Oral medications for diabetes Flashcards by Hannah McMahon

What is a post-prandial glucose (PPG)?

Glucose level taken 2 hours after eating

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What is the goal glucose level for a PPG?

< 140 mg/dL

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What is PPG level dependent on?

Upon the amount of food eaten
Overeating exacerbates glucose spikes

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When do plasma glucose concentrations peak in nondiabetics?

~ 60 min after start of a meal (rarely > 140) & return to pre-prandial levels within 2-3 hrs

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Oral diabetic meds can only be used for which type of DM?

Type 2

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Oral diabetic meds supplement what?

Lifestyle changes (diet & exercise)
Used when diet & exercise alone are insufficient for disease management

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Choice of oral diabetic med is dependent on what?

Comorbidities & patient needs

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Non-insulin management of diabetes should start with what two things?

1) diet
2) exercise

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Glycemic targets (ADA)

Individualized to person
A1C → < 7%
FPG → 80-130 (as close to normal as possible)
PPG → < 140

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What drug class does metformin (Glucophage) fall into?

Biguanides

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Metformin is considered a first line Tx for?

Type 2 DM
Can be used for pre-diabetics if diet/ exercise fail

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How does metformin work? Hint: 5

1) Decreases absorption of carbs
2) Decreases glucose production in liver
3) Decreases appetite
4) Can be given alone or in combo w/ other meds
5) improves how insulin works in body (insulin sensitizer)

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Additional benefits of metformin use HInt: 3

1) Off-label use for weight loss (due to appetite suppression)
2) can lower lipid levels
3) decreases PLT aggregation (reduces viscosity)

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List 5 common GI side effects of Biguanides (metformin)

1) bloating
2) diarrhea
3) abdominal pain
4) nausea
5) metallic taste

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Biguanides increase risk of _____ deficiency

Vitamin B12

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Is risk of hypoglycemia high or low when using biguanides?

Low when used alone, can increase if combined with poor diet

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Biguanides are contraindicated in what patients?

Patients with renal/ hepatic impairment & heart failure

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Precautions in using Biguanides

IV contrast dye (CT scans) → Hold for 48 hrs before & after to prevent acute kidney injury & lactic acidosis

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How can you reduce GI side effects from Biguanides?

Take the med with food

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What is the most commonly prescribed oral diabetic med?

Sulfonylureas

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How do sulfonylureas work?

1) stimulate beta cells to secrete insulin
2) decrease glucose production by the liver

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What two meds can give sulfonylureas be given with?

Metformin or insulin

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List 4 side effects of sulfonylureas

1) hypoglycemia
2) weight gain
3) GI side effects
4) increase risk of sunburn

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Precautions/ contraindications of sulfonylureas Hint: 6

1) Renal & hepatic impairment
2) Allergies to sulfa drugs
3) Pregnant/ lactating clients
4) Pts on a beta blocker
5) Avoid alcohol
6) take with food

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Onset & peak of sulfonylureas

Onset → 90 min Peak → 2-3 hrs

Drug interactions of sulfonylureas **Hint: 5**

1) oral anticoagulants 2) NSAIDs 3) H2 blockers 4) Warfarin 5) beta blockers

Sulfonylureas may have decreased concentrations from what three meds?

1) thiazides 2) steroids 3) TB meds

List 3 examples of sulfonylurea meds

1) Glipizide (Glucotrol) 2) Glyburide (DiaBeta) 3) Glymepride (Amaryl)

How do metglinides work?

Stimulate beta cells to produce more insulin **less hypoglycemia risk than sulfonylureas**

What oral diabetic med can be given to those with sulfa allergies?

Metglinides

Metglinides can be used alone or in combo with _____

metformin

List 2 examples of metglinide meds

1) Repaglinide (Prandin) 2) Nateglinide (Starlix)

When should you take metglinides?

with the first bite of food

Precautions to using metglinides

1) must eat within 15 min of taking med 2) skip the dose if skipping a meal (NPO patients need their dose held)

List 3 side effects of Metglinides

1) weight gain 2) angina 3) hypoglycemia

How do Thiazolidinediones work? **Hint: 2**

**Similar to metformin** 1) Improve the effectiveness of insulin by decreasing insulin resistance in adipose & muscle cells 2) blocks heaptic gluconeogenesis **slow onset**

How can thiazolidinediones be used/ taken?

1) alone or in combo 2) taken with or without food

list 4 side effects of thiazolidinediones

1) weight gain 2) fluid retention 3) edema 4) osteopenia

Thiazolidinediones are considered what line of Tx?

second or third line

Give an example of a Thiazolidinedione

Pioglitazone (actos)

Thiazolidinediones are contraindicated in those with?

Heart failure or hepatic impairment

What lab test should be monitored when taking Thiazolidinediones?

LFTs (before & during use)

Pioglitazone causes possible risk of?

bladder cancer

Alpha Glucosidase inhibitors are also known as ____ ____

Starch blockers

How do alpha glucosidase inhibitors work?

Inhibit alpha-glucosidase, b delaying the absorption of glucose in the SI after a meal; does not increase insulin secretion **Slows glucose entry into bloodstream, reducing postprandial glucose spikes**

When should alpha glucosidase inhibitors be taken?

