Antidiabetic Agents
Included In This Lesson
Outline
Overview
I. Overview
A. Diabetes management
B. Goal = Normoglycemia within 2-3 months
1. Diet
2. Exercise
3. Smoking cessation
C. If not achieved with lifestyle changes
1. Medications added
II. Mechanism of Action
A. Sulfonylureas
1. Stimulating insulin secretion from the beta cells of the pancreas
B. Meglitinides
1. Stimulating insulin secretion from the beta cells of the pancreas
C. Biguanide
1. Decreasing the production of glucose / increase uptake
D. Thiazolidinediones
1. Enhancing sensitivity of insulin receptors
a. Liver, skeletal muscle and adipose tissue
E. α-Glucosidase Inhibitors
1. Delays glucose absorption
a. Blocking enzyme, α-glucosidase
III. Types
A. Sulfonylureas
1. First Generation
a. Acetohexamide
b. Chlorpropamide
c. Tolazamide
d. Tolbutamide
2. Second Generation
a. Glimepiride
b. Glipizide
c. Glyburide
B. Meglitinides
2. Repaglinide
3. Nateglinide
C. Biguanide
4. Metformin
D. Thiazolidinediones
5. Troglitazone
6. Pioglitazone
7. Rosiglitazone
E. α-Glucosidase Inhibitors
8. Acarbose
9. Miglitol
IV. Indications
A Lower the blood glucose levels
1. Diet and lifestyle changes fail
V. Contraindications
A. Drug allergy
B. Active hypoglycemia
C. Severe liver or kidney disease
1. Depending on the required metabolic pathways
D. Pregnancy
1. Insulin therapy is preferred
VI. Interactions
A. Sulfonylureas
1. Hyperglycemia
a. Alcohol
b. β-blockers
c. MAOIs
d. Oral anticoagulants
e. Sulfonamides
2. Hypoglycemia
a. Herbal supplements
i. Garlic
ii. Ginseng
B. Meglitinides
1. Increased effects
a. Fluconazole
b. NSAIDS
c. Sulfonamides
2. Reduced effects
a. Phenobarbital
b. Phenytoin
c. Carbamazepine
d. Thiazide diuretics
C. Biguanide
1. Increased effects
a. Furosemide
b. Nifedipine
2. Lactic acidosis / acute renal failure
a. Iodine-containing radiologic contrast media
D. Thiazolidinediones
1. None
E. α-Glucosidase Inhibitors
1. Hyperglycemia
a. Diuretics
b. Corticosteroids
c. Thyroid replacement hormones
d. Antiepileptic drugs
VII. Side Effects
A. Sulfonylureas
1. Agranulocytosis
2. Hemolytic anemia
3. Thrombocytopenia
B. Meglitinides
1. Headache
2. Hypoglycemia
3. Dizziness
4. Weight gain
C. Biguanide
1. Abdominal bloating
2. Nausea
3. Cramping
4. Diarrhea
D. Thiazolidinediones
1. Weight gain
2. Edema
D. α-Glucosidase Inhibitors
1. Flatulence
2. Diarrhea
3. Abdominal pain
Nursing Points
Nursing Concepts
I. Glucose metabolism
II. Pharmacology
Patient Education
I. Signs of hypoglycemia
II. Signs of hyperglycemia
Transcript
Welcome back and today we are going to cover oral antidiabetic agents.
As mentioned before, meglitinides stimulate insulin secretion (which lower blood glucose) from beta cells in the pancreas, with medications ending in -GLINIDE. Biguanides decrease the production of glucose in the liver and the #1 drug in this class is metformin. Metformin is the preferred initial pharmacologic agent for the treatment of type 2 diabetes according to the American Diabetes Association. When patients are diagnostic with diabetes (type 2), their first drug prescribed is Metformin (if lifestyle changes are not effective). It’s a great drug and at most pharmacies the drug is free of charge. Thiazolidinediones work by enhancing the insulin receptors in various places – liver, skeletal muscle and adipose tissue with drugs ending in -GLITAZONE. While a-Glucosidase inhibitors work by delaying glucose absorption (which increases blood glucose) but blocking the enzyme – with two drugs acarbose and miglitol. Antidiabetic oral agents are indicated when lowering of blood glucose is needed and lifestyle changes have failed. Now, if our goal is to lower blood glucose we have to make sure we don’t cause hypoglycemia (and cause dangerously low levels). Why is glucose important? Glucose if the primary source of energy for the body, especially the brain. Lack of the important source causes various temporary and even permanent effects (which we will discuss later in the lecture). Contraindications include allergies, hypoglycemia (as these drugs lower glucose levels), liver & kidney disease (as these drugs are metabolized or excreted using these organs) and pregnancy (as insulin is preferred – as it doesn’t cross the placenta and is safe for the baby). I had a patient who was taking an oral antidiabetic agents but kept having hypoglycemic events. The patient ended up needing to see an endocrinologist has their blood glucose level couldn’t be managed properly. An endocrinologist is a specialist who can manage patients with complicated glucose cases. Sulfonylureas have hyperglycemic interactions with combined with alcohol, beta-blockers, MAOIs, anticoagulants and sulfonamides. It also has hypoglycemic interactions with herbal supplements, mainly garlic and ginseng. If your patient is taking herbal supplements, it is important they know about these interactions as hypoglycemia can occur.
Now meglitinides will have increased and decreased effects with medications mentioned here. What does that mean? It means your patients can experience hyperglycemia (due to reduced effects and medication not being effective) or hypoglycemia (due to increased effects and medication efforts be potentiated). It is important to ask your patients what other medications they are taking as others can alter the function of the antidiabetic agents. I had a patient who was taking nateglinide and phenobarbital, as a result, their blood glucose remain elevated. Metformin’s effects will be increased with the use of furosemide and nifedipine. One unique feature of metformin is its ability to cause lactic acidosis and acute renal failure with used with iodine-containing radiologic contrast media. Contrast media is used during certain diagnostic testing, commonly computerized tomography (CT) scans are the tests. If a patient is getting a CT scan with contrast, it is recommended that metformin be withheld after the administration of the contrast agent for 48 hours (in order to prevent acute renal failure).
α-Glucosidase Inhibitors are linked to hyperglycemia with administered with the following drugs. If you have a patient with uncontrolled diabetes, the first question should be, “What other medication are you taking?” Because oftentimes, it interaction and not due to noncompliance. As thyroid and antiepileptic medications are life-long drugs, it’s critical to ask these types of questions. Side effects of sulfonylureas are blood based and include agranulocytosis (severe leukopenia), hemolytic anemia (destruction of red blood cells) and thrombocytopenia (low platelet count). So, if you have a patient who has a blood disorder, this drug class might not be the best match. Side effects of meglitinides focus on headache, low blood glucose, dizziness and weight gain. While side effects of biguanides focus on the GI tract (bloating, nausea, cramping and diarrhea). Nursing concepts for antidiabetic agents include glucose metabolism and pharmacology. Let’s review. There are various mechanisms of actions with most focusing on the stimulation of insulin receptors and the decreased or delay of glucose production. Indications include lowering blood glucose levels, while contraindications revolve around hypoglycemia, liver/kidney disease and pregnancy. Interactions are plentiful and drug class based but include herbal supplements, diuretics and beta blockers (to name a few). And lastly, side effects are blood and GI tract based. Patient education is crucial as hyper- and hypo- glycemia can cause serious complications. And now you know all you need to know about antidiabetic oral agents. Now go out and be your best self and as always happy nursing!
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System