Diabetic Meds Flashcards
(17 cards)
Insulin Lispro (rapid-acting) Type 1 and Type 2
give subQ onset- 15-30 minutes peak 30-90 minutes duration- 3-6 hours Administer- immediately before eating example-humalog
R-regular insulin (short acting)
Type 1 and Type 2
Given: subQ, subQ infusion, IM, or IV Administer: before meals onset: 30-60 minutes peak-1-5 hours Duration-10 hours Example- Humulin
NPH (intermediate acting)
Type 1 and Type 2
Given: subQ Administer: 2 to 3 times daily to provide glycemic control between meals an during the night Onset- 60-120 minutes Peak-6-14 hours Duration- 16-24 hours
Glargine (long-acting)
Type 1 and Type 2
Given: SubQ Administer- Once daily Onset-70 minutes Peak-none Duration 18-24 hours
Metformin (Biguanide)
Type 2
Given- Tablets IR or ER
mechanism of action-inhibits glucose production in the liver, sensitizes insulin receptors in fat and skeletal muscle, slightly reduces glucose absorption in the gut
adverse effects
risk for hypoglycemia-none
significant interactions-decreased appetite, nausea, diarrhea; decreases absorption of Vitamin B12 and folic acid; lactic acidosis
nursing considerations- contraindicated for patients with heart failure; alcohol can inhibit breakdown of lactic acid and intensify toxicity. histamine blockers an increase risk of lactic acidosis; IV contrast is also contraindicated as it can further damage kidneys
Glipizide (sulfonylurea protoype)
Type 2 diabetes
Given: Oral
Mechanism of Action-block ATP-sensitive potassium channels in cell membrane, permitting an influx f calcium due to depolarization which in turn causes insulin release
Adverse reactions-mainly hypoglycemia
Risk of Hypoglycemia-high
Significant interactions- alcohol (flushing, palpitations, nausea), NSAIDS can intensify hypoglycemic response, Beta Blockers can diminish the medication affect by suppressing insulin release
Nursing Considerations- contraindicated during pregnancy and breast-feeding; should not be used with alcohol, use caution in patients with kidney or liver dysfunction
Pioglitazone (thiazolidinediones prototype)
Type 2
Given- orally, once daily
Mechanism of Action- reduces glucose levels by decreasing insulin resistance; activates PPAR gamma receptor which turns on insulin responsive genes that regulate carb and lipid metabolism
risk for hypoglycemia- low
adverse effects- URI, headache, sinusitis, and myalgia
significant interactions- drugs that induce or inhibit cyps
nursing considerations- contraindicated to patients with heart failure and liver dysfunction (hepatotoxic), may cause bladder cancer, increases risk of fractures in women, can cause ovulation
Repaglinide (Meglitinides)
Adminiser- Orally; patients must eat no later than 30 minutes after taking the drug to avoid hypoglycemia
mechanism of action- blocks ATP sensitive potassium channels on pancreatic beta cells to facilitate calcium influx which leads to increase of insulin release
risk for hypoglycemia-yes
significant interactions- drugs used to lower triglyceride levels can inhibit metabolism
adverse effects- generally well tolerated except those with liver dysfunction where the metabolism might be slowed
nursing considerations-identify high risk patients;
Acarbose (alpha-glucosidase inhibitors)
Type 2 diabetes
Mechanism of Action-delays absorption of dietary carbs
risk for hypoglycemia-none
adverse effects-flatulence, cramps, abdmonial distention, increase in bowel sounds, diarrhea
significant interactions-systemic effects are minimal since a low percentage of active drug is absorbed
nursing considerations- long term may cause liver dysfunction; identify high risk patients
DDP-4 Inhibitors (Gliptins)
Incretin Mimetics
type 2
Mechanism of Action- enhances actions of incretin hormones; ddp-4 acts to degrade incretin, incretin is important to stimulate further release of insulin
Risk for Hypoglycemia-uncommon
adverse effects- gi problems (nausea, diarrhea, stomach pain) flu like symptoms-headache, runny nose, sore throat, skin reactions
nursing considerations- increase risk of pancreatitis
Instruct patients to take DPP-4 inhibitors once daily without regard to meals. Encourage them to be consistent with the timing of their dose from day to day
Sitagliptin (incretin mimetics)
mechanism of action- enhances the actions of incretin hormones by stimulating glucose dependent release of insulin, suppresses postprandial release of glucagon, also inhibits dpp-4
risk of hypoglycemia- low
adverse effects- URI, headache, inflammation of nasal passages and throat
nursing considerations: patients should be informed about signs and symptoms of pancreatitis and instructed to stop medication immediately; has been incidences with hypersensitivity reactions including anaphylaxis
GLP-1 agonist
incretin mimetics
mechanism of action-enhancement of glucose-dependent insulin secretion, slowed gastric emptying, and reduction in postprandial glucagon
risk of hypoglycemia-yes
adverse effects- nausea, vomiting, diarrhea, headache, weakness, or dizziness
nursing considerations: identify high risk patients especially those with renal and hepatic insufficiency
Exenatide (incretin mimetics)
mechanism of action-activates receptors for GLP-1 and thereby causes the same effects as endogenous incretins; slows gastric emptying, stimulates glucose-dependent release of insulin, inhibits postprandial release of glucagon, suppresses appetite
risk of hypoglycemia-yes
adverse effects- dose-related hypoglycemia, nausea, vomiting, diarrhea, risk of pancreatitis, can cause renal impairment, fetal harm, and serious hypersensitivity reactions
nursing considerations-identify high risk patients
Pramlintide acetate (amylin analogs) type 1 or type 2
uses to complement the effects of mealtime insulin
mechanisms of action-reduces postprandial levels of glucose mainly by delaying gastric emptying and suppressing glucagon secretion; increases sense of satiety (fullness)
risk for hypoglycemia-yes when used with insulin
adverse effects- nausea, injection site reactions
nursing considerations- instruct patients to take other oral meds an hour prior to this one as it can affect absorption rates
Empagliflozin (SGLT2 Inhibitor)
mechanisms of action- increases urinary glucose excretion to decrease glucose levels and weight via caloric loss through the urine
risk for hypoglycemia- minimum
adverse effects- UTI, hypotension, euglycemic DKA
Nursing considerations-identify high risk patients; monitor kidneys
Levothyroxine
given- tablets or injection. Tablets in AM on a empty stomach
mechanism of action- synthetic preparation of t4, identical to the naturally occurring hormone
Therapeutic uses- all forms of hypothyroidism regardless of cause; should not be taken to treat obesity
Adverse Effects- rarely causes adverse effects. Acute overdose will cause thyrotoxicosis (tachy, angina, tremor, nervous, insomnia, hyperthermia, sweating, heat intolerance)
drug interactions- histamine blockers, proton pump inhibitors, Carafate, Mylanta, tums, iron supplements, magnesium salts can all reduce the absorption
enhances warfarin effects
increase cardiac responsiveness to E and NE
has a narrow therapeutic range
considerations- maintain patients on the same brand name product , if a switch is made retest serum TSH in 6 weeks and adjust accordingly. advise patients to check with their prescriber before allowing a pharmacist to switch to a different product
Evaluation- TSH levels should fall
For most replacement therapy is for life
Methimizole
to treat hyperthyroidism
mechanism of action- blocking synthesis of thyroid hormones
therapeutic use- graves disease, given with radiation therapy, suppress thyroid hormone synthesis in preparation for thyroid gland surgery, given to patients experiencing thyrotoxic crisis
Adverse Effects- generally well tolerated but should be avoided by women who are pregnant or breastfeeding; agranulocytosis is a form of toxicity related to this med
