Antidiabetic Agents
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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
A. Shakiness
B. Dizziness
C. Sweating
D. Hunger
E. Moodiness
F. Anxiety
II. Signs of hyperglycemia
A. Increased thirst
B. Trouble concentrating
C. Blurred vision
D. Frequent urination
E. Fatigue
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Transcript
Welcome back and today we are going to cover oral antidiabetic agents.
There are five types of oral antidiabetic agents. Please see the NRSNG presentation regarding insulin pharmacology, if needed. Sulfonylureas and meglitinides both stimulate insulin secretion (which lower blood glucose) from beta cells in the pancreas. Why the pancreas? Well the pancreas is apart of the endocrine system with one of its functions is to produce insulin. It’s the perfect site for glucose management. Lastly, we have biguanides, which decrease the production of glucose in the liver. Why the liver? Well one of the liver’s function, if filtering blood and remember glucose, attaches to hemoglobin? Yes, another great site!
The last two are unique drug classes. Thiazolidinediones work by enhancing the insulin receptors (allowing insulin function to work more efficiently) in various places – liver, skeletal muscle and adipose tissue. While a-Glucosidase inhibitors work by delaying glucose absorption (which increases blood glucose) but blocking the enzyme. Why these alternative options? Well, sometimes traditional medications aren’t effective and other routes of glucose management must be used. Depending on your patient’s organ function and performance, each drug class work responds differently to each patients.
The types of sulfonylureas have two generations, with most ending in -IDE. Now, sulfonylureas stimulate insulin secretion (which lower blood glucose) from beta cells in the pancreas. When you think on sulfonylureas think about the pancreas and the drugs ending in -IDE.
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!
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!
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Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Glaucoma
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Herpes Zoster – Shingles
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Skull Fractures
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Process – Assess
Nursing Process – Diagnose
Nursing Process – Evaluate
Nutrition (Diet) in Disease
Nutrition Assessments
Nutrition in Pregnancy
Obstetrical Procedures
Obstructive Heart (Cardiac) Defects
Omphalocele
Oncology Important Points
Opioid Analgesics
Opioid Analgesics in Pregnancy
Order of Lab Draws
Osteosarcoma
Outline Question Method (Note taking)
Ovarian Cancer
Pain and Nonpharmacological Comfort Measures
Paranoid Disorders
Parasympatholytics (Anticholinergics) Nursing Considerations
Patient Positioning
Pediatric Advanced Life Support (PALS)
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediculosis Capitis
Penetrating Abdominal Trauma
Penetrating Thoracic Trauma
Perioperative Nursing Roles
Peripheral Vascular Assessment
Peritoneal Dialysis (PD)
Personality Disorders
Pertussis – Whooping Cough
Pharmacology Course Introduction
Phenylketonuria
Phosphorus-Phos
Piaget’s Theory of Cognitive Development
Pill Crushing & Cutting
Pituitary Adenoma
Placenta Previa
Platelets (PLT) Lab Values
Pneumonia
Postpartum Discomforts
Postpartum Hematoma
Postpartum Hemorrhage (PPH)
Postpartum Physiological Maternal Changes
Potassium-K (Hyperkalemia, Hypokalemia)
PPE Donning & Doffing
Practice Settings
Precipitous Labor
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Preoperative (Preop) Nursing Priorities
Preoperative (Preop)Assessment
Pressure Line Management
Pressure Ulcers/Pressure injuries (Braden scale)
Preterm Labor
Prioritization
Prioritizing Assessments
Procedural Terminology
Process of Labor
Prostaglandins
Prostaglandins in Pregnancy
Provider Phone Calls
Psychiatry Terminology
Pulmonary Function Test
R – Real-Life
Radiation Cancer Treatment
Real-Life Experiences
Red Blood Cell (RBC) Lab Values
Renal (Kidney) Failure Labs
Reproductive Terminology
Resources for Lesson Creation
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
Restraints
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
Routine Neuro Assessments
Rubeola – Measles
Safety Checks
SBAR Communication
Schizophrenia
Scoliosis
Seizure Management in the ER
Selecting THE vein
Self Concept
Sensory Terminology
Sepsis Concept Map
Shift change and Patient handoff
Sickle Cell Anemia
Signs of Pregnancy (Presumptive, Probable, Positive)
Sinus Bradycardia
Sinus Tachycardia
Sodium-Na (Hypernatremia, Hyponatremia)
Somatoform
Spiking & Priming IV Bags
Spina Bifida – Neural Tube Defect (NTD)
Spinal Cord Injury
Spinal Precautions & Log Rolling
Start and End with the Linchpin
Sterile Gloves
Stoma Care (Colostomy bag)
Stomach Cancer (Gastric Cancer)
Stress and Crisis
Stroke (CVA) Management in the ER
Stroke Concept Map
Stroke Nursing Care (CVA)
Subinvolution
SubQ Injections
Sudden Infant Death Syndrome (SIDS)
Suicidal Behavior
Surgical Incisions & Drain Sites
Surgical Prep
Surgical Wound Classification Documentation for Certified Perioperative Nurse (CNOR)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Systemic Lupus Erythematosus (SLE)
Tenet 2 Linchpins & Connections
Tenet 3 Why Behind the What
Tenet 4 Learner-Centered Talkabouts
Tension and Cluster Headaches
Testicular Cancer
The 5-Minute Assessment (Physical assessment)
The EKG (ECG) Graph
The Medical Team
Thinking Like a Nurse
Thoracentesis
Thorax and Lungs Assessment
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Thrombocytopenia
Thyroid Cancer
Time Management
Tocolytics
Tocolytics
Tonsillitis
Topical Medications
Total Bilirubin (T. Billi) Lab Values
Trach Care
Trach Suctioning
Transient Tachypnea of Newborn
Transition To Practice
Transition to Practice Course Introduction
Trauma Survey
Triage in the ER
Troponin I (cTNL) Lab Values
Types of Exercise
Types of Schizophrenia
Umbilical Hernia
Urinary Elimination
Using Aseptic Technique
Uterine Stimulants (Oxytocin, Pitocin)
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Varicella – Chickenpox
Varicocele
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Vent Alarms
Vitals (VS) and Assessment
Vomiting
What Guides Nurses Practice
What is CCMM?
White Blood Cell (WBC) Lab Values
Working night shift
Working with a Preceptor
Wound Care – Assessment
Wound Care – Dressing Change
Wound Care – Selecting a Dressing
Wound Care – Wound Drains