Effects)

CNS: Headache, Weakness, Dizziness, Drowsiness, tinnitus, fatigue, vertigo
ENDO: HYPOGLYCEMIA
GI: HEPATOTOXICITY, CHOLESTATIC JAUNDICE, nausea, vomiting diarrhea, heartburn
HEMA: LEUKOPENIA, THROMBOCYTOPENIA, AGRANULOCYTOSIS, APLASTIC ANEMIA; increased AST, ALT, alk phos; PANCYTOPENIA, HEMOLYTIC ANEMIA
INTEG: rash, allergic reactions, pruritus, urticaria, eczema, photosensitivity, erythema, allergic vasculitis

6

Glipizide (Glucotrol)
(Nursing Considerations)

ASSESS:
-HYPO/HYPERGLYCEMIC REACTION that can occur soon after meals; for severe hypoglycemia give IV D50W, then IV dextrose solution
-Blood Glucose, A1c levels during treatment to determine diabetes control
-Blood Dyscrasias: CBC at baseline and throughout treatment; report decreased blood count

7

Glipizide (Glucotrol)
(Overdose Treatment)

Glucose 25g IV via dextrose 50% sol, 50ml, 1mg glucagon, or carbohydrate depending on severity

8

Human Insulin Lispro (Humalog)
(Type)

Rapid Acting

9

Human Insulin Lispro (Humalog)
(Onset)

0.5-1 hr

10

Human Insulin Lispro (Humalog)
(Peak Action)

2-4 hr

11

Human Insulin Lispro (Humalog)
(Nursing Implications)

Not to be given IV
Give within 15 min of a meal

12

Human Insulin Lispro (Humalog)
(Insulin Overdose Treatment)

Glucose 25g IV, via dextrose 50% sol, 50ml or glucagon 1mg

13

Insulin Aspart (NovoLog)
(Type)

Rapid Acting

14

Insulin Aspart (NovoLog)
(Onset)

5 to 15 min

15

Insulin Aspart (Novolog)
(Peak Action)

0.75 to 1.5 hr

16

Insulin Aspart (NovoLog)
(Nursing Implications)

Not to be given IV
Give within 15 min of a meal

17

Insulin Aspart (NovoLog)
(Insulin Overdose Treatment)

Glucose 25g IV, via dextrose 50% sol, 50ml or glucagon 1mg

19

Regular Insulin (Human)
(Type)

Short Acting

20

Regular Insulin (Human)
(Peak Action)

2 to 3 hr

21

Regular Insulin (Human)
(Nursing Implications)

Regular insulin may be given IV

22

Regular Insulin (Human)
(Insulin Overdose Treatment)

Glucose 25g IV, via dextrose 50% sol, 50ml or glucagon 1mg

23

Regular Insulin (Human)
(Onset)

30 to 60 min

24

Isophane insulin (NPH)
(Onset)

1 to 2 hr

25

Isophane Insulin (NPH)
(Peak Action)

6 to 12 hr

26

Isophane Insulin (NPH)
(Nursing Implications)

Not to be given IV

27

Isophane Insulin (NPH)
(Insulin Overdose Treatment)

Glucose 25g IV, via dextrose 50% sol, 50ml or glucagon 1mg

28

Insulin Glargine (Lantus)
(Type)

Long acting

29

Insuline Glargine (Lantus)
(Onset)

1.1 hr

30

Insulin Glargine (Lantus)
(Peak Action)

5hr (some sources say there is no peak)

31

Insulin Glargine (Lantus)
(Nursing Implications)

Not to be given IV
Recommended to give once daily, acts as basal insulin

32

Insulin Glargine (Lantus)
Insulin Overdose Treatment)

Glucose 25g IV, via dextrose 50% sol, 50ml or glucagon 1mg

33

Metformin
(Functional Classification)

Antidiabetic, oral

34

Metformin
(Chemical Classification)

Biguanide

35

Metformin
(Mechanism of Action)

Inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin

36

Metformin
(Uses)

Type 2 diabetes mellitus

37

Metformin
(Contraindications)

Hypersensitivity; hepatic disease; creatinine >1.5mg/ml (males), >/= 1.4 (females); alcoholism; cardiopulmonary disease; acidemia; acute MI; cardiogenic shock; diabetic ketoacidosis; metabolic acidosis

38

Metformin
(Side Effects)

CNS: Headache, Weakness, Dizziness, Drowsiness, tinnitus, fatigue, vertigo, Agitation
CV: HEART FAILURE
ENDO: LACTIC ACIDOSIS, hypoglycemia
GI: Nausea, Vomiting, Diarrhea, heartburn, anorexia, metallic taste
HEMA: THROMBOCYTOPENIA, decreased vit B12 levels
INTEG: rash

39

Metformin
(Nursing Considerations)

ASSESS:
-HYPOGLYCEMIC REACTIONS (sweating, weakness, dizziness, anxiety, tremors, hunger); hyperglycemic reactions soon after meals; these occur rarely with product, may occur when product combined with sulfonylureas
-CBC (baseline, q3mo) during treatment check LFTs periodcially, AST, LDH, renal studies: BUN, creatinine during treatment; glucose, A1c; folic acid, vit B12 q1-2yr
-LACTIC ACIDOSIS: malaise, myalgia, abdominal distress; risk increases with age, poor renal function; monitor electrolytes, lactate, pyruvate, blood pH, ketones, glucose

PERFORM/PROVIDE:
-Conversion from other oral hypoglycemic agents; change may be made without gradual dosage change; monitor serum glucose, urine ketones tid during conversion