With the first bite of food

List 3 side effects of alpha glucosidase inhibitors

1) anemia 2) GI → diarrhea, distention, flatulence 3) hypoglycemia (esp. when used in combo)

List 2 medications considered to be alpha glucosidase inhibitors

1) Acarbose (precose) 2) miglitol (Glyset)

Alpha glucosidase inhibitors should be avoided in patients with ____ _____

renal impairment

Alpha glucosidase inhibitors are contraindicated in what type of patients?

Patients with GI problems

Alpha glucosidase inhibitors can be used in combo with what type of meds?

Glucose lowering meds

What lab study should be monitored for patients on alpha glucosidase inhibitors?

LFTs

Glucagon-like peptide (GLP-1) receptor agonists are considered _____

incretin

List 5 mechanisms of action of GLP-1 receptor agonists

1) enhances secretion of insulin 2) blocks glucagon secretion 3) delay gastric emptying 4) decreased appetite; increased feeling of fullness 5) promotes growth & development of beta cells

How are GLP-1 receptor agonists considered hormone-based therapy? **basically same as mechanism of action; hint: 4**

1) stimulate pancreas → increases insulin & decreases glucagon 2) slows gastric emptying → delays glucose spikes 3) reduces appetite → leads to weight loss 4) crosses BBB → increases satiety

How are GLP-1 receptor agonists given?

Once a day or once a week injectable

If GLP-1 receptor agonists are used in combination it can cause ____

hypoglycemia

List 5 side effects of GLP-1 receptor agonists

1) Nausea 2) Abdominal pain 3) Constipation 4) Pancreatitis risk 5) Injection site reactions

List 4 examples of GLP-1 receptor agonists

1) Semaglutide (Rybelsus/ Ozempic) 2) Exenatide (Byetta) 3) Dulaglutide (Trulicity) 4) Liraglutide (Victoza)

Semaglutide (Rybelsus/ Ozempic)

Rybelus → oral agent Ozempic → SQ injection Also used for weight loss (Wegovy; diff name)

Exenatide (Byetta)

SQ injection Use cautiously in → pts w/ pancreatitis, gallstones, kidney dysfunctions & high triglycerides AVOID alcohol!

How is Dulaglutide (Trulicity) administered?

SubQ injection

How do DDP-4 (Gliptin) inhibitors work? **Hint: 4**

1) inhibits dipeptidyl peptidase 4 (DDP-4) enzyme, which destroys the GI incretin hormones GLP-1 & GIP 2) increase insulin secretion 3) decrease glucagon secretion to decrease glucose production 4) allows incretin hormones to remain in circulation longer

Do DDP-4 inhibitors speed up or slow down gastric emptying?

Slow gastric emptying **Can cause weight loss**

DDP-4 inhibitors can only cause hypoglycemia if combined with ____ or ____

insulin or sulfonylureas

List 4 examples of DDP-4 (gliptin) inhibitors

1) Sitagliptin (Januvia) 2) Saxagliptin (Onglyza) 3) Linagliptin (Tradjenta) 4) Alogliptin (Nesina)

What is the biggest DDP-4 inhibitor?

Januvia!!

List 8 side effects of DDP-4 inhibitors

1) Headache 2) Constipation/ Diarrhea 3) N/V 4) Pancreatitis 5) Joint pain 6) Renal impairment 7) Upper resp infections 8) Hypoglycemia

How do sodium glucose co-transporter 2 inhibitors (SGLT2) work?

Inhibit reabsorption of glucose in the proximal renal tubules; promote glucose excretion in urine

What line Tx are SGLT2 inhibitors considered?

Second line Tx

List 3 benefits to using SGLT2 inhibitors

1) Can cause weight loss 2) Decreases CV complications 3) decreases risk of hyperkalemia

SGLT2 inhibitors are contraindicated for patients with?

Renal impairment

SGLT2 inhibitors imcrease risk of what 3 things?

1) yeast infections 2) UTIs 3) amputations

List 2 key points to note when giving SGLT2 inhibitors

1) Take without regard to food 2) Increase PO fluid intake

List 3 examples of SGLT2 inhibitor meds

1) Canagliflozin (invokana) 2) Apagliflozin (Farxiga) 3) Empagliflozin (Jardiance)

What do all SGLTs inhibitors provide?

Renal protection by decreasing the protein loss & reducing the damage caused by hyper filtration

List 3 mechanisms of action of Amylin analogues (amylinomimetics)

1) slows gastric emptying, which helps regulate the postprandial rise in blood glucose 2) suppresses postprandial glucagon secretion 3) increases sense of satiety, possibly reducing food intake & promoting weight loss

When should Amylin analogues be given?

**Immediately** before meals

List one example of an Amylin analogues

1) pramlintide: Symlin injectable

3 key points to note when giving Amylin analogues

1) They are SQ injections 2) Do NOT give if not eating 3) Will cause Hypoglycemia

List an example of a hyperglycemia agent?

Glucagon

Define process of glycogenolysis

Triggers the liver to convert stored glucose (glycogen) into usable form & then releases into bloodstream

Who are hyperglycemic agents used for?

Severe hypoglycemia → when patient is unable to take oral glucose

What is administered to a patient if glucose levels fall below 70 mg/dL?

D50 (Ampid-50) or glucagon to raise blood sugar levels

List 3 routes of administration for Glucose (D50)

1) SubQ 2) IM 3) IV

Why should we provide a small snack when patient is awake or able to swallow after hypoglycemic episode?

To prevent rebound hypoglycemia after receiving Glucagon

Oral medications for diabetes Flashcards

(86 cards)