40

Pioglitazone (Actos)
(Functional Classification)

Antidiabetic; oral

41

Pioglitazone (Actos)
(Chemical Classification)

Thiazolidinedione

42

Pioglitazone (Actos)
(Mechanism of Action)

Specifically targets insulin resistance; an insulin sensitizer; regulates the transcription of a number of insulin-responsive genes

43

Pioglitazone (Actos)
(Uses)

Type 2 diabetes mellitus

44

Pioglitazone (Actos)
(Contraindications)

Breastfeeding, children, hypersensitivity to thiazolidinedione, diabetic ketoacidosis, CHF

45

Pioglitazone (Actos)
(Side Effects)

CNS: Headache
CV: MI, HEART FAILURE, DEATH (GERIATRIC PATIENTS)
ENDO: hypo/hyperglycemia
MISC: Sinusitis, Upper Respiratory Tract Infection, Pharyngitis, HEPATOTOXICITY, edema, weight gain, anemia, macular edema; RISK OF BLADDER CANCER (USE >1yr)
MS: RHABDOMYOLYSIS

46

Pioglitazone (Actos)
(Nursing Considerations)

ASSESS:
-For CHF: excessive/rapid weight gain >5lb, dyspnea, edema; may need to be reduced or discontinued
-RHABDOMYOLYSIS: muscle pain, increased CPK, weakness, swelling of affected muscles; if these occur and if confirmed by CPK, product should be discontinued
-HYPOGLYCEMIC REACTIONS: sweating, weakness, dizziness, anxiety, tremors, hunger; hyperglycemic reactions soon after meals (rare); do not give with NYHA class III/IV heart failure
-Check LFT's periodically: AST, LDH; do not start treatment in active heart disease or if ALT>2.5x upper limit of normal; if treatment has already begun, follow closely with continuing ALT levels; if ALT increases to >3x upper limit of normal, recheck ALT as soon as possible; if ALT remains >3x upper limit of normal, discontinue
-FBS, glycosylated HbA1c, plasma lipids/lipoproteins, BP, body weight during treatment
-CBC with differential prior to and during therapy; more necessary in those with anemia

PERFORM/PROVIDE:
-Conversion from other oral hypoglycemic agents; change may be made with gradual dosage change; monitor serum glucose during conversion

47

Repaglinide
(Functional Classification)

Antidiabetic

48

Repaglinide
(Chemical Classification)

Meglitinide

49

Repaglinide
(Mechanism of Action)

Causes functioning beta-cells in pancreas to release insulin, thereby leading to a drop in blood glucose levels; closes ATP-dependent potassium channels in the beta-cell membrane; this leads to the opening of calcium channels; increased calcium influx induces insulin secretion

50

Repaglinide
(Uses)

Type 2 diabetes

51

Repaglinide
(Contraindications)

Hypersensitivity to meglitinides; diabetic ketoacidosis, type 1 diabetes

52

Repaglinide
(Side Effects)

CNS: Headache, Weakness, paresthesia
ENDO: HYPOGLYCEMIA
GI: nausea, vomiting, diarrhea, constipation, dyspepsia
INTEG: rash, allergic reactions
MISC: chest pain, UTI, allergy
MS: back pains, arthralgia
RESP: URI, sinusitis, rhinitis, bronchitis

53

Repaglinide
(Nursing Considerations)

ASSESS:
-HYPO/HYPERGLYCEMIC REACTION, which can occur soon after meals: dizziness, weakness, headache, tremor, anxiety, tachycardia, hunger, sweating, abdominal pain, A1c, fasting, postprandial glucose during treatment

54

Repaglinide
(Overdose Treatment)

Glucose 25g IV via dextrose 50% solution, 50ml or 1mg glucagon

55

Sitagliptin
(Functional Classification)

Antidiabetic, oral

56

Sitagliptin
(Chemical Classification)

Dipeptidyl-peptidase-4 inhibitor (DPP-4 inhibitor)

57

Sitagliptin
(Mechanism of Action)

Slows the inactivation of incretin hormones; improves glucose homeostasis, improves glucose-dependent insulin secretion, lowers glucagon secretions, and slows gastric emptying time

58

Sitagliptin
(Uses)

Type 2 diabetes mellitus as monotherapy or in combination with other antidiabetic agents

59

Sitagliptin
(Contraindications)

Hypersensitivity, diabetic ketoacidosis (DKA)

60

Sitagliptin
(Side Effects)

CNS: Headache
ENDO: hypoglycemia
GI: Nausea, Vomiting, abdominal pain, diarrhea, PANCREATITIS, constipation
MISC: Peripheral Edema
SYST: ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME, ANGIOEDEMA

61

Sitagliptin
(Nursing Considerations)

ASSESS:
-HYPOGLYCEMIC REACTIONS: sweating, weakness, dizziness, anxiety, tremors, hunger; hyperglycemic reactions soon after meals
-SERIOUS SKIN REACTIONS: swelling of face, mouth, lips, dyspnea, wheezing
-PANCREATITIS: severe abdominal pain, nausea, vomiting; discontinue product
-RENAL STUDIES: BUN, creatinine during treatment
-Glycosylated hemoglobin A1c; monitor blood glucose (BG) as needed

PERFORM/PROVIDE:
-Conversion from other antidiabetic agents; change may be made with gradual dosage change

62

Isophane insulin (NPH)
(Type)

Intermediate Acting